Efficacy of short-term multidisciplinary intensive rehabilitation in patients with different Parkinson's disease motor subtypes: a prospective pilot study with 3-month follow-up

Parkinson's disease(PD) can be classified into three motor-based subtypes: postural instability/gait difficulty(PIGD), tremor dominant(TD), and indeterminate.The neuropathophysiological mechanisms of the three motor subtypes are different, which may lead to different responses to therapy.Sixty-nine patients with idiopathic Parkinson's disease(Hoehn–Yahr stage ≤ 3) were screened from 436 patients with Parkinsonism recruited through outpatient services and the internet.According to the Movement Disorder Society Unified Parkinson's Disease Rating Scale(MDS-UPDRS) TD/PIGD ratio, the patients were divided into PIGD(TD/PIGD ≤ 0.09;n = 36), TD(TD/PIGD ≥1.15;n = 19), and indeterminate(TD/PIGD = 0.90–1.15;n = 14) groups.All patients received 2 weeks of multidisciplinary intensive rehabilitation treatment(MIRT) during hospitalization, as well as a remote home rehabilitation health education class.Compared with the scores at admission, all patients showed significant improvements in their MDS-UPDRS III score, walking ability, balance, and posture control at discharge.Moreover, the MDS-UPDRS III score improvement was greater in the PIGD group than in the TD group.The follow-up data, collected for 3 months after discharge, showed that overall symptom improvement in each group was maintained for 1–3 months.Furthermore, there were no significant differences in the duration or grade effects of symptom improvement among the three groups.These findings suggest that 2 weeks of MIRT is effective for improving motor performance in all three motor subtypes.Patients in the PIGD group had a better response after hospitalization than those in the TD group.This study was approved by the Institutional Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University of China(approval No.2018 bkky022) on May 7, 2018 and registered with the Chinese Clinical Trial Registry(registration No.Chi CTR1900020771) on January 19, 2019.

The effect of shoe type on gait in forefoot strike runners during a 50-km run

Purpose:To observe the relative change in foot-strike pattern,pressure characteristics,surface electromyography(sEMG) recordings,and stride characteristics in forefoot strike runners wearing both minimalist and traditional shoes during a 50-km run.Methods:Four experienced minimalist runners were enrolled in this study.Each runner ran a 50-km simulated run in both minimalist shoes and traditional shoes.Pressure data,sEMG recordings,and limited 3D motion capture data were collected during the initial 0.8 km and final 0.8 km for each trial.Results:Three runners in the traditional shoe type condition and one runner in the minimalist shoe type condition demonstrated a more posterior initial contact area(midfoot strike(MFS) pattern) after the 50-km run.which was supported by increased activity of the tibialis anterior in the pre-contaet phase(as per root mean square(RMS) values).In addition,in both pre- and post-run conditions,there were increased peak pressures in the minimalist shoe type,specifically in the medial forefoot.Muscle fatigue as defined by a decreased median frequency observed in isometric,constant force contractions did not correspond with our hypothesis in relation to the observed foot strike change pattern.Finally,step rate increased and step length decreased after the 50-km run in both shoe type conditions.Conclusion:More runners adopted a more posterior initial contact area after the 50-km run in the traditional shoe type than in the minimalist shoe type.The runners who adopted a more posterior initial contact area were more closely associated with an increased median frequency of the medial gastrocnemius,which suggests there may be a change in motor unit recruitment pattern during long-distance,sustained velocity running.The increased peak pressures observed in the medial forefoot in the minimalist shoe type may predispose to metatarsal stress fractures in the setting of improper training.

Phantom limb pain: A review of evidence-based treatment options

Phantom limb pain(PLP) is not uncommon after amputation. PLP is described as a painful sensation perceived in the missing limb. Despite of its complicated pathophysiology, high prevalence of PLP has been associated with poor health-related quality of life, low daily activity and short walking distances. A prompt and effective management of PLP is essential in caring for the amputee population. Current treatments including physical therapy, psychotherapy, medications, and interventions have been used with limited success. In this review,we provided an updated and evidence-based review of treatment options for PLP.

Neuronal quantity and ultrastructure in extracorticospinal tract of newborn rabbits with cerebral palsy

BACKGROUND:The liver enzyme system and blood brain barrier function of newborn rabbits are incomplete.High level of bilirubin can lead to cerebral palsy(CP)of newborn rabbits.The pathological and ultrastructural changes of brains of immature rabbits may differ from those of mature rabbits.OBJECTIVE:To observe the changes in dopaminergic neuron amount and ultrastructure in the extracorticospinal tract of animal models of CP induced by hyperbilirubinemia.DESIGN:A randomized controlled observation.SETTING:Rehabilitation Medical College of Jiamusi University;Laboratory for Pediatric Neurology Rehabilitation of Jiamusi University.MATERIALS:Thirty newborn 2-to 5-day inbred Japanese rabbits,weighing about 50 g,of either gender,were provided by Experimental Animal Center,Jilin University.Bilirubin and tyrosine hydroxylase(TH)antibody were purchased from Sigma Corporation,USA.METHODS:This experiment was carried out in the laboratory for children neuro-rehabilitation,Jiamusi University between September 2002 and December 2005.①Thirty rabbits were randomly divided into 2 groups:control group(n=10)and model group(n=20).②Bilirubin of 100 mg/kg was given to the rabbits of model group through intraperitoneal injection,once every other day,3 times totally;The same amount of normal saline was given to the rabbits of control group.After injection,the newborn rabbits had been fed by maternal milk for 45 days.③TH-positive neurons in substantia nigra and corpora striatum in each area of 0.15 mm×0.15 mm were counted.Ultrastructures of substantia nigra and corpora striatum were observed under the electron miscroscope.The concentration of bilirubin in brain tissue of CP rabbits of model group was measured with high performance liquid chromatogram.MAIN OUTCOME MEASURES:Quantitative analysis results and ultrastructure of TH-positive neurons in substantia nigra and corpora striatum in two groups.RESULTS:Thirty newborn rabbits were involved,6 rabbits from model group died and 4 were failed in modeling,finally,20 rabbits were involved in the result analysis.①The concentration of bilirubin in brain tissue of newborn rabbits of model group was(59.9±17.04)mg/L,which was significantly higher than that of control group[(42.79±3.57)mg/L,P<0.01].②TH positive neurons amount in the substantia nigra and corpora striatum of newborn rabbits in the model group was 30.30±9.58,4.70±2.79,which was significantly less than that in the control group respectively(45.20±12.74,11±2.45,P<0.01).③The concentration of bilirubin in brain tissue was significantly negatively correlated with TH-positive neurons in substantia nigra(r=-0.69,P<0.01);The concentration of bilirubin in brain tissue was also significantly negatively correlated with TH-positive neurons in corpora striatum(r=-0.59,P<0.01).TH-positive neurons in substantia nigra were positively correlated with those in corpora striatum(r=0.77,P<0.01).④Under the electron microscope,the nerve cells in substantia nigra and corpora striatum of newborn rabbits of model group were significantly changed in ultrastructure as compared with control group.CONCLUSION:Ultrastructure of extracorticospinal tract of newborn rabbits with CP is significantly changed,presenting the injury of dopaminergic neuron and decrease of neuronal amount.

Exposure to ephedrine attenuates Th1/Th2 imbalance underlying OVA-induced asthma through airway epithelial cell-derived exo-somal lnc-TRPM2-AS

Although various anti-inflammatory medications,such as ephedrine,are employed to manage cough-variant asthma,their underlying mechanisms are yet to be fully understood.Recent studies suggest that exosomes derived from airway epithelial cells(AECs)contain components like messenger RNAs(mRNAs),micro-RNAs(miRNAs),and long noncoding RNA(lncRNA),which play roles in the occurrence and progression of airway inflammation.This study investigates the influence of AEC-derived exosomes on the efficacy of ephedrine in treating cough-variant asthma.We established a mouse model of asthma and measured airway resist-ance and serum inflammatory cell levels.Real-time polymerase chain reaction(RT-qPCR),Western blotting,and enzyme-linked im-munosorbent assay(ELISA)analyses were used to assess gene and protein expression levels.Exosomes were isolated and character-ized.RNA immunoprecipitation(RIP)and RNA pull-down assays were conducted to examine the interaction between hnRNPA2B1 and lnc-TRPM2-AS1.In the ovalbumin(OVA)-challenged mouse model,ephedrine treatment reduced inflammatory responses,air-way resistance,and Th1/Th2 cell imbalance.Exosomes from OVA-treated AECs showed elevated levels of lnc-TRPM2-AS1,which were diminished following ephedrine treatment.The exosomal lnc-TRPM2-AS1 mediated the Th1/Th2 imbalance in CD4^(+)T cells,with its packaging into exosomes being facilitated by hnRNPA2B1.This study unveils a novel mechanism by which ephedrine ameli-orates OVA-induced CD4^(+)T cell imbalance by suppressing AEC-derived exosomal lnc-TRPM2-AS1.These findings could provide a theoretical framework for using ephedrine in asthma treatment.

Effectiveness of acupuncture versus spinal-epidural anesthesia on labor pain： a randomized controlled trial

OBJECTIVE: To evaluate the effectiveness of acupuncture analgesia(AA) compared with combined spinal-epidural anesthesia(CSEA) for labor pain relief and labor outcomes.METHODS: We evaluated 131 primiparous women who received respiratory guidance during maternal uterine contractions and received either AA(n =43), CSEA(n = 45), or no additional treatment(control, n = 43). The groups were compared regarding visual analog scale(VAS) scores for abdominal and back pain, and labor outcomes.RESULTS: The abdominal VAS scores of the AA and CSEA groups were significantly lower than that of the control group. In addition, the VAS scores of the CSEA group were significantly lower than that of the AA group at 10 and 60 min after intervention.The back pain VAS scores of the AA and CSEA groups were significantly lower than that of the control group at 5, 10, and 60 min after intervention. The duration of the active phase of labor in the CSEA group was significantly longer than that of the AA and control groups. The rates of oxytocin use(4.70%), urinary retention(4.70%), and postpartum hemorrhage [(273.7 ± 53.6) m L] in the AA group were significantly lower than in the CSEA group [46.70%, 24.20%, and(320.0 ± 85.6) m L, respectively].CONCLUSION: Both AA and CSEA were effective for labor pain relief, CSEA provided more effective pain relief, while AA was associated with a shorter duration of labor and fewer adverse effects.and each has its advantages and disadvantages.

An instrument for methodological quality assessment of single-subject finite element analysis used in computational orthopaedics

The methodological quality of subject-specific finite element analysis papers depends on the rigor of the study design and detailed description of key elements,while assessment instruments are often confined to clinical trials or quasi-experiments.This study aims to present an instrument for methodological quality assessment of singlesubject finite element analysis used in computational orthopaedics(MQSSFE).Based upon existing instruments and relevant review papers,a pilot version was developed consisting of 37 items with 6 domains,including study design and presentation of findings,subject recruitment,model reconstruction and configuration,boundary and loading conditions(simulation),model verification and validation,and model assumption and validity.We interviewed four experts in the field to assess the face validity and refined the instrument.The instrument was tested for interrater reliability among two assessors on nine finite element study papers.Also,the criterion validity was evaluated by comparing the similarity of the MQSSFE and the modified Down and Black instrument.The intraclass correlation coefficient was 0.965,while the MQSSFE was significantly moderately correlated with the modified Down and Black instruments(r=0.61).We believed that MQSSFE was adequately appropriate,reliable,and valid for assessing the methodological quality for finite element studies used in computational orthopaedics.The instrument could facilitate quality assessment in the systematic reviews of finite element models and checklists for fidelity.

针灸治疗原发性高血压的系统评价再评价

目的:对针灸治疗原发性高血压(EH)的系统评价或Meta分析进行再评价,提出合理建议以促进临床研究规范化.方法:采用计算机检索荷兰医学文摘数据库(EMBASE)、PubMed、中国知网(CNKI)、重庆维普数据库(CQVIP)、中国生物医学文献数据库(CBM)及万方学术期刊全文数据库(Wanfang),搜集针灸治疗EH的系统评价或Meta分析.时间从建库至2020年7月,按照纳入标准与排除标准,对文献进行筛选和数据提取.采用系统回顾和荟萃分析的首选报告项目(PRISMA)量表,系统评价方法学质量评价工具2(AMSTAR 2)量表,推荐分级的评价、制定与评估(GRADE)量表对文献进行质量与证据等级评估.结果:共纳入14篇文献,含10篇中文文献和4篇英文文献,为2012年至2019年期间发表,涵盖70个结局指标.方法学质量均为极低,文献报告质量相对完全或存在一定缺陷,证据质量等级均为低级或极低级.结论:目前针灸治疗EH的系统评价和Meta分析的方法学质量和结局指标证据等级都较低,报告质量也有待进一步提高.