Analysis of the gait of stroke survivors with foot drop / 中华物理医学与康复杂志

Objective:To observe the clearance strategies of hemiplegic stroke survivors with foot drop.Methods:Thirty hemiplegic stroke survivors with foot drop formed the observation group and 30 healthy counterparts constituted the control group. A three-dimensional motion capture system was used to observe and compare the minimum toe clearance (MTC) and its variability between the two groups to draw the motion trajectory of the toe in the swing phase of their gaits. The gait parameters were correlated with the toe clearance.Results:The average MTC of the observation group subjects on both the hemiplegic and non-hemiplegic side (12.01±3.36 and 22.38±5.51mm) was significantly smaller than the control group′s averages. The variability of their MTCs on both sides was also significantly greater. Clearance on the hemiplegic side was significantly less and its variability was significantly greater. Among the observation group, MTC on the hemiplegic side was positively correlated with walking speed, step length, swing phase percentage, maximum angle of hip extension, maximum angle of knee flexion, maximum angle of ankle dorsiflexion, and the range of motion of the knee and ankle joints.Conclusions:Hemiplegic stroke survivors with foot drop walk unstably with little toe clearance. It is necessary to intervene at the hip, knee and ankle to improve their obstacle clearance.

The clinical efficacy and analysis of extracorporeal membrane oxygenation for adult severe acute respiratory distress syndrome / 中国基层医药

Objective To investigate the clinical experience and associated factors of extracorporeal membrane oxygenation(ECMO)for adult patients with severe acute respiratory distress syndrome(ARDS).Methods The clinical data of 22 adult patients with severe ARDS,which met the criteria for ECMO,were retrospectively collected and analyzed.The ECMO team all receiving VV-ECMO treatment (Veno-venous extracorporeal membrane oxygenation),data collection including the patients,general data,blood gas analysis,hemodynamics,mechanical ventilation parameter before and after the ECMO treatment and the auxiliary complications,etc.The control group were 14 cases of patients with severe ARDS which receiving conventional treatment;We collected the same data as the research team.Results In the research,8 patients treated with VV-ECMO,There were 5 males and 3 females,with an average age of (46.3 ± 14.1)years.Compared with the factors at the same time point in the control group,those of the ECMO group,except MAP (t =-0.872,P =0.357),Respiratory rate (t =-1.670,P =0.357),Heart rate (t =-1.973,P =0.042),PH (t =-1.432,P =0.033),PaCO2 (t =-2.564,P =0.024),PO2 (t =-4.955,P ＜ 0.001),PO2/FiO2 (t =-3.654,P ＜ 0.01),PEEP (t =-1.382,P =0.031),Pplateau (t =-2.785,P ＜ 0.01),Blood lactate (t =-2.564,P =0.024) were significantly improved after ECMO running 24 hours (all P ＜ 0.05).And also the factors such as the length of ICU stay (t =-2.452,P =0.027),the times of mechanical ventilation (t =-1.478,P =0.038),number of organ failure(t =-1.963,P =0.047),the hospital mortality rates(t =-1.970,P =0.045) and treatment costs(t =-1.667,P =0.035) between the ECMO group and the control group were significantly different (P ＜0.05).In the end,we divided the ECMO group into survival group and death group,and compare the time of Mechanical Ventilation before ECMO(P =0.031) the total time of Mechanical Ventilation(P =0.038),the time of ECMO adjutant (P =0.047),the length of ICU stay (P =0.043) and the cost of treatment (P =0.037) between the two groups;and there were also statistically significant difference (P ＜ 0.05).Conclusion ECMO can significantly improve the patients,oxygenation and respiratory physiology indexes which can not sustain under the conventional mechanical ventilation therapy and win the time for rest and repair of lung.Indexes such as age,time of mechanical ventilation before ECMO therapy,the primary cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.

Therapeutic effect of segmental scleral buckling and vitreoretinal surgery for stage 4 and 5 retinopathy of prematurity / 中华眼底病杂志

Objective To observe the therapeutic effect of segmental scleral buckling and vitrectomy with/without lensectomy on the retinopathy of prematurity (ROP) stage 4a,4b and 5.Methods One hundred and thirty-four ROP infants (181 eyes) diagnosed as stage 4a,4b and 5,and performed with segmental scleral buckling or vitreous with/without lensectomy were retrospectively analyzed.The operated 4a-,4b-and 5-stage eyes were 40,51 and 90 eyes.The operational method depended on the location and severity of fibrovascular membrane.Of 181 eyes,segmental scleral buckling was referred for 37 eyes which include 23 eyes with 4a stage and 14 eyes with 4b stage;vitrectomy was referred for 50 eyes which include 14 eyes with 4a stage,29 eyes with 4b stage and 7 eyes with 5 stage;vitrectomy with lensectomy was referred for 94 eyes which include 3 eyes with 4a stage,8 eyes with 4b stage and 83 eyes with 5 stage.The effect was classified as success,improved and failure.Failure includes lost eye.Follow-up for 4a,4b and 5 stage patients are 34,31 and 29 months respectively.Results Segmental scleral buckling was referred for 37 eyes,success in 23 eyes (62.16％),improved in 11 eyes (29.73 ％),failure in 3 eyes (8.11 ％).Vitrectomy was referred for 50 eyes,and success in 20 eyes (40.00％),improved in 22 eyes (44.00％),and failure in 8 eyes (16.00％).In the total of 94 eyes underwent vitrectomy with lensectomy,20 eyes was success (21.28％),improved in 17 eyes (18.08％),failure in 57 eyes (60.64％).In 40 stage 4a eyes,33 successes (82.50％),6 improved (15.00％) and 1 failure (2.50％).In 51 stage4b eyes,11 successes (21.57％),30 improved (58.82％) and 10 failures (19.61％).For 90 stage 5 eyes,14 successes (17.50％),19 improved (23.75％) and 57 failures (71.25％).The therapeutic effect of segmental scleral buckling for stage 4a was better than that for stage 5 (x2 =6.707,P=0.035).The difference of therapeutic effect of vitrectomy for different stage was significant (x2=21.010,P =0.000);stage 4a was the best;stage 4b was the second,stage 5 was the worst.The therapeutic effect of vitrectomy with lensectomy for stage 5 was worse than that for stage 4a and 4b (x2=16.066,P=0.003).Conclusion The surgery patterns of ROP was determined based on the disease severity,the surgery effects of stage 4a and 4b were better than stage 5,which had nothing to do with the surgical procedures.

Analysis of Static Balance Function in Patients with Lumbar Disc Herniation / 中国康复理论与实践

Objective To investigate the static postural balance of patients with lumbar disc herniation (LDH). Methods From January to September, 2015, thirty patients with LDH were as observation group, and thirty healthy adult people were as control group. Their bal-ance function were detected and compared. Results The sway length, sway area and anteroposterior sway velocity were higher in the obser-vation group than in the control group (t>2.262, P2.767, P2.326, P<0.05). Conclusion Impairment of the proprioception and lower back pain affected the postural control of patients with LDH, who relied more on vision input to maintain postural stability.

Features and Test-retest Reliability of Plantar Pressure Distribution in Patients with Lumbar Disc Herniation in Walking / 中国康复理论与实践

@#Objective To investigate the features of gait in patients with lumbar disc herniation suffering low back pain radiating to the unilateral lower limbs during walking, and estimate the test-retest reliability of the plantar pressure distribution. Methods 32 patients of lumbar disc herniation with low back pain radiating to the unilateral lower limb were tested with the Footscan plantar system during normal walking for 5 times. The gait phases, contacting time of every plantar region and maximum force were recorded in both the uneffected and the affected lower limbs in patients. The reliability was estimated with the intraclass correlation coefficient (ICC). Results There were significant differences between the uneffected and the affected lower limbs in the gait phase except for the Initial Contact Phase. The Forefoot Contact Phase and Foot Flat Phase of the affected lower limbs were obvious shorter than the uneffected ones (P<0.01), while the Forefoot Push Off Phase was longer (P<0.01). Except for the region of Metatarsal 5, the contacting time of every plantar region of the affected lower limbs were lower than the uneffected ones (P<0.05). The maximum force of regions of Metatarsal 4, Metatarsal 5 and Heel Lateral were lower in the affected limbs than the uneffected ones (P<0.05). ICCs of gait phase, the contacting time of every plantar region and maximum force were generally over 0.76. Conclusion Differences were found in gait phase, the contacting time of every plantar region and maximum force between the uneffected and the affected lower limbs in patients with lumbar disc herniation. All the variables are reliable for test-retest.

Design and application of real-time settlement system for medical insurance based on Outpatient One Card Solution / 医疗卫生装备

Objective To realize real-time medical insurance settlement system of Xi'an based on Outpatient One Card Solution to reduce the errors due to artificial accounting.Methods The system was developed with C# language and Oracle 10g, based on interface function dynamic library calling rule and HIS data structure requirements provided by Xi'an municipal medical insurance center.Results The system realized real-time settlement of the patient with medical insurance card.Conclusion The system simplifies medical insurance outpatient treatment flow and implements data communication.

Features and Test-retest Reliability of Plantar Pressure Distribution in Patients with Lumbar Disc Herniation in Walking / 中国康复理论与实践

Objective To investigate the features of gait in patients with lumbar disc herniation suffering low back pain radiating to the unilateral lower limbs during walking, and estimate the test-retest reliability of the plantar pressure distribution. Methods 32 patients of lum-bar disc herniation with low back pain radiating to the unilateral lower limb were tested with the Footscan plantar system during normal walking for 5 times. The gait phases, contacting time of every plantar region and maximum force were recorded in both the uneffected and the affected lower limbs in patients. The reliability was estimated with the intraclass correlation coefficient (ICC). Results There were signif-icant differences between the uneffected and the affected lower limbs in the gait phase except for the Initial Contact Phase. The Forefoot Contact Phase and Foot Flat Phase of the affected lower limbs were obvious shorter than the uneffected ones (P<0.01), while the Forefoot Push Off Phase was longer (P<0.01). Except for the region of Metatarsal 5, the contacting time of every plantar region of the affected lower limbs were lower than the uneffected ones (P<0.05). The maximum force of regions of Metatarsal 4, Metatarsal 5 and Heel Lateral were low-er in the affected limbs than the uneffected ones (P<0.05). ICCs of gait phase, the contacting time of every plantar region and maximum force were generally over 0.76. Conclusion Differences were found in gait phase, the contacting time of every plantar region and maximum force between the uneffected and the affected lower limbs in patients with lumbar disc herniation. All the variables are reliable for test-retest.