Dynamic biomechanical effect of lower body positive pressure treadmill training for hemiplegic gait rehabilitation after stroke: A case report

BACKGROUND Lower body positive pressure(LBPP)treadmill has potential applications for improving the gait of patients after stroke,but the related mechanism remains unclear.CASE SUMMARY A 62-year-old male patient suffered from ischemic stroke with hemiplegic gait.He was referred to our hospital because of a complaint of left limb weakness for 2 years.The LBPP training was performed one session per day and six times per week for 2 wk.The dynamic plantar pressure analysis was taken every 2 d.Meanwhile,three-digital gait analysis and synchronous electromyography as well as clinical assessments were taken before and after LBPP intervention and at the 4-wk follow-up.During LBPP training,our patient not only improved his lower limb muscle strength and walking speed,but more importantly,the symmetry index of various biomechanical indicators improved.Moreover,the patient’s planter pressure transferring from the heel area to toe area among the LBPP training process and the symmetry of lower body biomechanical parameters improved.CONCLUSION In this study,we documented a dynamic improvement of gait performance in a stroke patient under LBPP training,which included lower limb muscle strength,walking speed,and symmetry of lower limb biomechanics.Our study provides some crucial clues about the potential dynamic mechanism for LBPP training on gait and balance improvement,which is related to rebuilding foot pressure distribution and remodeling symmetry of biomechanics of the lower limb.

Effects of lower body positive pressure treadmill on functional improvement in knee osteoarthritis:A randomized clinical trial study

BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.

Evaluation of global cardiac systolic performance and diastolic filling in central hypovolumia by lower body negative pressure with Doppler echocardiography

Objective ：To overall evaluate the change of global cardiac systolic performance and diastolic filling in hypovoleamia by LBNP, Methods：10 healthy male subjects were placed in a standard LBNP chamber. Baseline haemodynamic and echocardiographic measurements were made after a period of least 10 min resting supine within the chamber. Pressure was then decreased to -10,-20 and -30 mmHg, with each pressure maintained for 15 rain. The indices of four transvalvular and SVC flow were measured using Doppler echocardiography. Results ：The results showed that S wave, Re wave ,and VTI of SVC progressively decreased with increasing LBNP. At -30 mmHg stage, S wave decreased by 35.4 % （change of 0.21±0.03 m/s, P 〈 0.001）. This reduction in pre-load Was associated with a progressive decrease in SV（by 21.5 ± 4.5 ml at -30 mmHg,P 〈 0.001 ）, decrease in CO（by 1.2 ± 0.2 L min^-1 at -30 mmHg LBNP,P 〈 0.001 ）. The diastolic filling of mitral and tricuspid flow also reduced significantly. At -30 mmHg stage, the E wave of MVF and TVF decreased 31% and 32% respectively （change of 0.23 ± 0.05 m/s,P 〈 0.001 and 0.18 ± 0.01 m/s,P 〈 0.001）. VTI of MVF and TVF decreased 27% and 27.7% respectively（change of 5.55 ± 1.41cm,P 〈 0.01 and 4.25 ± 0.44 cm,P 〈 0.01）. A wave of both sides did not change significantly. Conclusion：Doppler indices changes in different LBNP stage can roughly reflect the degree of hypovoleamia caused by blood volume redistribution. The indices of Doppler echocardiography are more sensitive than traditional physiological indexes in evaluating cardiovascular responses of LBNP. Echocardiography techniques overall can evaluate the global cardiac function including systolic performance and diastolic filling.

Nitroglycerin reduces augmentation index and central blood pressure independent of effects on cardiac preload

Objective To determine whether reduction in central pressure augmentation and central systolic blood pressure by nitroglycerine (NTG) results from effects on pre-load or is due to arterial dilation. Methods We compared effects of NTG with those of lower body negative pressure (LBNP). Hemodynamic measurements were made at rest,during LBNP (10,20 and 30 mmHg,each for 15 min) and after NTG (10,30 and 100 μg/min,each dose for 15 min) in ten healthy volunteers. Cardiac pre-load,stroke volume and cardiac output were assessed by echocardiography. Central pressure augmentation and central systolic pressure were obtained by radial tonometry using a transfer function. Results LBNP (20 mmHg) and NTG (30 μg/min) reduced pre-load (as measured by the peak velocity of the S wave in the superior vena cava) to a similar degree [by (26.8±3.8)% and (23.9±3.4)%,respectively]. Compared to LBNP,NTG reduced systemic vascular resistance [by (32.9±7.5)%,P<0.01],decreased peripheral and central pressure augmentation [by (20.8±3.4)% units and (12.9±2.9)% units,respectively,each P<0.01]. Conclusion These results suggest that a reduction in pre-load does not explain reduction in pressure augmentation and central systolic blood pressure by NTG and that these effects are mediated through arterial dilation.

Selective laser trabeculoplasty in pseudophakic and phakic eyes:a prospective study

AIM：To compare the efficacy of selective laser trabeculoplasty（SLT） in replacing medical therapy in pseudophakic and phakic eyes.METHODS：Subgroup of a prospective randomized clinical trial including patients with primary open angle glaucoma or ocular hypertension controlled with medication.Of 38 pseudophakic eyes were matched with 38 phakic eyes.SLT was offered as a way to decrease medication while maintaining the same low eye pressure.SLT was performed over 360°,at 3ns,spotsize 400 μm,100 spots.Data [intraocular pressure（IOP）,number of medications needed] were measured at 1h,1wk,1,3,6 and 12 mo.An independent-samples t-test was performed to compare baseline characteristics of the phakic and the pseudophakic group and differences in evolution of mean IOP and number of used medications.Chi-squared analysis was performed to investigate proportions of fast,slow and non-responders.RESULTS：The mean IOP measurement was 13.00± 2.88 mm Hg in the phakic group（38 eyes） and 13.51±3.06 mm Hg in the pseudophakic group（38 eyes）（P〉0.05）.This changed little after SLT and IOP lowering effect was comparable between the two groups.Main aim however was to lower the amount of medication needed.In the phakic group medication lowered from 1.29±0.62 at baseline,to 0.15±0.46 after 12mo;a reduction of 88.37%.In the pseudophakic group,used medication changed from 1.71±1.04,to 0.41±0.61;a 76.02% reduction.The differences were not statistically significant at any time point（P〉0.05）.IOP lowering occurred slightly faster in thepseudophakic group（50% of patients after one week） than in the phakic group（68% of patients after more than 4wk）.The difference was not significant（P〉0.05）.CONCLUSION：IOP lowering effect of SLT is comparable between phakic and pseudophakic eyes.

THE DETERMINATION OF ESOPHAGEAL FUNCTION IN 100 HEALTHY ADULTS

Esophageal motility was determined by using SGY-3 manometer in 100 healthy adults to observe the regular pattern of esophageal motility in different sex and age. The normal data was reported in this paper including LESP; UESP; peristaltic amplitude; esophageal conduction velocity and so on. We wish this data can be useful to the diagenosis of the esophageal motor disorder.

Clinical observation of kidney-qi deficiency syndrome patients with hypertension by Bushenjiangya decoction

OBJECTIVE: To observe the clinical efficacy of Bushenjiangya(reinforcing kidney and lowering blood pressure) decoction in curing hypertension of kidney Qi deficiency type. METHODS: First 60 patients with hypertension of kidney Qi deficiency type were divided into control group and treatment group randomly; the conventional western medicine was given to patients of the control group for antihypertensive therapy, while the traditional Chinese medicine Bushenjiangya decoction was added for patients in the treatment group based on the therapy for those in control group; after 2 months, the blood pressure, clinical efficacy and urine microalbumin changes of patients in the two groups before and after the treatment were observed. RESULTS: a. The systolic pressure of patients in the two groups was all reduced obviously(P<0.05); b. The total effective rate of experiment group in antihypertensive effect was 76.7%, while that of control group was 83.3%(P>0.05); c. The total effective rate of experiment group in TCM syndrome effect was 86.7%, while that of control group was 63.3%, showing that the effect of experiment group was better than that of control group(P<0.05); d. The 24 h urine microalbumin reduction of experiment group was better than that of control group(P<0.05). CONCLUSIONS: The curative effect of Bushenjiangya decoction in combination with the western medicine is better than that of simple western medicine for hypertension of kidney Qi deficiency type, and also the urine microalbumin can be obviously reduced to protect the kidney function.

New Guidelines Lower Blood Pressure Levels

选注者言:没有人死于高血压,但死于心脏病、中风及肾病者,其背后的元凶则是高血压。现在美国发布了新的关于高血压的界定标准。新标准认为:当血压达到115/75时,心脏病的危险即已经开始,此前,血压达到140/90时,医生才开始担心。本文对高血压的用药也发表了意见。

Successive digestion of tilapia collagen by serine proteinase and proline specific endopeptidase to produce novel angiotensin l-converting enzyme inhibitory peptides

Serine proteinase,purified from the hepatopancreas of Pacific white shrimp(Litopenaeus vannamei), was used to hydrolyze acid solubilized collagen(ASC)isolated from Nile tilapia(Oreochromis sp.)skin to produce angiotensin I-converting enzyme(ACE)inhibitory peptides(ACEIPs).A series of column chromatography assays were used to separate the ACEIPs.A peptide,NPARTCR,was isolated as it exhibited high ACE inhibition potential.Further digestion of this peptide by a proline specific endopeptidase(PSEP),produced a pentapeptide ARTCR with ACE inhibitory activity(IC_(50))of 77.0 pmol/L.Both NPARTCR and ARTCR inhibited ACE in a non-competitive manner.An in vivo study in rats demonstrated that ARTCR has ACE inhibitory activity via lowering systolic blood pressure in spontaneously hypertensive rats(SHRs).These results suggest that processing by-products from shrimp and tilapia are ideal raw materials for the production of serine proteinase and collagen,respectively.Serine proteinase and collagen are both ideal raw materials that can be used to derive ACE inhibitory active peptides against hypertension.