Effect of comprehensive nursing on the quality of life and swallowing function in individuals diagnosed with ischemic stroke

BACKGROUND Ischemic stroke(IS)is a widely recognized disease characterized by high preva-lence,mortality,morbidity,disability,and recurrence rates.It ranks prominently in terms of mortality,constituting 60%-80%of stroke cases.AIM To explore the impact of comprehensive nursing care on the quality of life and swallowing function in individuals diagnosed with IS.METHODS This study comprised 172 patients with IS admitted to our hospital between February 2018 to March 2021.The participants were divided into two groups,namely the control group(n=80)receiving routine care and the research group(n=92)receiving comprehensive care.Various assessment scales,including the standard swallowing function assessment scale(SSA),National Institutes of Health Stroke scale(NIHSS),European stroke scale(ESS),self-rating anxiety scale(SAS),self-rating depression scale(SDS),Barthel index(BI),and the motor func-tion assessment scale(MAS),were employed to evaluate the improvement in swallowing function,neurological deficits,clinical outcomes,anxiety,depression,daily living activities,and motor function before and after care.Furthermore,the study compared the occurrence of adverse reactions during the nursing period,life quality before and after the intervention,rehabilitation compliance,and nursing satisfaction between the two groups.RESULTS After the nursing intervention,the research group exhibited significantly improved SSA and NIHSS scores compared to the control group(P<0.05).Moreover,both groups demonstrated significant reductions in SAS and SDS scores(P<0.05),with the research group showing more obvious advantages(P<0.05).Compared to the control group,the research group displayed significantly better ESS,BI,and MAS scores(P<0.05),coupled with a lower incidence of adverse reactions(P<0.05).Additionally,the research group demonstrated markedly higher levels of life quality,rehabilitation compliance,and nursing satisfaction compared to the control group(P<0.05).CONCLUSION Comprehensive nursing effectively improved swallowing function,quality of life,and patient satisfaction,high-lighting its clinical significance.

Effects of different acupuncture methods combined with routine rehabilitation on gait of stroke patients

BACKGROUND Stroke refers to a group of cerebrovascular diseases associated with organic braininjury. It is characterized by the sudden and rapid onset of focal or diffusedysfunction. In recent years, in addition to routine treatment, Chinese medicineacupuncture has been administered to patients with hemiplegia, and it can beconsidered a new treatment for rehabilitation.AIM To investigate the effects of eye acupuncture needle retention and bodyacupuncture combined with routine rehabilitation on gait performance andplantar pressure in patients recovering from stroke.METHODS Thirty-two stroke patients who met the inclusion criteria were randomly dividedinto an experimental group and a control group, with 16 patients in each group.Both groups underwent routine rehabilitation. The experimental group wastreated by eye acupuncture needle retention, and the control group was treated bybody acupuncture. Before and after 4 wk of treatment, both groups underwentkinematic and plantar pressure synchronous tests to assess gait performance.RESULTS The step length, gait speed, step frequency, joint angles of the lower limbs, andground reaction force impulse in the anterior region of the affected foot in bothgroups significantly increased from before to after treatment (P < 0.05);the center of mass displacement, peak pressure values, and impulse in the anterior region ofthe healthy foot and posterior regions of both the affected and healthy feetsignificantly decreased from before to after treatment (P < 0.05). The patients inthe experimental group showed greater improvement in the following parametersthan the control group: Step length, gait speed, step frequency, lower extremityjoint angles, center of gravity displacement, and peak pressure values andimpulse in the anterior and posterior regions of both the affected and healthy feet(P < 0.05).CONCLUSION Eye acupuncture needle retention and body acupuncture combined with routinerehabilitation can effectively improve the gait performance of patients recoveringfrom stroke. Between these two treatments, eye acupuncture needle retentioncombined with routine treatment is better than body acupuncture, and it can beconsidered a practical and effective clinical treatment.

Left atrial appendage occluder implantation for stroke prevention in elderly patients with atrial fibrillation： acute and long-term results

Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. As it hasbeen reported previously, 3-year survival rate among pa-tients with AF over 75 years of age after stroke is less than50%, and almost 90% of those patients will remain dis-abled.

Neural regeneration by regionally induced stem cells within poststroke brains: Novel therapy perspectives for stroke patients

Ischemic stroke is a critical disease which causes serious neurological functional loss such as paresis. Hope for novel therapies is based on the increasing evidence of the presence of stem cell populations in the central nervous system (CNS) and the development of stem-cell-based therapies for stroke patients. Although mesenchymal stem cells (MSCs) represented initially a promising cell source, only a few transplanted MSCs were present near the injured areas of the CNS. Thus, regional stem cells that are present and/or induced in the CNS may be ideal when considering a treatment following ischemic stroke. In this context, we have recently showed that injury/ischemia-induced neural stem/progenitor cells (iNSPCs) and injury/ischemia-induced multipotent stem cells (iSCs) are present within post-stroke human brains and post-stroke mouse brains. This indicates that iNSPCs/iSCs could be developed for clinical applications treating patients with stroke. The present study introduces the traits of mouse and human iNSPCs, with a focus on the future perspective for CNS regenerative therapies using novel iNSPCs/iSCs.

Factors associated with activities of daily living among the disabled elders with stroke

Objective:To determine the factors associated with activities of daily living(ADL)among the disabled elders post-stroke.Methods:A total of 158 patients were chosen from community health service stations in eighteen regions of Tianjin city by convenience sampling from March to November in 2013.The Barthel Index(BI)and the short-formmini-nutritional assessment(MNA-SF)were used to evaluate the ADL,the nutritional status respectively.Statistical analysis was performed using independent sample t-test,one-way ANOVA,Pearson correlation and multiple linear regression analysis.Barthel ADL index was the main outcome.Results:The mean score of ADL was 50.50±27.125.The multiple linear regression showed that the factors which had significant impact on ADL were stroke frequency,types of stroke,nutritional status,financial status,and age.Conclusions:Disabled elders with recurrent strokes,hemorrhagic stroke,dependent financial resources,older age,worse nutritional status and living with family had poorer strokerelated outcome.Healthcare providers can discover the high-risk groups of disability and implement individualized preventive interventions in accordance with the related factors.

Motor relearning program and Bobath method improve motor function of the upper extremities in patients with stroke

BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.

Observation of activation status of motor-related cortex of patients with acute ischemic stroke through functional magnetic resonance imaging

BACKGROUND： About more than three fourth of patients with stroke have motor dysfunction at different degrees, especially hand motor dysfunction. Functional magnetic resonance imaging （fMRI） provides very reliable visible evidence for studying central mechanism of motor dysfunction after stroke, and has guiding and applicable value for clinical therapy. OBJECTIVE： To observe the activation of motor-related cortex of patients with acute ischemic stroke with functional magnetic resonance imaging, and analyze the relationship between brain function reconstruction and motor restoration after stroke. DESIGN ： A contrast observation SETTING： Medical Imaging Center, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. PARTICIPANTS ： Nine patients with acute ischemic stroke who suffered from motor dysfunction and received the treatment in the Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA between August and December 2005 were recruited, serving as experimental group. The involved patients including 5 male and 4 female, aged 16 to 87 years, all met the diagnostic criteria of cerebrovascular disease revised by The Fourth National Conference on Cerebrovascular Disease, mainly presenting paralysis in clinic, and underwent fMRI. Another 9 right handed persons matched in age and gender who simultaneously received healthy body examination were recruited, serving as control group. All the subjects were informed of the detected items. METHODS ： ①Muscular strength of patients of the experimental group was evaluated according to Brunnstrom grading muscular strength （Grade Ⅰ -Ⅳ）. ②Passive finger to finger motion was used as the mission （alternate style of quiescence, left hand motion and quiescence, nght hand motion was repeated 3 times, serving as 1 sequence, 20 s per block and 20 s time interval. The whole process of scanning was 260 s）, and subjects of 2 groups were given Bold-fMRI examination with GEl .5T double gradient 16-channel magnetic resonance imaging system. All the data were given off-line management, and fMRI was treated with SPM2 softwere. The activation of passive finger-to-finger motion-related cortex of subjects in 2 groups was observed. ③ Results of fMRI of subjects in 2 groups were compared. The size of activation region of brain and signal intensity were measured and unilateral index was calculated. The data of activation region of cerebral hemisphere of different sides at finger motion were given statistical analysis of unilateral index. Differences among unilateral indexes at hand motion were compared between intact and affected hands of patients in experimental group. The relationship between unilateral index and muscular strength of affected hands at affected hand motion in patients of the experimental group was performed Spearman correlation analysis. MAIN OUTCOME MEASURES： ① The activation of motion-related cortex passive finger-to-finger motion between handedness and non-handedness was detected with functional magnetic resonance imaging of subjects in 2 groups. ②Relationship between unilateral index and muscular strength of subjects of experimental group at affected hand motion. RESULTS： Nine patients with ischemic stroke and 9 controls all participated in the final result analysis. ① Passive fMRI detection results between handedness and non-handedness of controls： Right-handed finger-to-finger motion of subjects of control group mainly activated contralateral sensonmotor cortex, and left-handed finger-to-finger motion not only activated above-mentioned brain region, but also activated supplementary motor area （SMA） of contralateral brain region; ②In the experimental group, sensorimotor cortex of contralateral hemisphere was activated at affected hand motion, and homolateral posterior parietal cortex （PPC）was also obviously activated. Bilateral sensonmotor cortex was activated at affected hand motion in 2 patients, and homolateral activation area was larger than contralateral one. At intact hand motion, contralateral sensorimotor cortex was activated, but no obvious homolateral activation area was found. ③ Correlation of unilateral index with muscular strength： Passive finger-to-finger fMRI （ between affected and intact hands of subjects of experimental group： Unilateral index at passive single finger motion of affected and intact hand of subjects of experimental group was -0.018±0.01 and 0.319±0.187, respectively, with significant difference （t=4.059, P 〈 0.01 ）. Unilateral index was significantly positively correlated with the muscular strength of affected hand at affected hand motion（r=0.834, P 〈 0.05）.CONCLUSION ： ①fMRI can objectively shows different activation states of motor cortex between patients with ischemic stroke and healthy controls, and brain functional compensation and recombination exist. Both primary sensorimotor cortex and SMA of bilateral hemispheres participant in affected hand motion, at the same time, parietal lobe and cortex of intact side also obviously participant in the affected hand motion. ②Correlation analysis of unilateral index and muscular strength of affected hand performed through fMRI can be used as an effective means to investigate the relationship between motion rehabilitation and brain functional recombination after stroke.

Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

BACKGROUND:Botulinum toxin type A(BTX-A)is mostly to be used to treat various diseases of motor disorders,whereas its effect on muscle spasm after stroke and brain injury needs further observation.OBJECTIVE:To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury.DESIGN:A randomized controlled observation.SETTINGS:Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University.PARTICIPANTS:Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation,Department of Neurology and Department of Neurosurgery,the Second Hospital of Hebei Medical University from January 2001 to August 2006.They were all confirmed by CT and MRI,and had obvious increase of spastic muscle strength in upper limbs,their Ashworth grades were grade 2 or above.The patients were randomly divided into treatment group(n=30)and control group(n=30).METHODS:①Patients in the treatment group undertook comprehensive rehabilitative trainings,and they were administrated with domestic BTX-A,which was provided by Lanzhou Institute of Biological Products,Ministry of Health(S10970037),and the muscles of flexion spasm were selected for upper limbs,20-25 IU for each site.②Patients in the treatment group were assessed before injection and at 1 and 2 weeks,1 and 3 months after injection respectively,and those in the control group were assessed at corresponding time points.The recovery of muscle spasm was assessed by modified Ashworth scale(MAS,grade 0-Ⅳ;Grade 0 for without increase of muscle strength;GradeⅣfor rigidity at passive flexion and extension);The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment(FMA,total score was 226 points,including 100 for exercise,14 for balance,24 for sense,44 for joint motion,44 for pain and 66 for upper limb);The ADL were evaluated with Barthel index,the total score was 100 points,60 for mild dysfunction,60-41 for moderate dysfunction,<40 for severe dysfunction).MAIN OUTCOME MEASURES:Changes of MAS grade,FMA scores and Barthel index before and after BTX-A injection.RESULTS:All the 60 patients with brain injury and stroke were involved in the analysis of results.①FMA scores of upper limbs:The FMA score in the treatment group at 2 weeks after treatment was higher than that before treatment[(14.98±10.14),(13.10±9.28)points,P<0.05],whereas there was no significant difference at corresponding time point in the control group.The FMA scores at 1 and 3 months in the treatment group[(23.36±10.69),(35.36±11.36)points]were higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].②MAS grades of upper limbs:There were obviously fewer cases of gradeⅢin MAS at 2 weeks after treatment than before treatment in the treatment group(0,9 cases,P<0.05),whereas there was no obvious difference in the control group.There were obviously fewer cases of gradeⅢin MAS at 2 weeks and 1 month after treatment in the treatment group(0,0 case)than the control group(5,2 cases,P<0.01).③Barthel index of upper limbs:The Barthel index at 2 weeks after treatment was higher than that before treatment in the treatment group[(30.36±22.25),(28.22±26.21)points,P<0.05],whereas there was no significant difference in the control group.The Barthel indexes at 1 and 3 months after treatment in the treatment group were obviously higher than those in the control group[(20.55±10.22),(30.33±10.96)points,P<0.01].CONCLUSION:BTX-A has obvious efficacy on decreasing muscle tension after stroke and brain injury,and relieving muscle spasm;Meanwhile,the combination with rehabilitative training can effectively ameliorate the motor function of upper limbs and ADL of the patients.

Predictive modeling for postoperative delirium in elderly patients with abdominal malignancies using synthetic minority oversampling technique

BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.

Patent foramen ovale in an old patient with ischemic stroke following carotid surgery

Post-procedural strokes have been observed in 0.5-2.7% of patients after carotid endarterectomy （CEA）. They are frequently due to carotid embolism or thrombosis of the operated artery. lntracerebral haemorrhages and technical difficulties are less common underlying factors.

Doppler examination and cerebral arterial stricture in patients with ischemic stroke

BACKGROUND: With the development of interventional therapy, it is necessary for evaluating cerebral vessels to instruct treatment and determine prognosis of patients with ischemic stroke; however, correlation of distribution of infarction focus and clinical symptoms with degrees of cerebrovascular stricture is still unclear. OBJECTIVE: To evaluate the characteristics of cerebral arterial stricture of patients with ischemic stroke with transcranial Doppler (TCD) and color duplex flow imaging (CDFI) and compare the correlation between distribution of cerebral infarction focus and clinical types with magnetic resonance imaging (MRI). DESIGN: Contrast observation. SETTING: Department of Neurology, the First Hospital of Jilin University. PARTICIPANTS: A total of 159 patients with ischemic stroke were selected from the Department of Neurology, the First Hospital of Jilin University from January to December 2005, including 106 males and 53 females aged from 27 to 88 years. Bases on diagnostic criteria of cerebrovascular disease established by Rao et al, clinical manifestations of all patients were evaluated with CT or nuclear magnetic resonance. All patients provided the confirmed consent. METHODS: The accepted patients received TCD and CDFI examination at 1 week after onset of ischemic stroke. Among them, 112 patients received cerebrovascular imaging examination simultaneously. MRI was used to check cerebral infarction focus and cerebrovascular stricture > 50% was regarded as the accepted vessels. In addition, DWI-T2 TCD (Germany) was used to check middle cerebral artery, and degrees of middle cerebral artery were classified into mild, moderate and severe stricture based on blood velocity (140 cm/s, 180 cm/s). Stroke was classified based on characteristics of infarction focus and clinical symptoms showed with MRI and correlation with degrees of cerebrovascular stricture was analyzed simultaneously. MAIN OUTCOME MEASURES: Correlation between the characteristics of ischemic stroke and clinical symptoms checked with TCD and CDFI. RESULTS: A total of 159 patients with ischemic stroke were involved in the final analysis; in addition, 112 cases received cerebrovascular imaging examination simultaneously. ① MRI results of 159 patients with cerebral artery occlusive disease (CAOD): There were 131 patients (82.3%) with cerebral infarction, 40 (25.2%) with transient ischemic attack and 4 (2.5%) with subclavian steal syndrome (SSS). ② Infarction types with MRI examination: There were 33 patients (20.8%) with solitary cerebral infarction and 98 (61.6%) with multiple-cerebral infarction. ③ Results of TCD, CDFI, MRI angiography, CT angiography and digital subtraction angiography (DSA): Among 112 patients, 181 lesion sites (61.8%) were located in cranium and 112 lesion sites were located out of cranium; especially, lesion site was mostly observed in stem of middle cerebral artery (31.2%) and watershed of basilar artery (7.2%) in cranium and the beginning site of internal carotid artery (21.4%) out of cranium. ④ Correlation of vascular stricture checking with TCD, MRI and clinical diagnosis: On one hand, MRI and clinical diagnosis demonstrated that 68 patients had a watershed infarction; meanwhile, TCD examination indicated that there were 3 patients with mild vascular stricture, 24 with moderate vascular stricture and 36 with severe vascular stricture. On the other hand, among 68 patients with non-watershed infarction, there were 27 patient with mild vascular stricture, 26 with moderate vascular stricture and 15 with severe vascular stricture. There were significant differences (χ2 =26.854, P =0.001). Clinical diagnosis indicated that 40 patients had transient ischemic attack and TCD examination demonstrated that there were 8 patient with mild vascular stricture, 12 with moderate vascular stricture and 20 with severe vascular stricture. There were significant differences as compared with 68 patients with watershed infarction (χ2 =21.258, P =0.001). ⑤ Correlation of vascular stricture checking with CDFI, MRI and clinical diagnosis: On one hand, among patients who were determined as watershed infarction with MRI and clinical diagnosis, CDFI examination indicated that there were 32 patients with mild vascular stricture at neck, 25 with moderate vascular stricture and 6 with severe vascular stricture. On the other hand, among patients with non-watershed infarction, there were 48 patient with mild vascular stricture, 18 with moderate vascular stricture and 2 with severe vascular stricture. There were significant differences (χ2 =6.018, P =0.019). Among patients with transient ischemic attack checking with clinical diagnosis, there were 23 patient with mild vascular stricture, 9 with moderate vascular stricture and 8 with severe vascular stricture. There were no significant differences as compared with patients with non-watershed infarction (χ2 =0.597, P =0.440). CONCLUSION: ① TCD and CDFI are effective marks to determine cerebral arterial stricture and hemodynamical changes. ② Infarction and transient ischemic attack at watershed are generally clinical phenotypes of CAOD patients and infarction at watershed is correlated with degrees of cerebrovascular stricture. ③ TCD, MRI and clinical analysis of stroke types are significant for instructing treatment and evaluate prognosis.

Simple Nutritional and Inflammatory Markers Associated with Bed Sores in Elderly Stroke People

Background: Bed sores are major burden to hospital care and usually associated with worse prognosis and longer hospital stay. Aims: To evaluate whether simple biochemical inflammatory and nutritional markers would differ between those with bedsores and those without in elderly stroke patients and if there is a distinction between recent bed sore stroke patients and old bed sore stroke patients as regard these biomarkers. Methods: 80 Stroke elderly patients were enrolled and divided into four groups: patients with recent stroke who developed bedsores, patients with recent stroke who did not develop bedsores, patients with old stroke who developed bedsores and patients with old stroke who did not develop bedsores. Nutritional markers (albumin, total protein, magnesium, iron, total iron binding capacity (TIBC), hemoglobin and cholesterol) and inflammatory markers (total leucocyte count, neutrophil to lymphocyte ratio and ferritin) were compared between the four groups. Results: Concerning nutritional markers, albumin (P =< 0.001), Alb/Pr ratio (P =< 0.001), TIBC (P =< 0.001) and cholesterol (P = 0.005) are lower in the acute stroke with bed sore patients versus acute stroke without bed sore. Lower albumin (P =< 0.001) is only found in comparison between chronic stroke with bed sore patients and chronic without bed sore patients. There is a difference between acute stroke with bed sore and chronic stroke with bed sore concerning albumin (P =< 0.001), TIBC (P =< 0.001) and TG (p =< 0.001). Albumin is lower while TG and TIBC are higher in those with acute stroke with bed sores. Regarding inflammatory markers, high neutrophil and ferritin (p =< 0.001) were found in acute stroke with bed sore patients versus acute stroke without bed sore. No difference was found between chronic stroke with bed sore patients and chronic stroke without bed sore patients. Acute stroke with bed sore group has higher TLC, neutrophil, neut/lymph ratio and ferritin (p =< 0.001) than chronic stroke with bed sore group. Conclusions: Acute stroke patients with bed sores are the highest group as regard inflammatory markers due to acute stroke and bed sores together. The presence of bed sore itself causes or is caused by decrease in nutritional markers especially albumin in both, acute and chronic strokes. Other markers are more evident in acute stroke patients who develop bed sore like higher ferritin and neutrophils and lower TIBC, alb/prot ratio and cholesterol. TG differs only in relation to acute stroke but not bed sore. MG was not different between the four groups.

Alternation in F-wave parameters of median nerve from unaffected extremity in stroke patients with hemiplegia under dynamic state

BACKGROUND: For many years, the extremities of stroke patients are divided into affected side and unaffected side according to clinical symptoms and body signs. Moreover, previous rehabilitation function training is developed simply aiming to the dysfunction manifested by unaffected extremity. Problems of unaffected extremity are always ignored, such as left- and right- side connection dysfunction, abnormal muscular tension of unaffected side and so on. OBJECTIVE: To observe neurophysiological change characteristics of unaffected extremity of stroke patients with hemiplegia by electromyographical method. DESIGN: Case-control observation. SETTING: First Hospital, Jilin University. PARTICIPANTS: Eighty stroke patients with hemiplegia confirmed by skull CT or MRI, who firstly hospitalized in the Department of Neurology, First Hospital, Jilin University between July 2004 and March 2005, were retrieved. They were scored > 8 points in Glasgow Coma Scale and had stable vital sign. Nineteen normal persons who received healthy examination in the clinic were involved in normal control group. Following the classification criteria of Brunnstrom's Recovery Stages of Stroke (BRSS), 80 stroke patients with hemiplegia were assigned into 3 groups: BRSS Ⅰ-Ⅱ group (n =36), BRSS Ⅲ-Ⅳ group (n =23) and BRSSⅤ-Ⅵ (n =21). METHODS: F-wave parameters of median nerve of unaffected extremity were detected by electromyographical technique. The recording electrode (muscular belly of abductor pollicis brevis) and reference electrode (first finger bone) were connected with grounding electrode. Stimulating electrode was placed in the median part of wrist joint with stimulation intensity of 130% that of threshold stimulation, stimulation frequency of 2 Hz, current pulse width of 0.2 ms, time course of 5 ms and sensitivity of 2 mV. The F-wave of median nerve of affected extremity under the resting stage (static status) and that of unaffected extremity under the maximum resistant contracted state were detected in order. The amplitude and appearance percentage of F wave were recorded. MAIN OUTCOME MEASURES: Comparison of F-wave parameters of median nerve between the unaffected extremity of stroke patients with hemiplegia and the extremity of control subjects under different status. RESULTS: All the patients accomplished the detection, and all of them participated in the final analysis. ①Under dynamic status, the amplitude and appearance percentage of F wave of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group were significantly higher than those in the normal control group, respectively[(0.803 9±0.157 3) mV vs. (0.406 7±0.170 3) mV; (0.856 1±0.266 8)% vs. (0.650 0±0.197 6)%, P < 0.05]. Under static status, there were no significant differences in F-wave parameters of median nerve in the unaffected extremity of patients between BRSS Ⅰ-Ⅱ group and BRSS Ⅴ-Ⅵ group (P > 0.05). ②F-wave parameters of median nerve of unaffected extremity of patients in BRSS Ⅰ-Ⅱ group and BRSS Ⅴ-Ⅵ group under dynamic statewere higher than those under static status, without significant difference (P > 0.05), while the amplitude and appearance percentage of F wave of median nerve of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group under dynamic statewere significantly higher than those under static state[(0.803 9±0.157 3) mV vs. (0.391 7±0.131 6) mV; (0.856 1±0.266 8 )% vs.(0.639 1 ±0.259 4)%,P < 0.05]. ③ There was no significant difference in F wave parameters among groups under static state(P > 0.05). However, under dynamic status, the amplitude and appearance percentage of F wave parameters of median nerve of unaffected extremity of patients in BRSS Ⅲ-Ⅳ group [(0.803 9±0.157 3) mV,(0.856 1±0.266 8)%] were significantly lower than those in the other two groups [(0.395 1±0.148 8),(0.437 1±0.157 6) mV;(0.612 5±0.232 8)%,(0.657 1±0.232 5)%,P < 0.05]. CONCLUSION: With the development of disease condition and the increase of muscular tension at anesthetic side, combination motor of affected extremity is caused following movement and muscular tension enhances to non-anesthetic-side. Therefore, F-wave parameters increase under dynamic status.

Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

BACKGROUND： Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE： To observe the effect of percutaneous neuromuscular electric stimulation （PNES） on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN： Randomized grouping and controlled observation SETTING： Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation （NES）. Patients were randomly divided into control group and treatment group with 30 in each group. METHODS： Control group： Patients received routinely neurological therapy. Treatment group： Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of （temperature of axilla on the injured side - temperature of axilla on the healthy side）. Motor function of limbs was measured with FugI-Meyer Motor Assessment （FMA） during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES ： Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS： All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature： Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group： （0.056±0.000）, （0.024±0.003） ℃; control group： （0.250±0.001）, （0.131 ±0.001）℃; hospitalization; （0.513±0.001） ℃, P 〈 0.05-0,01]. ② FMA scores： Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group; （43.50±15.09）, （67.97 ±18.21） points; control group： （33.33 ±13.54）, （40.87±19.34） points; hospitalization： （26.43 ±11.87） points, P 〈 0.05-0.01]. ③ Correlation： Difference in temperature of axilla was negative correlation with FMA scores （c=- -0.255 1, P 〈 0.05）. CONCLUSION： ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.

Recovery after ischemic stroke:Effects of FuekFone home-based program on upper limb and cognitive function

Objectives:This study aimed to explore the effects of the“FuekFone(F.F.)home-based program”on the upper limb and cognitive function of ischemic stroke patients after discharge.Methods:A single group pre-and post-test design was conducted.A total of 40 patients with recovery after ischemic stroke were recruited from two university hospitals in Thailand.The study was conducted between June 2022 and January 2023.Participants underwent a six-week“F.F.home-based program,”which combined an upper limb and cognitive function rehabilitation device with Android games,including stationary barrel,adventure walk,adventure stroll,sliding barrel,sauce squeeze,and cut objects.Each game has different difficulty levels.Patients can perform corresponding exercises through the games according to their conditions under the guidance of medical staff.The patients played for 24 min per time,4 min each game,three days a week.The second week,let the patients play games for 30 min per time,5 min each game,3 days a week.Then,in the 3e6 weeks,let the patients play games for 1 h per time,10 min each game,5 days a week.At the pre-and post-intervention,the Thai version of the National Institutes of Health Stroke Scale(NIHSS),the Motor Assessment Scale,and the Montreal Cognitive Assessment(MoCA score)were administered to patients at discharge and at 2,4,and 6 weeksafter discharge,and the results were compared.Results:All participants completed this program.Participants had statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 2,4,and 6 weeks after discharge(P<0.001).In the comparison of upper limb function and cognitive function at each of the study times,we found statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 4,and 6 weeks after discharge when compared to after discharge and 2 weeks after discharge,respectively(P<0.05).Conclusions:Continuing care of patients post-stroke after discharge from hospital,such as F.F.homebased program should be applied at home to enhance upper limb and cognitive function.

Stroke following off-pump coronary artery bypass in patients with prior stroke

Objective To analyze the risk factors and clinical features of stroke following off-pump coronary artery bypass grafting in patients with prior stroke. Methods From January 2006 to July 2009,the clinical information of 437 patients undergoing OPCABG in Anzhen Hospital

Phase II Clinical Study of Three-Dimensional Printed Coplanar Template Combined with CT-Guided Percutaneous Core Needle Biopsy of Pulmonary Nodules in Elderly Patients

Background: As the population age structure gradually ages, more and more elderly people were found to have pulmonary nodules during physical examinations. Most elderly people had underlying diseases such as heart, lung, brain and blood vessels and cannot tolerate surgery. Computed tomography (CT)-guided percutaneous core needle biopsy (CNB) was the first choice for pathological diagnosis and subsequent targeted drugs, immune drugs or ablation treatment. CT-guided percutaneous CNB requires clinicians with rich CNB experience to ensure high CNB accuracy, but it was easy to cause complications such as pneumothorax and hemorrhage. Three-dimensional (3D) printing coplanar template (PCT) combined with CT-guided percutaneous pulmonary CNB biopsy has been used in clinical practice, but there was no prospective, randomized controlled study. Methods: Elderly patients with lung nodules admitted to the Department of Oncology of our hospital from January 2019 to January 2023 were selected. A total of 225 elderly patients were screened, and 30 patients were included after screening. They were randomly divided into experimental group (Group A: 30 cases) and control group (Group B: 30 cases). Group A was given 3D-PCT combined with CT-guided percutaneous pulmonary CNB biopsy, Group B underwent CT-guided percutaneous pulmonary CNB. The primary outcome measure of this study was the accuracy of diagnostic CNB, and the secondary outcome measures were CNB time, number of CNB needles, number of pathological tissues and complications. Results: The diagnostic accuracy of group A and group B was 96.67% and 76.67%, respectively (P = 0.026). There were statistical differences between group A and group B in average CNB time (P = 0.001), number of CNB (1 vs more than 1, P = 0.029), and pathological tissue obtained by CNB (3 vs 1, P = 0.040). There was no statistical difference in the incidence of pneumothorax and hemorrhage between the two groups (P > 0.05). Conclusions: 3D-PCT combined with CT-guided percutaneous CNB can improve the puncture accuracy of elderly patients, shorten the puncture time, reduce the number of punctures, and increase the amount of puncture pathological tissue, without increasing pneumothorax and hemorrhage complications. We look forward to verifying this in a phase III randomized controlled clinical study. .

Effectiveness of Remimazolam Benzenesulfonate Combined with Alfentanil in Elderly Patients Undergoing Painless Gastroenteroscopy

Objective:To observe the effects of remimazolam benzenesulfonate combined with alfentanil during painless gastroenteroscopy in elderly patients.Methods:This study analyzes patients aged 60–85 years old undergoing painless gastroenteroscopy.A total of 140 patients,examined between February 2023 and February 2024,voluntarily participated and were randomly divided into an experimental group and a control group.The control group received alfentanil combined with propofol for anesthesia,while the experimental group received alfentanil combined with remimazolam benzenesulfonate.The relevant indices of both groups were separately analyzed.Results:Patients in the experimental group had a shorter awakening time,a faster discharge rate(P<0.05),and a shorter examination duration;however,the difference in examination time between the two groups was not statistically significant(P>0.05).Before anesthesia,there was no significant difference in the basic information and vital signs of the two groups(P>0.05).Two minutes after anesthesia,both groups showed a decline in vital signs,but the vital signs of the experimental group remained more stable after the procedure,with the group’s indices showing improvement over the control group(P<0.05).Additionally,the incidence of adverse reactions in the experimental group was lower than in the control group(P<0.05).Conclusion:In painless gastroenteroscopy for elderly patients,anesthesia using a combination of remimazolam benzenesulfonate and alfentanil improves anesthesia effectiveness,hastens patient recovery,enhances the stability of vital signs,and effectively controls adverse reactions,thereby improving patient comfort.

Analysis of the Degree of Psychological Distress of Elderly Patients with Recurrent Trigeminal Neuralgia and Its Influencing Factors

Objective:To analyze the degree of psychological distress among elderly patients with recurrent trigeminal neuralgia and its influencing factors.Methods:A single-center cross-sectional study was conducted on 126 elderly patients with recurrent trigeminal neuralgia who visited the Pain Department of our hospital from March 2022 to April 2024.Logistic regression analysis was employed to evaluate the factors influencing psychological distress,based on general patient data,the Distress Thermometer(DT),the Perceived Social Support from Family Scale(PSS-Fa),and the Pitsburgh Sleep Quality Index(PSQI).Results:Among the 126 elderly patients with recurrent trigeminal neuralgia,those with a DT score≥4(72 patients,57.14%)were more prevalent than those with a DT score<4(54 patients,42.86%).The average DT score for all patients was 4.35±1.72.Patients in the DT score≥4 group were older than those in the DT score<4 group(t=4.207,P=0.000),had lower PSS-Fa scores(t=5.925,P=0.000),and had higher PSQI scores(t=17.858,P=0.000).There were no statistically significant differences in gender,marital status,residence area,education level,disease type,or pain location(all P>0.05).Older age and poor sleep quality were identified as independent risk factors for psychological distress in elderly patients with recurrent trigeminal neuralgia(OR=1.258,OR=1.713,both P<0.05),while higher levels of family support were identified as a protective factor(OR=0.581,P=0.025).Conclusion:Elderly patients with recurrent trigeminal neuralgia experience psychological distress,and the degree of severity depends on age,quality of sleep,and level of family support.