Reaching task performance is associated to neuromuscular junction adaptations in rats with induced diabetes mellitus

Upper limb performance is affected by diabetes mellitus (DM). Neuromuscular junction (NMJ) is a key structure to understand the relationship between performance and morphology in DM. The aim of the study was to analyze NMJ plasticity due to DM in an animal model and its relationship with the function of forelimbs in rats. Twelve Wistar rats were divided into control (C) and DM groups. Animals were trained to perform a grasping task, following procedures of habituation, shaping, and reaching task. DM was induced using streptozotocin. Forelimb neuromuscular performance for dexterity was evaluated one day before DM induction and five weeks following induction. After that, biceps, triceps, and finger flexors and extensors were removed. Connective tissue and muscle fiber cross-sectional area (CSA) were measured. NMJ was assessed by its morphometric characteristics (area, perimeter, and maximum diameter), using ImageJ software. Motor performance analyses were made using single pellet retrieval task performance test. Student's t-test was used for comparisons between groups. A significant decrease in all NMJ morphometric parameters was observed in the DM group compared with the C group. Results showed that DM generated NMJ retraction in muscles involved in a reaching task. These alterations are related to signs of muscular atrophy and to poor reaching task performance. In conclusion, induced DM caused NMJ retraction and muscular atrophy in muscles involved in reaching task performance. Induced DM caused significantly lower motor performance, especially in the final moments of evaluation, when DM compromised the tropism of the muscular tissue.

Application of pasta matrix reaching task in rats for forelimb motor function test after stroke / 中华行为医学与脑科学杂志

Objective To construct a scientific behavioral research of pasta matrix reaching task (PMRT) and comprehensively evaluate sensory-motor dysfunction caused by brain injury.Methods Twenty-one SD rats were subjected to 14-days pasta matrix grasping training and then were randomly divided into model group (11 rats) and sham group (6 rats).Motor cortex ischemia was induced by injection of endothelin-1 in SD rats.The number of pasta grabed by the injured forelimb and the location in matrix were evaluated daily 7 days after surgery.The infarct volume was measured by Nissl staining at the 7 days,14 days,and 28 days after stroke.Results The number of pasta obtained by rats was reduced from (33.43± 1.02) to (20.57±0.57) at 7 days post stroke in model group,and then increased to (26.85±0.98) at 28 days post stroke,although there was a significant difference between sham group (32.33± 1.45) and ischemic group (t=3.198,P＜0.05).The frequency of retrieval from each slot of the pasta matrix represented that sham group demonstrated a significant gain in performance in the antero quadrant of the matrix compared to ischemic rats by the fourth week after stroke.The stroke volume was decreased from (37.82± 1.17)mm3 at 7 days post-stroke to (24.35±0.38)mm3 at 28 days post-stroke,indicating brain recovery from ischemic injury.Conclusion The pasta matrix reaching task can function as a versatile and sensitive behavioral assay that permits experimenters to collect accurate outcome data and manipulate limb use to mimic human clinical phenomena including compensatory strategies and focused rehabilitative training after stroke.

A cross-sectional study on nutritional status of ICU patients in the mainland China / 解放军医学杂志

Objective To investigate nutritional treatment in the intensive care unit (ICU) of the mainland China. Methods A cross-sectional study was conducted in 116 ICUs of 118 mainland hospitals on April 26th, 2017. All patients of these ICUs were investigated at 0 o'clock on April 26th. Demographic and clinical parameters of those patients on April 25th (the investigation day) were recorded, including the dates of hospitalization, ICU admission and nutrition initiation and clinical outcome on 28 days after the investigation day. Results A total of 1953 patients were collected, including 631 females and 1306 males. The mean age was (64.1±19.3) years old (1950 cases). The means of Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores were (10.76±4.35)(1749 cases), (5.65±3.52)(1783 cases), (17.14±7.31)(1792 cases), respectively. The outcomes of 28 days after the investigation day were 1483 survivors (75.9%), 312 non-survivors (16.0%) and 158 cases (8.1%) being lost to follow-up. There were no significant differences between the males and the females in age, severity of disease and clinical outcomes of 28 days but in height and weight. There were 73.7%(1440 cases) of patients with normal or mildly injured gastrointestinal function, 10.8%(210 cases) with moderately or severely injured function, 1.7%(33 cases) with gastrointestinal failure and 13.2%(258 cases) without evaluation. To the investigation day, enteral nutrition (EN) had been initiated in 69.4%(1356 cases) of patients and parenteral nutrition (PN) in 36.4%(711 cases) of patients. There were 1720(88.1%) patients with EN administration on the investigation day. The proportion of patients with nausea, vomit/regurgitation, aspiration, abdominal pain, abdominal distention and diarrhea was 4.8%(93 cases), 5.4%(105 cases), 0.9%(17 cases), 8.7%(170 cases), 27.5%(538 cases) and 4.3%(84 cases) respectively, while that of patients using EN was 3.1%(40 cases), 4.25%(54 cases), 0.79%(10 cases), 4.41%(56 cases), 26.85%(341 cases) and 5.43%(69 cases) correspondingly. The proportion of cases starting EN within 24, 48 and 72 hours after ICU entry was 22.4%(437/1953), 38.6%(754/1953) and 46.6%(911/1953), respectively. The proportion of cases receiving ≥80% estimated energy target (=past body weight ×25 kcal/kg.d) within 3, 7 and 14 days after ICU entry was 12.9%(78/607), 18.7%(189/1010) and 23%(305/1325) respectively, while that of cases with EN was 9.9%(60/607), 15.0%(151/1010) and 18.6%(246/1325) correspondingly. Conclusions Nowadays, most of patients in the mainland ICUs receive nutrition therapy and the EN usage rate is much higher than the PN rate. However, the time of EN initiation and the target-reaching rate of energy are suboptimal and an individualized plan of nutrition therapy is still missing. Details of energy delivery still need to be improved.

Application of pasta matrix reaching task in rats for forelimb motor function test after stroke / 中华行为医学与脑科学杂志

Objective@#To construct a scientific behavioral research of pasta matrix reaching task (PMRT) and comprehensively evaluate sensory-motor dysfunction caused by brain injury.@*Methods@#Twenty-one SD rats were subjected to 14-days pasta matrix grasping training and then were randomly divided into model group (11 rats) and sham group (6 rats). Motor cortex ischemia was induced by injection of endothelin-1 in SD rats. The number of pasta grabed by the injured forelimb and the location in matrix were evaluated daily 7 days after surgery. The infarct volume was measured by Nissl staining at the 7 days, 14 days, and 28 days after stroke.@*Results@#The number of pasta obtained by rats was reduced from (33.43±1.02) to (20.57±0.57) at 7 days post stroke in model group, and then increased to (26.85±0.98) at 28 days post stroke, although there was a significant difference between sham group(32.33±1.45) and ischemic group (t=3.198, P<0.05). The frequency of retrieval from each slot of the pasta matrix represented that sham group demonstrated a significant gain in performance in the antero quadrant of the matrix compared to ischemic rats by the fourth week after stroke.The stroke volume was decreased from (37.82±1.17)mm3 at 7 days post-stroke to (24.35±0.38)mm3 at 28 days post-stroke, indicating brain recovery from ischemic injury.@*Conclusion@#The pasta matrix reaching task can function as a versatile and sensitive behavioral assay that permits experimenters to collect accurate outcome data and manipulate limb use to mimic human clinical phenomena including compensatory strategies and focused rehabilitative training after stroke.

Influência do peso adicional no alcance manual de lactentes a termo e pré-termo: análise de variáveis categóricas do movimento / Influence of additional weight in the reaching behavior of full-term and preterm infants: analysis of categorical variables of movement

Resumo Objetivo: Investigar o efeito do peso adicional nos ajustes proximais e distais do alcance em lactentes a termo (AT) e pré-termo tardios (PTT). Método: Foram avaliados 10 lactentes AT e 9 PTT dos 5 aos 7 meses de idade. As variáveis analisadas foram: a) ajustes proximais: unimanuais ou bimanuais; b) ajustes distais: abertura das mãos (aberta, fechada ou semiaberta) e orientação das mãos (horizontalizada, verticalizada ou oblíqua). Os procedimentos analisados foram: P1 (linha de base) e P2 (acréscimo de 20% da massa do membro superior de peso adicional). Para verificar a associação entre os procedimentos e as variáveis dependentes utilizou-se o Teste Qui-quadrado (p<0,05). Resultados: O peso adicional proporcionou a diminuição de alcances bimanuais aos 5 e 7 meses no grupo PTT, o aumento da frequência de mão verticalizada e a diminuição da frequência de mão aberta no início do movimento, aos 6 meses. No grupo AT, o peso implicou no aumento da mão verticalizada no início e no fim do movimento, aos 5 meses, e ao final do movimento, aos 7 meses, e diminuiu a frequência de mão aberta no início e final do alcance, aos 6 meses. Conclusão: O peso adicional favoreceu um movimento mais maduro na maioria das variáveis analisadas e, de forma mais expressiva, no grupo prematuro. Assim, pode tornar-se um instrumento para o treino inicial do alcance, quando o objetivo for a estimulação de alcances unimanuais com a mão verticalizada.

Abstract Objective: The aim of this work is to investigate the effects of additional weight in the proximal and distal adjustments of the reaching behavior of full-term and preterm infants. Method: We evaluated 10 full-term and 9 low risk preterm infants from 5 to 7 months age. The following variables were analyzed: a) proximal adjustments: unimanual or bimanual; b) distal adjustments: hand opening (open, closed, semi-open) and hand orientation (horizontal, vertical, oblique). Variables were analyzed in two procedures: P1 (baseline) and P2 (addition of 20% of the total mass of the infant's upper limb). To verify the association between procedures and dependent variables was applied Chi-Square Test (p<0,05). Results: Additional weight decreased of bimanual frequency for the preterm group at 5 and 7 months old, increased vertical hand frequency and decreased open hand frequency at 6 months. In the full-term group, additional weight increased the vertical hand frequency at the initiation and at the end of the movement at 5 months and at the end of the movement at 7 months. It also decreased open hand frequency at the initiation and at the end of the reaching at 6 months. Conclusion: Additional weight favored a more mature movement in the majority of variables analyzed, more expressively in the preterm group. Therefore, it can become an instrument of training this skill in the beginning of the reaching, when looking for verticalized hand unimanual reaching stimulation.

Effect of Forward and Backward Arm Extension Movement of Pilates Exercise Using Cadillac Instrument on Trunk Muscle Activity / 대한스포츠의학회지

PURPOSE: This study analyzed the muscle activity changes induced by motions of reaching forward and chest expansion that were examined from the bilateral muscles with rectus abdominis, external oblique, multifidus, and longissimus thoracic using Pilates cadillac instrument. METHODS: Nine young adult women, who have no musculoskeletal disorder and any of chronic diseases, were participated. Surface electromyography system was used for recording of all signals produced by muscles, and then normalized as percentage of maximum voluntary isometric contraction (%MVIC). The paired t-test and repeated measures of analysis of variance was performed. RESULTS: Reaching-forward motion showed a higher muscle activity from non-dominant external oblique muscle than that of the chest-expansion motion. During both reaching-forward motion and chest-expansion motion, MVIC values collected from dominant side of external oblique muscle were shown a significantly lower than the values obtained from non-dominant side (p < 0.05). Conversely, %MVIC values in external oblique muscle collected from dominant side showed a significantly higher than the values obtained from non-dominant side of the same oblique muscle (p < 0.05). Reaching-forward motion was caused a higher %MVIC on non-dominant external oblique muscle than that of the chest-expansion motion (p < 0.05). Regardless of dominant or non-dominant sides, external oblique muscle was shown the highest activation rate of all the other muscles during reaching forward action, and longissimus thoracic muscle was shown the highest activation rate of all the other muscles during chest expansion action. CONCLUSION: Reaching-forward motion is suitable for activating an external oblique muscle, and chest-expansion motion is an effective enough in activating of longissimus thoracic muscle.

Quantitative analysis of the reaching ability of stroke survivors with synchronous surface electromyography / 中华物理医学与康复杂志

Objective To assess the reaching ability of hemiplegic stroke survivors using a motion capture unit (MCU) combined with surface electromyography (sEMG).Methods Sixteen stroke survivors with hemiplegia formed the experimental group,while healthy counterparts were selected as the control group.Both groups were asked to sit on a chair and reach for a cup on a table in front of their shoulder at arm's length using their affected arms in the experimental group and their right arms in the control group.MCUs were fixed on their spines and arms to obtain kinematic signals,and the sEMG signals of the trapezius,the anterior deltoids,biceps and triceps of the tested limb were recorded.Each subject repeated the test 3 times,and the best result was retained for further analysis.After signal processing,the range of movement of the shoulders and elbows was extracted along with the time used to reach the cup,peak angular velocity,time to peak velocity of the shoulders and elbows,work of the muscles and work ratios of the trapezius/deltoid and biceps/triceps.The upper limb section of the Fugl-Meyer assessment (FMA) was also administered to evaluate the patients' upper limb function.Independent sample rank sum tests compared the patients with the controls in terms of kinematics and sEMG parameters.Spearman analysis was used to explore the correlation between the FMA scores and the kinematics and sEMG characteristics.Results Significant differences in the kinematic and myoelectric indicators were found between the patients and the controls.The average FMA score of the patients was correlated with the peak velocity of the shoulder joint.Moreover,the ROM of the shoulder was closely related to the work of the trapezius,while the time for the shoulder joint to reach peak velocity was closely related to the work ratio of the biceps and triceps.Conclusion An MCU integrated with synchronous sEMG can quantitatively assess the kinematics and kinetics of hemiplegic stroke survivors,at least in reaching.This can provide objective guidance to optimize clinical rehabilitation.

Result Analysis of 2 608 Samples of Serum Concentration for Valproate and Carbamazepine / 中国药师

Objective: To analyze the serum concentration results of sodium valproate (VPA) and carbamazepine (CBZ) and explore the relationship between the serum concentration and age, clinical efficacy and adverse reactions to provide reference for the rational clinical use.Methods: Retrospective analysis was used to collect the clinical data of the patients from March 2015 to March 2016, including gender, age, clinical diagnosis, medication, usage and dosage, the last medication time, sampling time, blood concentration and the other related data, and the data were compared and analyzed.Results: Totally 2608 samples were collected, including 2 205 ones for VPA and 403 ones for CBZ.Totally 1 123 cases (50.93%) of VPA and 292 cases (72.46%) of CBZ were within the range of therapeutic windows.In the 2 205 cases of VPA, 1 814 cases (82.27%) were with single drug treatment, and the serum concentration lower than the lower limit of therapeutic window accounted for 790 cases (43.55%) with the effective rate of 43.55% for epilepsy.The serum concentration within the range of therapeutic window accounted for 921 cases (50.77%) with the effective rate of 88.27% for epilepsy, and that higher than the higher limit of therapeutic window accounted for 103 cases (5.68%) with the effective rate of 81.55%.As for CBZ, the number was 58 cases (22.39%) with the effective rate of 48.28%, 195 cases (72.29%) with the effective rate of 79.49% and 6 cases (2.32%) with the effective rate of 83.34%, respectively.Totally 391 cases (87.21%) of VPA combined with the other antiepileptic drugs, such as levetiracetam and lamotrigine.The effect of age on the serum concentration of VPA and CBZ was significant (P<0.05).Conclusion: There are great individual differences in serum concentration of VPA and CBZ among patients.The therapeutic effect and adverse reactions of VPA and CBZ are closely related to the serum concentration.Monitoring the serum concentrations may provide evidence for the rational administration and plays an important role in the treatment of epilepsy.

Hemiplegia affects the biomechanics of reaching with the unaffected upper limb / 中华物理医学与康复杂志

Objective To analyze the bio-mechanics when hemiplegics reach with the unaffected upper limb.Methods Thirty post-stroke hemiplegics were selected into the patient group,while 23 healthy counterparts were chosen for the control group.Both groups completed a reaching test of their upper limbs which divided reaching into a moving stage and a holding stage.Surface electromyography (sEMG) data were recorded during the tests along with the degree of torso twist,the range of motion of the shoulder,movement velocity,smoothness of movement and angle divergence collected using a wearable micro-sensor motion capture system.Results For the stroke patients whose dominant upper limb was unaffected,the average root mean square (RMS) signal from the upper trapezius (34.3 μV) and the average torso twist (-1.4°) in the moving phase were significantly larger than among the control subjects (19.7 μV and-2.3°),but their average movement velocity was significantly slower.In the holding phase the average RMS signal from the upper trapezius (55.4 μV) was still significantly higher than in the control group,but their average pectoralis major signal and the integrated EMG ratio of the anterior segments of the deltoid and upper trapezius muscle pairs were significantly lower.For the stroke patients whose dominant upper limbs were affected,in thc moving phase their average signal from the middle segments of the deltoid were significantly greater than those of the controls,but their movement velocity was significantly slower.For the control subjects,in the moving phase the average signal from the upper trapezius on their non-dominant side was significantly higher than that from the dominant upper limb.The integrated EMG ratio from the anterior segments of the deltoid and upper trapezius muscle pairs on that side was smaller throughout the whole reaching movement.Conclusion The bio-mechanical characteristics in reaching of the unaffected upper limbs of stroke patients are not the same as those of the corresponding upper limbs of healthy subjects.It is more reasonable to select the corresponding upper limbs of healthy subjects as controls when a bio-mechanical study of the affected upper limbs is conducted.

The biomechanics of hemiplegic stroke survivors' upper limb motor function / 中华物理医学与康复杂志

Objective To document the kinematics of upper-limb motor dysfunction among hemiplegic stroke survivors.Methods Thirty-nine stroke survivors with hemiplegia were selected as the experimental group,while twenty-five healthy counterparts were chosen as the control group.Reaching movements performed in the sagittal plane were divided into an anteflexion phase and a holding phase.Three-dimensional kinematics data were captured using a micro-sensor motion capture system,and surface electromyograms (sEMGs) were recorded synchronously from the upper trapezius (UT),the anterior (AD) and middle (MD) segments of the deltoid,the biceps brachii (BB) and the triceps brachii (TB).The torso twist (TTD),the range of motion (ROM) of the shoulder,movement velocity (MV),isotonic instability degree (IT) and isometric instability degree (IM) were extracted.Integrated electromyography (iEMG) and work ratios were chosen as indicators to compare the two groups.The experimental group's kinematic indicators were correlated with that group's sEMG parameters.Results The average TTD,IT and IM in the experimental group were significantly larger than those of the control group,while the ROM of the shoulder and the MV were significantly smaller.During the anteflexion phase,the average iEMG from the UT in the experimental group was significantly larger than that of the control group,while the average iEMGs from their AD and TB were significantly smaller;The BB/TB work ratios in the experimental group were significantly greater than those of the conrol group,while the AD/UT and AD/MD ratios were significantly smaller.The results during the holding phase were similar.In the experimental group,torso twist was found to be positively correlated with the iEMG of the UT,and the ROM of the shoulder and movement velocity were also positively correlated with the iEMG of the AD.Conclusions Kinematics variables and sEMG features can be used to evaluate the motor dysfunction of hemiplegic stroke patients' affected upper limbs quantitatively and provide guidance for rehabilitation.

Effects of aging on interjoint coordination during arm reaching

Abstract Introduction Moving the arm towards an object is a complex task. Movements of the arm joints must be well coordinated in order to obtain a smooth and accurate hand trajectory. Most studies regarding reaching movements address young subjects. Coordination differences in the neural mechanism underlying motor control throughout the life stages is yet unknown. The understanding of these changes can lead to a better comprehension of neuromotor pathologies and therefore to more suitable therapies. Methods Our purpose was to investigate interjoint coordination in three different aging groups (children, young, elderly). Kinematics and kinetics specific variables were analyzed focusing on defined parameters to get insight into arm coordination. Intersegmental dynamics was used to calculate shoulder and elbow torques assuming a 2-link segment model of the upper extremity (upper arm and forearm) with two friction-less joints (shoulder and elbow). A virtual reality environment was used to examine multidirectional planar reaching in three different directions (randomly presented). Results Seven measures were computed to investigate group interlimb differences: shoulder and elbow muscle torques (peak and impulse), work performed by shoulder and elbow joints, maximum velocity, movement distance, distance error at final position, movement duration and acceleration duration. Our data analysis showed differences between movement performances for all analyzed variables, at all ages. Conclusion We found that the intersegmental dynamics for the interlimb (left/right) comparisons were similar for the elderly and children groups as compared to the young. In addition, the coordination and control of motor tasks changes during life, becoming less effective in old age.

Postural Control Influence on Upper Extremity Function among Children with Cerebral Palsy: A Literature Review / Jurnal Sains Kesihatan Malaysia

Performance of upper extremity function and movement sequence is influenced by postural control. Motor disorders lead to deficits in postural control, which subsequently may lead to postural instability of children with cerebral palsy (CWCP). This will limit their upper extremity activity performance. Management strategies help to support and enhance the CWCP’s upper extremity function so that they may engage with the activities of daily living. The purpose of this paper is to review previous literature on the influence of postural control towards upper extremity function. Literature searches were conducted in various electronic databases, including ProQuest, Science Direct, Springer Link, Sage, Wiley Online Library, and Google Scholar using specific key terms. Search terms included children with cerebral palsy; postural control; postural adjustments; upper extremity function; reaching and sitting and from references of retrieved articles. Nineteen journal articles published between 2000 and May 2015 were found. Most search results consisted of experimental studies, while others are reviews, case studies, and cross-sectional studies. Findings show that, postural control has a major influence on upper extremity function. In conclusion, it is necessary to highlight the importance of both factors to the CWCP parents or caregivers, as understanding and awareness on this matter is still inadequate in the community. Hence, a study is needed on the awareness of the postural control influence on upper extremity function among caregivers, as well as examining the implementation of management strategies in community settings.

Survey on blood lipids in 440 perimenopausal women in Jjiangbei district of Nanjing / 重庆医学

Objective To understand the blood lipidcondition of perimenopausal women ,control and standard-reaching situ-ation of dyslipidemi.MethodSix hundred and forty inpatientaged 45-55 yearold (including 400 femaleand 200 males) ad-mitted in the Jiangbei People′Hospital from January 2000 to January 2014 and 200 femaleaged ove60 yearwere selected .TG , TLDL-,HDL-,complicating disease,control of blood pressure and blood lipid,and the lipid-regulating drugapplication situ-ation were recorded .ResultThe prevalence rate of dyslipidemiin perimenopausal women wa23 .40% .The blood lipidcontrol standard-reaching rate wa40 .80% ;the average levelof TG ,LDL-and Tin the perimenopausal women were highethan those in the men of the same age ,while the average level of HDL-walowethan thain the men of the same age .The prevalence rate of dyslipidemiwahighethan thain the men .The average lipid level in the femaleaged ove60 yearwere highethan thaof the perimenopausal women .Conclusion The lipid level of perimenopausal women ihighethan thain the men athe same age . The prevalence rate of dyslipidemiilowethan thain the femaleaged ove60 year,and the control standard-reaching rate is lower.

Improvement effect of early goal-directed therapy on the prognosis in patients with septic shock / 中华危重病急救医学

Objective To evaluate the effect of the early goal-directed therapy (EGDT) on mortality in patients with septic shock, and to analyze the risk factors of mortality.Methods A retrospective controlled study was conducted.Complete clinical data of patients with septic shock admitted to emergency intensive care unit (EICU) of Sichuan Provincial People's Hospital from May 1994 to December 2014 were recorded and analyzed.According to the International Guidelines for Management of Severe Sepsis and Septic Shock (SSC) with the time of promulgation as dividing point, the patients were divided into two groups as before and after the publication of the guideline, i.e.early group (from May 1994 to April 2004) and late group (from May 2004 to December 2014).The patients of the late group were subdivided into 6-hour and 24-hour reaching standard groups and non-reaching standard group according to the time of reaching standard of EGDT.All patients were divided into death group and survival group according to the 28-day survival.The patients in early group were not treated according to EGDT guidance, so only age, the case history of chronic disease, the main site of infection, organ dysfunction, vital signs, urine output, the amount of fluid for resuscitation, blood routine, blood gas analysis, time for starting antibiotics treatment, the use of vasoactive drugs and hormone, etc.were recorded.The central venous pressure (CVP), central venous oxygen saturation (ScvO2), blood lactate (Lac), and the monitor of other parameters of patients in late group were consummated late.The relationship of EGDT compliance standard time and tissue perfusion index recovery time between the two groups of patients was observed.The risk factor for mortality was analyzed by multiple factors logistic regression.Results ① 134 patients were included,and the overall 28-day mortality was 49.25％.② The 6-hour EGDT compliance rate of early group was 0 (0/58),and it was 28.95％ (22/76) in late group (x2 =20.087, P =0.000).Compared with the early group, the 6-hour urine volume in the late group was significantly increased (mL·h-1·kg-1: 1.72± 1.04 vs.0.89±0.24, t =11.950, P =0.001),6-hour mean arterial pressure (MAP, mmHg, 1 mmHg =0.133 kPa) was elevated (64.24±3.90 vs.56.21 ±5.95, t =6.444, P =0.012), the use of antibiotics within 1 hour was increased (76.32％ vs.48.28％, x2 =11.250, P =0.001), the use of vasocative drugs (21.05％ vs.89.66％, x 2 =61.942, P =0.000) and hormone (8.57％ vs.34.48％, x 2 =14.871,P =0.000) were lowered, and the 28-day mortality rate was lowered significantly [34.21％ (26/76) vs.68.96％ (40/58),x2 =15.897, P =0.000].The difference was not statistically significant in the total recovery of liquid volume between late group and early group (mL: 1 856.31±805.81 vs.1 903.1 ± 897.11, t =0.101, P =0.752).③ In all patients, it was shown by single factor analysis that the age, infection sites, altered mental status at admission, white blood cell (WBC) before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour, and incidence of acute renal injury (AKI) or acute lung injury/acute respiratory distress syndrome (ALI/ARDS) within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).In the late group, it was shown by single factor analysis that the age, the case history of chronic disease, infection sites, WBC, pH value, Lac, and ScvO2 before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour,and incidence of AKI or ALI/ARDS within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).It was shown by the logistic regression analysis that aging [odds ratio (OR) =4.81, P =0.02], failure of 2 organs (OR =28.63,P =0.00) or ≥ 3 organs (OR =62.69, P =0.00) were the independent risk factors for mortality in patients with septic shock.④ The 76 patients of late group were subdivided into three groups, namely 6-hour reaching standard of EGDT group (n =22), 24-hour reaching standard of EGDT group (n =28), and non-reaching standard of EGDT group (n =28).Compared with those before treatment, the Lac after therapy was decreased obviously both in 6-hour EGDT group and 24-hour EGDT group, and the CVP, MAP, and ScvO2 were increased significantly.The Lac in 6-hour EGDT group was lowered more significantly as compared with that in 24-hour EGDT group (mmol/L: 1.64 ± 0.40 vs.3.01 ± 1.13, P ＜ 0.01),while MAP and ScvO2 were increased significantly [MAP (mmHg): 81.82 ± 8.01 vs.69.01 ± 9.63;ScvO2:0.718 ± 0.034 vs.0.658 ±0.036, P ＜ 0.05 and P ＜ 0.01].The urine output in both reaching standard of EGDT groups was more than 0.5 mL·h-1·kg-1, without statistically different significance.The 28-day mortality rate of 24-hour EGDT group was 14.29％, and it was 0 in 6-hour EGDT group.Conclusions Mortality was as high as 68.96％ during 10 years when the period before the use of 2004 SSC, and the mortality rate was lowered to 34.21％ during 10 years during which the early fluid resuscitation treatment was based on EGDT.Aging and failure of more than 2 organs were independent risk factors for mortality in patients with septic shock.Compared with reaching the standard of EGDT within 24 hours,reaching the standard of EGDT within 6 hours can rapidly reverse hypoxic-ischemic tissue, thereby improving the prognosis of the patient with lowering of mortality rate.

Aging related responses to conflicting proprioceptive and visual information about initial position during reaching

INTRODUCTION: The purpose of the current study was to examine whether age-related differences are exhibited in the relative contributions of vision and proprioception with initial hand position to the control of movement distance of single-joint reaching movements. METHODS: We use a virtual reality display to systematically change the relationship between the actual hand position and the displayed hand position (virtual position) as subjects' positioned a cursor within a start circle. Visual feedback of the reaching hand was only available before movement onset. Two groups of subjects (older and young) reached to two different visual targets (115º and 125º elbow angle) from four possible starting locations (90º, 95º, 100º, 105º elbow angle) under four virtual/actual dissociation conditions (0º, 5º, 10º, 15º). RESULTS: For the mismatched conditions movement distance was generally longer for the older adults as compared to the younger. Also, the younger group better scaled their movement extent with cursor initial location, whereas, the older group showed scaling with hand location. Our results indicate age-related differences in the effects of initial position information when vision and proprioception initial information were dissociated. CONCLUSION: The young were able to completely rely on visual information through feedforward mechanism applying acceleration amplitude manipulation for controlling movement distance. In contrast, older subjects relied on proprioceptive information for the scaling of peak velocity with movement distance, suggesting more reliance on feedback-mediated error-correction mechanisms during the course of movement.

Influence of specific training on spatio-temporal parameters at the onset of goal-directed reaching in infants: a controlled trial

BACKGROUND: There is evidence that long-term experience can promote functional changes in infants. However, much remains unknown about how a short-term experience affects performance of a task. OBJECTIVE: This study aims to investigate the influence of a single training session at the onset of goal-directed reaching on the spatio-temporal parameters of reaching and whether there are differences in the effects of training across different reaching positions. METHOD: Thirty-three infants were divided into three groups: 1) a control group; 2) a group that was reach trained in a reclined position; and 3) a group trained in the supine position. The infants were submitted to two assessments (pre- and post-training) in two testing positions (supine and reclined at 45°). RESULTS: The short-duration training sessions were effective in promoting shorter reaches in the specific position in which the training was conducted. Training in the reclined position was associated with shorter and faster reaches upon assessment in the reclined position. CONCLUSIONS: A few minutes of reach training are effective in facilitating reaching behavior in infants at the onset of reaching. The improvements in reaching were specific to the position in which the infants were trained. .

Visibilidade dos braços afeta a preferência manual em bebês / Arms visibility affects manual preference in infants

Um aspecto de interesse sobre a formação da preferência manual humana em idades precoces é a extensão em que ela é afetada por informações aferentes. O objetivo deste estudo foi investigar o efeito da oclusão visual do braço preferido sobre a preferência manual e desempenho motor em bebês. Participaram cinco bebês com cinco meses de idade, que realizaram alcances com visão plena ou oclusão visual do braço preferido. O desempenho motor foi avaliado por meio de medidas cinemáticas. Os resultados indicaram que a oclusão visual induziu redução da frequência de alcances unimanuais com o braço ocluído durante e imediatamente após a oclusão visual. Oclusão visual não alterou o desempenho motor. Estes resultados indicam que a formação da preferência manual durante o desenvolvimento motor é afetada pela disponibilidade de informação visual dos braços, embora os bebês pareçam ter pouca capacidade de usar a visão para controle motor.

An interesting aspect about formation of human manual preference in early ages is the extent to which it is affected by afferent information. This study aimed at investigating the effect of visual occlusion of the preferred arm on manual preference and motor performance in infants. Five 5-month-old infants performed reaching movements under full vision or occlusion of their preferred arm. Motor performance was assessed through kinematic measures. Results indicated that visual occlusion led to reduction of frequency of unimanual reaches using the visually occluded arm. Visual occlusion did not impair motor performance. These results indicate that formation of manual preference during motor development is affected by availability of visual afference of the arms, although infants seem to have reduced capacity to use vision for motor control.

A quantitative analysis of the kinematics of reaching by hemiplegic stroke patients using microsensor motion capture / 中华物理医学与康复杂志

Objective To evaluate the feasibility of using a microsensor motion capture unit (MCU) to assess the reaching characteristics of hemiplegic stroke patients. Methods Twenty-three hemiplegic stroke patients with an average age of (61 ± 11) years and ten normal subjects of matching age were asked to sit on a chair and use the affected arm (for the patients) or the right arm (for the normal subjects) to reach for a cup on a table just in front of the shoulder at arm's length away.Four small sensor boxes which could detect movement and its speed and smoothness in three dimensions were fixed to the subject's spine,upper arm,forearm and hand.The test was repeated four times after two trial runs.The average velocity,peak velocity,degree of joint dispersion,entropy of acceleration,joint coordination and active range of motion ( AROM ) of the shoulder were analyzed.The patients and normal subjects were statistically compared.The results were correlated with Fugl-Meyer upper extremity scores using Spearman correlation analysis. Results All of the measured variables showed significant differences between the patients and normal subjects.In the correlation study,the average velocity,peak velocity,AROM of the shoulder and joint coordination showed significant correlation with the Fugl-Meyer scores.There was,however,no significant correlation between degree of dispersion of the shoulder or elbow joints or the entropy of acceleration ( which represented the quality of movement) and Fugl-Meyer upper extremity scores. Conclusions The results suggest that microsensor MCUs can quantitatively assess the kinematics of reaching among hemiplegic stroke patients.They can provide valuable and objective data about the functional quality of multiple joint movements in three dimensions.

Efeito do laser de baixa intensidade (660 nm) na regeneração do nervo isquiático lesado em ratos / Effect of low- power laser (660 nm) on regeneration of injured rat sciatic nerve

Os nervos periféricos são estruturas que, ao sofrerem lesões, podem originar incapacidades motoras e sensitivas importantes. O laser de baixa intensidade é um dos diversos recursos terapêuticos para promover a regeneração nervosa precoce, mas ainda não há consenso sobre sua utilização. O objetivo deste estudo foi investigar, por meio de avaliação funcional, o efeito da terapia a laser de baixa intensidade (660 nm) na regeneração do nervo isquiático após esmagamento. Foram utilizados 18 ratos (Wistar) submetidos à lesão do nervo isquiático divididos em dois grupos, controle e grupo laser, submetido ao tratamento a laser (AsGaAl, 660 nm, 10J/cm2, 30 mW e 0,06 cm2) por 21 dias no local da lesão. Para a avaliação funcional, foi aplicado o índice funcional do ciático (IFC) no pré-operatório e nos 7º, 14º e 21º dias de pós-operatório. Quando comparados o IFC dos grupos no 14o dia de pós-operatório, foi encontrada melhora significante no grupo laser em relação ao controle. Na amostra analisada e nos parâmetros utilizados, pôde-se constatar que a aplicação do laser foi eficaz na recuperação funcional precoce do nervo ciático esmagado.

Peripheral nerves, when injured, may originate important motor and sensitive disability. Studies have used several therapeutic resources in order to achieve early nervous regeneration, such as low-power laser; but there is no consensus on its use, which leads to controversial conclusions. The purpose of this study was to assess the effect of GaAlAs laser (660 nm) on functional recovery of the sciatic nerve in rats. Sciatic nerves of 18 Wistar rats were crushed and divided into sham group and treated group, the latter submitted to laser therapy (660 nm, 10 J/cm2, 30 mW and 0.06 cm2) for 21 days. The sciatic functional index (SFI) was measured before surgery and on the 7th, 14th and 21st postoperative days. A significant difference, showing better regeneration of the treated group, was found when comparing SFI on the 14th day. Hence, the use of low-power laser, with the parameters and methods here used, showed positive results in early regenerating rat crushed sciatic nerve.