Predictive value of FLAIR signal intensity ratio in onset time≤4.5 h in acute ischemic stroke patients with poor collateral circulation / 中华神经医学杂志

Objective:To investigate the predictive value of fluid-attenuated inversion recovery (FLAIR) signal strength ratio (SIR) in onset time≤4.5 h in patients with acute ischemic stroke.Methods:A retrospective analysis was performed; 180 acute ischemic stroke patients admitted to Department of Neurology, Nanjing Hospital Affiliated to Nanjing Medical University from January 2020 to June 2023 were chosen. Hypoperfusion intensity ratio (HIR) was used to evaluate the collateral circulation (poor collateral circulation: HIR≤0.4; good collateral circulation: HIR>0.4); clinical data and imaging indexes between poor collateral circulation and good collateral circulation groups were compared. Univariate and multivariate Logistic regressions were used to analyze the influencing factors for onset time≤4.5 h in patients with acute ischemic stroke. Correlation between SIR and onset time was analyzed in patients with acute ischemic stroke. Role of HIR as agency between SIR and onset time was explored. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of SIR and diffusion weighted imaging (DWI)-FLAIR mismatch in onset time≤4.5 h in acute ischemic stroke patients.Results:Of the 180 patients, 100 were into the good collateral circulation group and 80 were into the poor collateral circulation group; compared with the good collateral circulation group, the poor collateral circulation group had significantly higher percentage of patients with hyperlipidemia, larger DWI infarction volume before treatment, larger perfusion weighted imaging (PWI)-DWI mismatch volume and higher SIR ( P<0.05). In these 180 patients, 76 had onset time≤4.5 h and 104 had onset time>4.5 h. Univariate Logistic regression analysis showed that hyperlipidemia, DWI infarct volume before treatment, DWI-FLAIR mismatch, HIR and SIR were influencing factors for onset time≤4.5 h in acute ischemic stroke patients ( P<0.05). Multivariate Logistic regression analysis showed that hyperlipidemia ( OR=6.654, 95% CI: 5.751-8.824, P<0.001), HIR ( OR=0.724, 95% CI: 0.521-1.321, P=0.041) and SIR ( OR=739.881, 95% CI: 383.296-14 258.065, P<0.001) were independent influencing factors for onset time≤4.5 h in acute ischemic stroke patients. Pearson correlation analysis showed that SIR was positively correlated to onset time in patients with acute ischemic stroke ( r=0.420, P<0.05), and SIR was positively correlated to onset time in patients from poor collateral circulation group ( r=0.781, P<0.05). ROC curve showed that AUC of SIR in predicting onset time≤4.5 h was 0.917 (95% CI: 0.814-1.000, P<0.001) and that of DWI-FLAIR mismatch in predicting onset time≤4.5 h was 0.530 (95% CI: 0.509-0.757, P=0.075) in poor collateral circulation group, enjoying significant difference in predictive efficacy. Conclusion:Acute ischemic stroke patients with low HIR and SIR have higher odds of onset time≤4.5 h; SIR can more accurately predict the onset time in these patients with poor collateral circulation.

Profile of Ankle Isokinetic Strength and Proprioception in Elite Female Handball Players / Perfil de Fuerza Isokinética del Tobillo y Propiocepción en Jugadoras de Balonmano de Élite

SUMMARY: The evaluation of the invertor and evertor muscle strength and proprioception are important in terms of determining the risk of injury in handball players. The aim of this study was to determine the isokinetic strength and proprioception profile of the ankle invertor and evertor muscles of elite female handball players. Fifteen elite female handball players were included. Ankle invertor and evertor muscle strength and proprioception were evaluated using the isokinetic system. The isokinetic strength test was performed in concentric mode at 30°/s (5 repetitions) and 120°/s (10 repetitions). Proprioception sense was evaluated as active joint position sense. There was no statistically significant difference between the dominant and nondominant sides in terms of invertor and evertor muscle strength, evertor/invertor (Ever/Inver) ratio, and active joint position sense at both angular speeds (p>0.05). The Ever/Inver ratio on both sides was lower than normal values. It was concluded that the female handball players showed bilateral symmetry in the invertor and evertor muscles. However, the fact that the Ever/Inver strength ratio was lower than normal values on both sides suggested that caution should be exercised in terms of risks such as ankle sprain or chronic ankle instability. Pre-season evaluations should be made and it would be beneficial to add strengthening exercises to related muscle groups in training programs to normalize the unilateral ratios in these athletes.

La evaluación de la fuerza muscular inversora y eversora y la propiocepción son importantes para determinar el riesgo de lesión en los jugadores de balonmano. El objetivo de este estudio fue determinar la fuerza isocinética y el perfil de propiocepción de los músculos inversores y eversores del tobillo de jugadoras de balonmano de élite. Se incluyeron 15 jugadoras de élite de balonmano. La fuerza muscular inversora y eversora del tobillo y la propiocepción se evaluaron mediante el sistema isocinético. El test de fuerza isocinética se realizó en modo concéntrico a 30º/s (5 repeticiones) y 120º/s (10 repeticiones). El sentido de propiocepción se evaluó como sentido activo de posición articular. No hubo diferencias estadísticamente significativas entre los lados dominante y no dominante en términos de fuerza muscular inversora y eversora, relación eversor/inversor (Ever/ Inver) y sentido activo de la posición de la articulación en ambas velocidades angulares (p>0.05). La relación Ever/Inver en ambos lados fue inferior a los valores normales. Se concluyó que las jugadoras de balonmano presentaron simetría bilateral en los músculos inversores y eversores. Sin embargo, el hecho de que la relación de fuerza Ever/Inver fuera inferior a los valores normales en ambos lados sugirió que se debe tener precaución en términos de riesgos como el esguince de tobillo o la inestabilidad crónica de tobillo. Se deben realizar evaluaciones de pretemporada y sería beneficioso agregar ejercicios de fortalecimiento a los grupos musculares relacionados en los programas de entrenamiento para normalizar las proporciones unilaterales en estas atletas.

Distribution of Weakness at the Lower Extremity of Hemiparesis Patients / 영남의대학술지

The maximal voluntary strength of knee extension and flexion on both the right and left sides was measured in patients with hemiparesis of upper motor neuron type and in a group of normal subjects. Significant differences of maximal voluntary strength were found between male and female but the ratio of flexor to extensor strength did not vary significantly between the sides, between the exs in normal subjects. The maximal voluntary strength of uninvolved side were not reduced significantly but involved side reduced significantly in patients. The ratio of flexor to extensor strength in hemiparetic side was significantly less than the ratio for the normal subjects but not significant difference in uninvolved side of patients. According to the above results, the maximal voluntary strength of flexion was more reduced than that of the extension on lower extremity of hemiparesis patients. The strength ratio of flexion to extension was a useful parameter for guiding the rehabilitation of hemiparesis.