Contributing factors and interventions for fear of falling in stroke survivors: a systematic review.

OBJECTIVES: The purpose of this study was to provide a comprehensive overview of the prevalence, measurement tools, influencing factors, and interventions for fear of falling (FOF) in stroke survivors. METHODS: A PRISMA-guided systematic literature review was conducted. PubMed, EMBASE, Cochrane, and Web of Science were systematically searched. The search time was up to February 2023. All observational and experimental studies investigating FOF in stroke patients were included. The assessment tool of the Joanna Briggs Institute was used to assess the quality of the included studies and the risk of bias assessment. (PROSPERO: CRD42023412522). RESULT: A total of 25 observational studies and 10 experimental studies were included. The overall quality of the included studies was "low" to "good." The most common tool used to measure the FOF was the Falls Efficacy Scale-International (FES-I). The prevalence of FOF was 42%- 93.8%. Stroke survivors with physical impairments have the highest prevalence of FOF. The main risk factors for the development of FOF in stroke survivors were female gender, use of assistive devices, balance, limb dysfunction, and functional mobility. The combination of cognitive behavioral and exercise interventions is the most effective strategy. CONCLUSIONS: This review suggests that the prevalence of FOF in stroke survivors is high and that understanding the factors associated with FOF in stroke patients can help develop multifactorial prevention strategies to reduce FOF and improve quality of life. In addition, a uniform FOF measurement tool should be used to better assess the effectiveness of interventions for stroke survivors. ETHICS APPROVAL: PROSPERO registration (CRD42023412522).

Safety and Efficacy of Dexmedetomidine as a Sedative Agent for Performing Awake Intubation: A Meta-analysis.

To compare the efficacy and safety of dexmedetomidine with other alternative sedative agents used for performing awake intubation. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared the effects of dexmedetomidine with other alternative sedative agents used during awake intubation. The biomedical databases PubMed, Science Direct, and the Cochrane Library were searched for relevant RCTs with no restriction on the language of publication. The efficacy (level of sedation, success rate for intubation at the first attempt, intubation time, intubation conditions, and patient satisfaction) and safety (incidence of hypertension, hypotension, tachycardia, bradycardia, hypoxia, postsurgical memory, hoarseness, and sore throat) were assessed. Thirteen RCTs with a combined subject population of 591 patients came within the purview of this meta-analysis. Use of dexmedetomidine was associated with a higher Ramsay sedation scale score [mean difference (MD): 1.02, 95% confidence interval (CI), 0.77-1.28, P < 0.00001], vocal cord movement score (MD = 0.72, 95% CI, 0.20-1.24, P = 0.007), coughing scores (MD = 0.66, 95% CI, 0.10-1.22, P = 0.02), limb movement scores (MD = 0.69, 95% CI, 0.47-0.91, P < 0.00001); increased risk of bradycardia [relative risk (RR): 3.03, 95% CI, 1.38-6.68, P = 0.006] and hypotension (RR: 2.87, 95% CI, 1.44-5.75, P = 0.003); and lower risk of hypoxia (RR: 0.32, 95% CI, 0.15-0.70; P = 0.004) and postsurgical memory (RR: 0.50, 95% CI, 0.35-0.72, P = 0.0002). As indicated by our results, dexmedetomidine appears to be an effective and well-tolerated agent for performing awake intubation. Its use was associated with better intubation conditions, preservation of airway patency, and reduced recall of intubation, as compared with the traditional sedative agents. The risk of bradycardia and hypotension was significantly higher with dexmedetomidine as compared with that with other sedatives. However, these were easily managed with atropine and vasoactive agents.

Network Meta-Analysis on the Efficacy of Dexmedetomidine, Midazolam, Ketamine, Propofol, and Fentanyl for the Prevention of Sevoflurane-Related Emergence Agitation in Children.

Sevoflurane is associated with a relatively high incidence of emergence agitation (EA) in children. Prophylactic treatment, including midazolam, dexmedetomidine, ketamine, fentanyl and propofol, has been used to prevent EA. However, the question of which prophylactic treatment should be preferred to decrease the incidence of EA is still unclear. We conducted a network meta-analysis of randomized controlled trials to investigate the comparative efficacy of midazolam, dexmedetomidine, ketamine, fentanyl, and propofol for the prevention of sevoflurane-related EA in children. First, we used the odds ratios and 95% confidence interval as effect size. The results revealed that dexmedetomidine 0.19 (0.14-0.27), midazolam 0.22 (0.07-0.60), ketamine 0.28 (0.16-0.51), propofol 0.23 (0.10-0.53), and fentanyl 0.25 (0.17-0.36) led to a significant reduction of the incidence of EA when compared with placebo. With placebo as the standard of comparison, the degree of incoherence (a measure of how closely the entire network fits together) was small (ω = 8.66728e-08). The logor were dexmedetomidine -1.75 (-2.11 to -1.39), midazolam -1.07 (-1.54 to -0.60), ketamine -1.292 (-1.92 to -0.66), and fentanyl -1.13 (-1.56 to -0.70). When compared with dexmedetomidine, the logor were placebo 1.75 (1.39-2.11), midazolam 0.67 (0.09-1.25), ketamine 0.45 (-0.25-1.15), propofol 0.75 (0.19-1.31), and fentanyl 0.617 (0.13-1.11). When compared with ketamine, the logor were placebo 1.29 (0.66-1.92), midazolam 0.22 (-0.56 to 1.00), dexmedetomidine -0.45 (-1.15-0.25); propofol 0.29 (-0.45-1.03); and fentanyl 0.16 (-0.59-0.92). The study that showed dexmedetomidine, midazolam, ketamine, propofol, and fentanyl could significantly decrease the incidence of EA when compared with placebo. One interesting finding of this network meta-analysis is that dexmedetomidine might be the best choice to prevent EA. However, there is weak evidence that dexmedetomidine is better than ketamine for the prevention of sevoflurane-related EA in children. As a result, more studies are needed to compare dexmedetomidine with ketamine.

[Effect of acupuncture-anesthetic composite anesthesia on the incidence of POCD and TNF-alpha, IL-1beta, IL-6 in elderly patients].

OBJECTIVE: To explore the effect of acupuncture-anesthetic composite anesthesia (AACA) on the incidence of postoperative cognitive dysfunction (POCD) and changes of TNF-alpha, IL-1beta, and IL-6 in elderly patients. METHODS: Totally 83 patients undergoing surgical resection of gastrointestinal tumor were randomly assigned to the simple anesthesia group (A group, 41 cases) and the AACA group (B group, 42 cases). Patients in Group A received endotracheal general anesthesia. Those in Group B were induced by acupuncture anesthesia for 30 min by needling at Baihui (DU20), Neiguan (PC6), Zusanli (ST36). The electro-acupuncture (EA) apparatus was connected after arrival of qi, with the wave pattern of density 2/100 Hz. The stimulus intensity was set by patients' tolerance, with the peak current of 5 mA. Then the endotracheal general anesthesia was performed and the EA lasted till the end of the surgery. The cognitive function of all patients was assessed before operation and at day 3 after operation using mini-mental state examination (MMSE). POCD was confirmed if with one or more decreased stand- ard. The peripheral venous blood was collected before anesthesia induction (TO), immediately at the end of surgery (T1), 24 h after operation (T2), and 48 h after operation (T3), and serum concentrations of IL-1beta, IL-6, and TNF-alpha were correspondingly measured using ELISA. RESULTS: The postoperative anesthesia awakening time was shorter in Group B than in Group A [(20.37 +/- 6.09) min vs (29.24 +/- 7.48) min, P < 0.05]. The remifentanil dose used during the operation was less in Group B than in Group A (P < 0.05). The incidence of POCD at day 3 was lower in Group B than in Group A [10/41 (23.8%) vs 15/42 (36.5%), P < 0.05]. The concentrations of IL-1beta, IL-6, and TNF-alpha at T1-T3 were higher than those at TO in the two groups (P < 0.05). The increment of TNF-alpha and IL-1beta was less in Group B than in Group A (P < 0.05). CONCLUSION AACA could reduce the incidence of POCD and inhibit postoperative release of TNF-alpha, IL-1beta, and IL-6 in elderly patients undergoing colorectal cancer resection.

Preconditioning effects of physiological cyclic stretch on pathologically mechanical stretch-induced alveolar epithelial cell apoptosis and barrier dysfunction.

BACKGROUND: We aim to investigate the effects of preconditioning of physiological cyclic stretch on the alveolar epithelial cell apoptosis induced by pathologically mechanical stretch and barrier dysfunction and how these effects are linked to differential expression of small GTPases Rac and Rho mRNA. METHODS: Pulmonary alveolar epithelial cells were subjected to different treatments of cyclic stretch (CS) at 5% and 20% elongation, respectively. Cells maintained in normal cell culture were used as negative control. On the other hand, cell apoptosis and Rac/Rho activities in cells with or without preconditioning of physiologically relevant magnitudes of CS (5% CS) with different durations (0, 15, 30, 60 and 120 min) in prior to 6-h treatment with pathological CS stimulation (20% CS) were compared and measured. RESULTS: Pathological CS could cause a significant increase in apoptosis rate, which is considered to be associated with the repression of Rac mRNA and activation of Rho mRNA. In contrast, physiological 5%-CS preconditioning suppressed cell apoptosis and induced nearly complete monolayer recovery with fewer actin stress fibers and paracellular gap formation. Consistent with differential effects on cell apoptosis and epithelial cell integrity, physiological CS preconditioning enhanced expression of Rac mRNA but inhibited Rho activation. CONCLUSIONS: Physiological CS preconditioning has an inhibitory effect on cell apoptosis while exerts a stimulatory impact on epithelial cell recovery via regulation of Rac and Rho activities.

[Impacts of the different frequencies of electroacupunctrue on cognitive function in patients after abdominal operation under compound anesthesia of acupuncture and drugs].

OBJECTIVE: To observe the impacts of different frequencies of electroacupuncture (EA) on post-operative cognitive function and the change in serum S-100beta protein under the compound anesthesia of acupuncture and drugs. METHODS: One hundred and twenty-four patients of abdominal operation at selective time were randomized into a routine drug anesthesia group (group A, 24 cases), a meridian point 2 Hz group (group B, 26 cases), a me ridian point 2 Hz/100 Hz group (group C, 25 cases), a meridian point 100 Hz group (group D, 24 cases) and a transcutaneous acupoint electric stimulation 2 Hz/100 Hz group (group E, 25 cases). In group A, the endotrachea-lgeneral anesthesia was applied. In the rest groups, the acupuncture anesthesia was induced for 30 min before the endotracheal general anesthesia, at Baihui (GV 20), Yintang (GV 29) and Neiguan (PC 6), with G6805-2 electric acupuncture apparatus used. In group B, the continuous wave and 2Hz in frequency were selected. In group C, the disperse-dense wave and 2 Hz/100 Hz in frequency were selected. In group D, the continuous wave and 100 Hz in frequency were selected. In group E, the disperse-dense wave and 2 Hz/100 Hz in frequency were selected, and the electrode pads were stick on the acupoints and connected with the electric stimulation till the end of operation. Mini-mental state examination (MMSE) was adopted to evaluate and record the changes in cognitive function 1 day before operation and on the 3rd day after operation. The conditions of post-operative cognitive dysfunction (POCD) in the patients and the changes in serum S-100beta protein were monitored before and at the end of operation. RESULTS: The incidence rate of POCD on the 3rd day after operation was 41.7% (10/24) in group A. The incidence rates of POCD were 26.9% (7/26), 16.0% (4/25), 33.3% (8/24) and 16.0% (4/25) in group B, C, D and E separately. Compared with group A, the incidence rate of PCOD in group B, C, D and E were reduced (all P<0.05), the incidence rate in group C and E were lower than that in groups B and D (all P<0.05). At the end of operation, the level of serumS-100beta protein was (0.186 +/- 0.027) microg/L in group A, the levels were (0.165 +/- 0. 028) microg/L, (0.166 +/- 0.027) microg/L, (0.163 +/- 0.025) microg/L and (0.164 +/- 0.025) microg/L in group B, C, D and E separately. The levels of serum S-100beta protein in group B, C, D and E were lower than that in group A separately (all P<0.05). CONCLUSION: The general anesthesia assisted with EA at different frequencies reduces the incidence of cognitive dysfunctionand, decreases the level of serum S-100beta protein after intestinal cancer resection. The effects of the meridian point electric stimulation at 2 Hz/100 Hz and the transcutaneous electric stimulation at 2 Hz/100 Hz are the best. Hence, these two approaches of anesthesia deserve to be recommended practically.

Early administration of propofol protects against endotoxin-induced acute lung injury in rats by inhibiting the TGF-beta1-Smad2 dependent pathway.

OBJECTIVE: To assess the effects of propofol treatments at different time points on acute lung injury and on the expression of transforming growth factor (TGF)-beta1 and the downstream target of TGF-beta1, Smad 2, in the lung tissues in the endotoxic rats. METHODS: Seventy-six Wistar rats were randomly assigned to five groups: control group (saline only), endotoxemic group [lipopolysaccharide (LPS) 8 mg kg(-1), i.v.], and three propofol-treated groups. For the propofol-treated groups, propofol (5 mg kg(-1), i.v. bolus) was administered either 1 h before LPS, simultaneously with LPS, and 1 h after LPS, and all were followed by infusion of 10 mg kg(-1) h(-1) of propofol for 5 h after LPS. Lung tissues were sampled to measure myeloperoxidase activity and expression of TGF-beta1 and Smad2 and to assess pulmonary microvascular permeability and histopathological changes. RESULTS: The hemodynamics, arterial blood gases, 5 h survival rate, pulmonary microvascular permeability, and acute lung injury scores were significantly better, and expression of TGF-beta1 and Smad2 and myeloperoxidase activity in lung tissues was significantly lower in the pretreatment and simultaneous treatment groups compared to the endotoxemic group. However, there were no significant differences in all observed variables between the endotoxemic and postreatment groups. Except for TGF-beta1 expression in lung tissues, the other observed variables were also not significantly different between the pretreatment and simultaneous treatment groups. CONCLUSIONS: In the endotoxic rat model, pretreatment and simultaneous treatment with propofol provided protection against acute lung injury by inhibiting the TGF-beta1-Smad2 dependent pathway.

[Key issues on the clinical pathway development: a view from Chinese medicine and integrative medicine].

Comparing with the Western medicine, the clinical pathway development of Chinese medicine (CM)/integrative medicine (IM), on one hand, should follow the basic principles of general clinical pathway; on the other and prior hand, it ought to coordinate with the rule of CM, and display sufficiently the advantages of CM based upon the evidences. Several key issues which may be encountered in the development and the relevant strategies were introduced in this paper.

Effects of different resuscitation fluids on acute lung injury in a rat model of uncontrolled hemorrhagic shock and infection.

BACKGROUND: To investigate the effects of different resuscitation fluids on acute lung injury in a rat model of uncontrolled hemorrhagic shock (HS) followed by mimicked infection. METHODS: Sixty Sprague-Dawley rats were randomly assigned to one of the five groups (n = 12 per group) to receive the following treatments: (1) control group (group C), surgery, no hemorrhage, and no resuscitation; (2) no fluid resuscitation group; (3) lactated Ringer's solution group; (4) 7.5% hypertonic saline (HTS) group; and (5) hydroxyethyl starch group (group HES). All experimental groups were subjected to three phases: phase I entailed massive hemorrhage with a mean arterial pressure of 35 mm Hg to 40 mm Hg for 60 minutes by tail amputation and followed by mimicked infection by intratracheal administration of lipopolysaccharide 2 mg/kg. The animals in each group were then partially resuscitated with the fluid assigned to the group. Phase II of 60 minutes commenced at tail ligation, involved hemostasis, and return of all the blood initially shed. Phase III was an observation phase with no any further treatment and lasted for 3.5 hours. The survival rate at the end of the phase III was recorded. After phase III, arterial blood gases were recorded. The wet to dry lung weight ratio, pulmonary microvascular permeability, the expression of transforming growth factor (TGF)-beta1, and Smad2 were determined. The lung histology was also assessed. RESULTS: HES and HTS solutions were more effective than no fluid resuscitation and lactated Ringer's solution in reducing the detrimental effects of HS and infection on the lungs, as seen by the significantly lower pulmonary microvascular permeability and wet to dry lung weight ratio, the improved arterial blood gases and lower levels of TGF-beta1and Smad2 expression in lung tissues. These beneficial effects were most pronounced in the group HES. CONCLUSIONS: This study demonstrated that resuscitation with HTS and especially with HES could reduce lung tissue damage and pulmonary edema after severe uncontrolled HS. The TGF-beta1/Smad2 signaling pathway might play a key role in regulation of pulmonary permeability and formation of pulmonary edema in a rat model of uncontrolled HS and infection.

[Effects of propofol on the changes in cytoskeleton and cellular permeability of human umbilical vascular endothelial cells monolayer induced by lipopolysaccharide].

OBJECTIVE: To investigate the effects of propofol on the changes in actin cytoskeleton and permeability of cultured human umbilical vascular endothelial cells (HUVECs) monolayer induced by lipopolysaccharide (LPS). METHODS: HUVECs were randomly assigned to one of the following seven groups: no additives (negative control), LPS alone (1 mg/L and 10 mg/L), propofol alone (4 mg/L), introlipid alone, LPS (10 mg/L ) combination with propofol (4 mg/L) and LPS (10 mg/L ) together with introlipid (4 mg/L). Changes in filtration coefficients (Kf) and osmotic reflection coefficients (sigma) were measured, and changes in filamentous actin (F-actin) measured by F-actin fluorometry, and expression of nitrotyrosine analyzed by immunocytochemistry were observed in cultured HUVECs. RESULTS: Compared with the control group, the LPS alone group Kf values were significantly increased and the sigma values decreased,the F-actin content was decreased and the expression of nitrotyrosine was increased (all P<0.01), especially in the high dose LPS alone group. The co-treatment of propofol and LPS significantly reduced levels of LPS-enhanced nitrotyrosine protein, and significantly attenuated the changes in Kf and sigma values (all P<0.01), while introlipid group had no such beneficial effects. CONCLUSION: Propofol rather than introlipid, significantly inhibit LPS-induced increase in permeability of HUVECs and alterations in F-actin organization. The scavenging actions of propofol on peroxynitrite may be helpful to attenuate endothelial barrier dysfunction as shown in our current study.

[Association of interleukin-6 and interleukin-18 gene polymorphism with rheumatoid arthritis in Guangdong Han population].

OBJECTIVE: To investigate the single-nucleotide polymorphisms (SNPs) at positions -572 and -174 in the promoter region of interleukin-6 (IL-6) gene and at -607 and -137 in the promoter region of interleukin-18 (IL-18) gene for their association with rheumatoid arthritis (RA) in the Chinese Han population in Guangdong Province. METHODS: SNPs of IL-6 and IL-18 genes were detected in 120 patients with RA and 168 normal subjects using polymerase chain reaction with sequence-specific primers (PCR-SSP). RESULTS: SNPs at -572 and -174 of IL-6 gene and at -607 and -137 of IL-18 gene were detected in this population. There was a significant difference in the genotype and allele frequency at -572 and -174 of IL-6 gene and -607 of IL-18 gene (P<0.001), but not in the distribution of genotype frequencies at -137 of IL-18 gene between the RA patients and healthy subjects (P=0.141). A significant difference was found, however, in the allele frequency at -137 of IL-18 (P=0.024). Logistic regression analysis revealed significant association of age, gender, IL-6 gene -572, -174 and IL-18 gene -137 SNPs with RA (P<0.05). CONCLUSIONS: The polymorphisms of the promoter region of IL-6 gene at positions -572 and -174 is probably associated with RA, and further study is needed to understand the relation of the polymorphisms of IL-18 gene at positions -607C/A and-137G/C with RA.