Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Epidemiological investigation of military training injuries for sea trainingand parachuting training

Objective: To study epidemiological characteristics of the military training injuries (MTI) during parachuting training of the air force and sea training of the navy. Methods:The subjects of this study were 1382, including 971 navy soldiers (300 recruits and 671 soldiers) and 411 for force recruits. Navy: Each of injured soldiers was investigated by the trained battalion surgeon; Air force: When the parachuting training finished , two doctors in specific field screened and investigated them one by one. Results: The incidence of injury in for force recruits was 16.3% and in navy recruits was 18. 7%. The incidence of navy soldiers was 5.5%, which was significantly lower than that of navy recruits. There was a peak of incidence in the 2nd training month of navy recruits. The peak of incidence of navy soldiers was in 1st training month. The incidence of air force maintained at a high level except 2nd training month. The incidences of lower legs and ankles were higher than those of other sites in navy with percentage of 42.9% and 17.9% respectively. The incidences of ankles and lumbar region were higher than those of other sites in air force with percentage of 26.9% and 23.9% respectively. Incidence of acute traumatic injuries was highest during special course. Conclusion: The result showed the incidence of injury in sea and parachuting training varied. Different preventive measures should be adopted during special training.

Total body water percentage and 3rd space water are novel risk factors for training-related lower extremity muscle injuries in young males

Purpose:To identify the risk factors for training-related lower extremity muscle injuries in young males by a non-invasive method of body composition analysis.Methods:A total of 282 healthy young male volunteers aged 18-20 years participated in this cohort study.Injury location,degree,and injury rate were adjusted by a questionnaire based on the overuse injury assessment methods used in epidemiological studies of sports injuries.The occurrence of training injuries is monitored and diagnosed by physicians and treated accordingly.The body composition was measured using the BodyStat QuadScan 4000 multifrequency Bio-impedance system at 5,50,100 and 200 kHz to obtain 4 impedance values.The Shapiro-Wilk test was used to check whether the data conformed to a normal distribution.Data of normal distribution were shown as mean±SD and analyzed by t-test,while those of non-normal distribution were shown as median(Q1,Q3)and analyzed by Wilcoxon rank sum test.The receiver operator characteristic curve and logistic regression analysis were performed to investigate risk factors for developing training-related lower extremity injuries and accuracy.Results:Among the 282 subjects,78(27.7%)developed training injuries.Lower extremity training injuries revealed the highest incidence,accounting for 23.4%(66 cases).These patients showed higher percentages of lean body mass(p=0.001),total body water(TBW,p=0.006),extracellular water(p=0.020)and intracellular water(p=0.010)as well as a larger ratio of basal metabolic rate/total weight(p=0.006),compared with those without lower extremity muscle injuries.On the contrary,the percentage of body fat(p=0.001)and body fat mass index(p=0.002)were lower.Logistic regression analysis showed that TBW percentage>65.35%(p=0.050,odds ratio=3.114)and 3rd space water>0.95%(p=0.045,odds ratio=2.342)were independent risk factors for lower extremity muscle injuries.Conclusion:TBW percentage and 3rd space water measured with bio-impedance method are potential risk factors for predicting the incidence of lower extremity muscle injuries in young males following training.

Surgical intervention combined with weight-bearing walking training improves neurological recoveries in 320 patients with clinically complete spinal cord injury:a prospective self-controlled study

Although a large number of trials in the SCI field have been conducted,few proven gains have been realized for patients.In the present study,we determined the efficacy of a novel combination treatment involving surgical intervention and long-term weight-bearing walking training in spinal cord injury(SCI)subjects clinically diagnosed as complete or American Spinal Injury Association Impairment Scale(AIS)Class A(AIS-A).A total of 320 clinically complete SCI subjects(271 male and 49 female),aged 16–60 years,received early(≤7 days,n=201)or delayed(8–30 days,n=119)surgical interventions to reduce intraspinal or intramedullary pressure.Fifteen days post-surgery,all subjects received a weight-bearing walking training with the“Kunming Locomotion Training Program(KLTP)”for a duration of 6 months.The neurological deficit and recovery were assessed using the AIS scale and a 10-point Kunming Locomotor Scale(KLS).We found that surgical intervention significantly improved AIS scores measured at 15 days post-surgery as compared to the pre-surgery baseline scores.Significant improvement of AIS scores was detected at 3 and 6 months and the KLS further showed significant improvements between all pair-wise comparisons of time points of 15 days,3 or 6 months indicating continued improvement in walking scores during the 6-month period.In conclusion,combining surgical intervention within 1 month post-injury and weight-bearing locomotor training promoted continued and statistically significant neurological recoveries in subjects with clinically complete SCI,which generally shows little clinical recovery within the first year after injury and most are permanently disabled.This study was approved by the Science and Research Committee of Kunming General Hospital of PLA and Kunming Tongren Hospital,China and registered at ClinicalTrials.gov(Identifier:NCT04034108)on July 26,2019.

The effect of wilderness and medical training on injury and altitude preparedness among backcountry hikers in Rocky Mountain National Park

BACKGROUND:The purpose of this study was to document the correlation between medical and wilderness training with levels of preparedness for acute mountain sickness(AMS),illness,and injury among backcountry hikers.METHODS:We conducted a cross-sectional,convenience survey in Rocky Mountain National Park in July and August 2015.The study group consisted of 380 hikers who completed a written survey that collected information about demographics,wilderness experience,altitude experience,hiking equipment,communications devices,and trip planning.RESULTS:Factors such as wilderness training(wilderness first aid[WFA],wilderness first responder[WFR],or wilderness emergency medical technician[WEMT]),wilderness experience,and altitude experience all affected hikers’emergency preparedness.Respondents with medical training were more prepared to avoid or respond to AMS(62.3%vs.34.3%[P<0.001]).They were also more prepared to avoid or manage injury/illness than hikers without medical training(37.7%vs.20.7%[P=0.003]).Participants with wilderness training were more likely to be prepared to avoid or respond to AMS(52.3%vs.36.8%[P=0.025])but not significantly more likely to be prepared to manage illness/injury(31.8%vs.22.0%[P<0.11]).Adjusting for experience,wilderness training,age,and gender,we found that medical training was associated with increased preparedness for AMS(OR2.72;95%CI 1.51–4.91)and injury/illness(OR 2.71;95%CI 1.5–4.89).CONCLUSION:Medically trained hikers were more likely to be prepared to avoid or manage AMS,medical emergencies,and injuries than their non-medically trained counterparts.Wilderness training increased hikers’preparedness for AMS but did not significantly alter preparedness for illness/injury.

Effect of vocal respiratory training on respiratory function and respiratory neural plasticity in patients with cervical spinal cord injury:a randomized controlled trial

In previous studies,researchers have used singing to treat respiratory function in patients with spinal cord injury.However,few studies have examined the way in which vocal training affects respiratory neural plasticity in patients with spinal cord injury.Vocal respiratory training(VRT)is a type of vocal muscle-related treatment that is often a component of music therapy(MT)and focuses on strengthening respiratory muscles and improving lung function.In this randomized controlled study,we analyzed the therapeutic effects of VRT on respiratory dysfunction at 3 months after cervical spinal cord injury.Of an initial group of 37 patients,26 completed the music therapy intervention,which comprised five 30-minute sessions per week for 12 weeks.The intervention group(n=13)received VRT training delivered by professional certified music therapists.The control group(n=13)received respiratory physical therapy delivered by professional physical therapists.Compared with the control group,we observed a substantial increase in respiratory function in the intervention group after the 12-week intervention.Further,the nerve fiber bundles in the respiratory center in the medulla exhibited a trend towards increased diversification,with an increased number,path length,thickness,and density of nerve fiber bundles.These findings provide strong evidence for the effect of music therapeutic VRT on neural plasticity.This study was approved by the Ethics Committee of China Rehabilitation Research Center(approval No.2020-013-1)on April 1,2020,and was registered with the Chinese Clinical Trial Registry(registration No.Chi CTR2000037871)on September 2,2020.

Fine motor skill training enhances functional plasticity of the corticospinal tract after spinal cord injury

Following central nervous system injury, axonal sprouts form distal to the injury site and extend into the denervated area, reconstructing neural circuits through neural plasticity. How to facilitate this plasticity has become the key to the success of central nervous system repair. It remains controversial whether fine motor skill training contributes to the recovery of neurological function after spinal cord injury. Therefore, we established a rat model of unilateral corticospinal tract injury using a pyramidal tract cutting method. Horizontal ladder crawling and food ball grasping training procedures were conducted 2 weeks before injury and 3 days after injury. The neurological function of rat forelimbs was assessed at 1, 2, 3, 4, and 6 weeks after injury. Axon growth was observed with biotinylated dextran amine anterograde tracing in the healthy corticospinal tract of the denervated area at different time periods. Our results demonstrate that compared with untrained rats, functional recovery was better in the forelimbs and forepaws of trained rats. The number of axons and the expression of growth associated protein 43 were increased at the injury site 3 weeks after corticospinal tract injury. These findings confirm that fine motor skill training promotes central nervous system plasticity in spinal cord injury rats.

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: ① Patients 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. ② Patients 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; Grade Ⅳ for 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. ① FMA 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]. ② MAS grades of upper limbs: There were obviously fewer cases of grade Ⅲ in 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 grade Ⅲ in 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). ③ Barthel 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.

APPLICATION OF PUNCTURING THE POINTS OPPOSITE TO THE DISEASED SIDE IN THE TREATMENT OF TRAINING INJURY IN TROOPS——A Report on 2560 Cases

Puncturing points opposite to the diseased side was used to treat injuries in 2560soldiers during their training.The instant effective rate and curative rate of the therapy was up to 96.25％and 38.44％respectively.

Maturity-associated considerations for training load,injury risk,and physical performance in youth soccer:One size does not fit all

Biological maturation can be defined as the timing and tempo of progress to achieving a mature state.The estimation of age of peak height velocity(PHV)or percentage of final estimated adult stature attainment(%EASA)is typically used to inform the training process in young athletes.In youth soccer,maturity-related changes in anthropometric and physical fitness characteristics are diverse among individuals,particularly around PHV.During this time,players are also at an increased risk of sustaining an overuse or growth-related injury.As a result,the implementation of training interventions can be challenging.The purpose of this review was to(1)highlight and discuss many of the methods that can be used to estimate maturation in the applied setting and(2)discuss the implications of manipulating training load around PHV on physical development and injury risk.We have provided key stakeholders with a practical online tool for estimating player maturation status(Supplementary Maturity Estimation Tools).Whilst estimating maturity using predictive equations is useful in guiding the training process,practitioners should be aware of its limitations.To increase the accuracy and usefulness of data,it is also vital that sports scientists implement reliable testing protocols at predetermined time-points.

Training load characteristics and injury and illness risk identification in elite youth ski racing:A prospective study

Purpose:The study aimed to investigate the role of training load characteristics and injury and illness risk in youth ski racing.Methods:The training load characteristics as well as traumatic injuries,overuse injuries,and illnesses of 91 elite youth ski racers(age=12.1±1.3 years,mean±SD)were prospectively recorded over a period of 1 season by using a sport-specific online database.Multiple linear regression analyses were performed to monitor the influence of training load on injuries and illnesses.Differences in mean training load characteristics between preseason,in-season,and post-season were calculated using multivariate analyses of variance.Results:Differences were discovered in the number of weekly training sessions(p=0.005)between pre-season(4.97±1.57)and post-season(3.24±0.71),in the mean training volume(p=0.022)between in-season(865.8±197.8 min)and post-season(497.0±225.5 min)and in the mean weekly training intensity(Index)(p=0.012)between in-season(11.7±1.8)and post-season(8.9±1.7).A total of 185 medical problems were reported(41 traumatic injuries,12 overuse injuries,and 132 illnesses).The weekly training volume and training intensity was not a significant risk factor for injuries(p>0.05).Training intensity was found to be a significant risk factor for illnesses in the same week(β=0.348;p=0.044;R^(2)=0.121)and training volume represents a risk factor for illnesses in the following week(β=0.397;p=0.027;R^(2)=0.157).Conclusion:A higher training intensity and volume were associated with increased illnesses,but not with a higher risk of injury.Monitoring training and ensuring appropriate progression of training load between weeks may decrease incidents of illness in-season.

Effect of sinew-regulating and bone-setting manipulating combined with exercise training in the treatment of joint injury of distal radio-ulnar

Objective: To observe the effect of the joint injury of the distal radio-ulnar joint. Methods: 60 patients with Distal Radioulnar Joint (DRUJ) injury were divided into observation group and control group according to random number method. 30 cases were included in each of the two groups.Before and after treatment in patients with Visual Analogue Scale (Visual Analogue Scale, VAS) score, forearm pronation and supination electromyographic activity, methods of electric integral value (integral electromyogram, iEMG) and Wrist in patients with self assessment Scale (Patient - Rated Wrist Evaluation, PRWE) score evaluation, comparison, and the clinical observation on diagnosis of disease and curative effect of traditional Chinese medicine standard (assessment process by blind method).Results: compared with the two groups before and after treatment, VAS score decreased, forearm pronation and postpronation activity increased, iEMG value increased, and PRWE scale score decreased (all P < 0.05), and the curative effect of the treatment group was better than that of the control group (P < 0.05). The total effective rate of the treatment group [93.3% (28/30)] was higher than that of the control group [50%(15/30), P < 0.05].Conclusion: the combined exercise training of muscle and bone setting technique can effectively alleviate the pain of patients with radial ulnar joint injury, improve the rotation of the forearm, increase the recruitment of the anterior rotatory muscle, and improve the wrist function of patients, and the effect is better than if combined with forearm support fixation.

Are High School Students Ready to Stop the Bleed from Injuries? Needs Assessment in a Low Resource Country

Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.

Effect of aerobic exercise + relaxation training on the cytokine secretion and endothelial injury in patients with coronary heart disease

Objective: To study the effect of aerobic exercise + relaxation training on the cytokine secretion and endothelial injury in patients with coronary heart disease. Methods: Patients who were diagnosed with stable angina pectoris in West China Hospital, Sichuan University between August 2014 and October 2017 were enrolled in the study and divided into the exercise training group who accepted aerobic exercise + relaxation training and the normal control group who accepted routine intervention. The levels of cytokines and endothelial injury molecules in serum as well as the expression of oxidative stress molecules in peripheral blood were determined before intervention as well as 56 d and 112 d after intervention. Results: Compared with the corresponding indexes of same group before intervention, serum FGF21, MIF, MIP-1α, SDF-1α, sICAM1, vWF, ET-1, sVCAM-1 and ESM1 levels as well as peripheral blood MPO, NOX2, NOX4, LOX-1 and CX3CR1 expression intensity of both groups of patients were significantly lower 56 d and 112 d after intervention, and serum FGF21, MIF, MIP-1α, SDF-1α, sICAM1, vWF, ET-1, sVCAM-1 and ESM1 levels as well as peripheral blood MPO, NOX2, NOX4, LOX-1 and CX3CR1 expression intensity of exercise training group 56 d and 112 d after intervention were lower than those of normal control group. Conclusion: Aerobic exercise + relaxation training can reduce the secretion of inflammatory cytokines and the degree of endothelial oxidative stress injury in patients with coronary heart disease.

Effects of gangliosides combined with family rehabilitation training on nerve injury, neurodevelopment and oxidative stress in children with HIE

Objective:To study the effects of gangliosides combined with family rehabilitation training on nerve injury, neurodevelopment and oxidative stress in children with HIE.Methods:Children with HIE who were treated in Zigong Third People's Hospital between March 2015 and October 2017 were selected and randomly divided into two groups, rehabilitation training group received gangliosides combined with family rehabilitation training and negative control group accepted gangliosides combined with conventional rehabilitation intervention. The contents of nerve injury molecules, neurotrophic molecules and oxidative stress molecules in serum were measured before intervention and 3 months after intervention.Results: Compared with those of same group before intervention, serum VILIP1, NSE, UCH-L1, TNF-α, IL-6, NO, DM and MDA levels of both groups of children were significantly lower whereas BDNF, TRKB, NTF, NGF, SOD and GSH-PX levels were significantly higher 3 months after intervention, and serum VILIP1, NSE, UCH-L1, TNF-α, IL-6, NO, DM and MDA levels of rehabilitation training group after intervention were lower than those of negative control group whereas BDNF, TRKB, NTF, NGF, SOD and GSH-PX levels were higher than those of negative control group.Conclusion: Gangliosides combined with family rehabilitation training can reduce the nerve injury, improve the neurodevelopment and inhibit the oxidative stress in children with HIE.

Incidence and distribution of stress fractures in recruits during basic training

Stress fracture（SF）in military recruits in China was investigated using99mTc-MDP bone scintigraphy in a randomized sample of 432 injured who wereclinically screened from 1060 recruits during basic training.The relationship between SFand training intensity was discussed.It was shown that the total incidence was 32.5%.There were two peaks during 9 training-weeks:one was in the 2nd week,and the otherin the 7th.Infantry soldiers had a more intensive training and,therefore a higher inci-dence than in artillery and service troops.Although SF was found in most ofweight-bearing bones,tibia was most commonly fractured（67%）.The findings suggestthat SF is a major training-related injury in military recruits and improperly strengthenedtraining can increase the incidence.

Effect of rehabilitation training combined with neurotrophic therapy on the nerve cytokine secretion and oxidative stress in rehabilitation period of patients with traumatic brain injury

Objective:To study the effect of rehabilitation training combined with neurotrophic therapy on the nerve cytokine secretion and oxidative stress in rehabilitation period of patients with traumatic brain injury.Methods:A total of 98 patients in rehabilitation period of traumatic brain injury who were treated in our hospital between July 2013 and September 2016 were collected and divided into control group and observation group according to the random number table method, and 49 cases in each group. Control group received regular neurotrophic therapy, and observation group received rehabilitation training combined with neurotrophic therapy. The differences in the contents of nerve cytokines and oxidative stress indexes were compared between the two groups before and after intervention.Results:Before intervention, differences in serum levels of nerve injury indexes, neurotrophy indexes, amino acid neurotransmitters and oxidative stress indexes were not statistically significant between the two groups of patients. After intervention, serum nerve injury indexes MBP, NGB, NSE and S-100B levels as well as excitatory amino acids Glu and Asp levels of observation group were lower than those of control group;neurotrophy indexes BDNF and GDNF levels as well as inhibitory amino acids GABA and Gly levels were higher than those of control group;serum oxidative stress indexes SOD and CAT levels were higher than those of control group;MDA level was lower than that of control group.Conclusions:Rehabilitation training combined with neurotrophic therapy can effectively optimize the nerve function and reduce the systemic oxidative stress state of patients in rehabilitation period of traumatic brain injury.

Animal model-based simulation training for three emergent and urgent operations of penetrating thoracic injuries

Purpose:To develop animal models of penetrating thoracic injuries and to observe the effects of the animal model-based training on improving the trainees’performance for emergent and urgent thoracic surgeries.Methods:With a homemade machine,animal models of lung injuries and penetrating heart injuries were produced in porcine and used for training of chest tube drainage,urgent sternotomy,and emergent thoracotomy.Coefficient of variation of abbreviated injury scale and blood loss was calculated to judge the reproducibility of animal models.Five operation teams from basic-level hospitals(group A)and five operation teams from level III hospitals(group B)were included to be trained and tested.Testing standards for the operations were established after thorough literature review,and expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards.Tests were carried out after the training.Pre-and post-training performances were compared.Post-training survey using 7-point Likert scale was taken to evaluate the feelings of the trainees to these training approaches.Results:Animal models of the three kinds of penetrating chest injuries were successfully established and the coefficient of variation of abbreviated injury scale and blood loss were all less than 25%.After literature review,testing standards were established,and expert questionnaire results showed that the scientific score was 7.30±1.49,and the feasibility score was 7.50±0.89.Post-training performance was significantly higher in both group A and group B than pre-training performance.Post-training survey showed that all the trainees felt confident in applying the operations and were generally agreed that the training procedure were very helpful in improving operation skills for thoracic penetrating injury.Conclusions:Animal model-based simulation training established in the current study could improve the trainees’performance for emergent and urgent thoracic surgeries,especially of the surgical teams from basic-level hospitals.

Effects of scalp acupuncture intervention combined with rehabilitation training on the neurotrophy status and nerve injury in patients with convalescent period of cerebral hemorrhage

Objective: To investigate the effects of scalp acupuncture intervention combined with rehabilitation training on the neurotrophy status and nerve injury in patients with convalescent period of cerebral hemorrhage. Methods: A total of 78 patients with convalescent period of cerebral hemorrhage who were treated in West China Hospital between January 2016 and March 2017 were divided into the control group and the experimental group by random number table, each with 39 cases. Control group received the routine rehabilitation training, and the experimental group received scalp acupuncture intervention combined with rehabilitation training. The differences in neurotrophy status and nerve injury were compared between the two groups before and after intervention. Results: Before intervention, there was no statistically significant difference in neurotrophy status and nerve injury between the two groups. After 1 week of intervention and after 2 weeks of intervention, serum neurotrophy indexes NGF and BDNF contents of experimental group were higher than those of control group;serum nerve injury indexes GFAP, NSE and S100B contents were lower than those of control group;serum inflammatory mediators IL-18, HMGB1 and IFN-γ contents were lower than those of control group. Conclusion: scalp acupuncture intervention combined with rehabilitation training can effectively improve the neurotrophy state and reduce the nerve injury in patients with convalescent period of cerebral hemorrhage.

Physical Training and Cardioprotection

Experimental, clinical and epidemiologic studies have provided strong evidence that physical training has beneficial effects on cardiovascular health. Numerous investigations have demonstrated that exercise increases coronary blood flow and myocardial perfusion. Importantly, training also can stimulate angiogenesis and accelerate collateral vessel growth in animal models with coronary artery occlusion. Cardiac adaptation such as increased vascularity or capillary density has been evidenced after regular endurance exercises. More recently, several studies indicate that physical training induces high levels of myocardial heat shock protein and antioxidant protein expression, which may play an important role in myocardial protection against ischemia-reperfusion injury.