Prevalence of retinal pathologies in people over 60 years:the Tehran Geriatrics Eye Study

AIM:To determine the prevalence of some retinal pathologies in people over 60y and their association with demographic and ocular factors.METHODS:A cross-sectional study was conducted in Tehran using multistage cluster sampling.After selecting subjects aged 60 and over,optometric,and ophthalmic examinations were done.For retinal examination,a 90 D lens was used and indirect ophthalmoscopy was performed after instilling tropicamide drops.Biometry was done using the IOL Master for all participants.RESULTS:Of 3791 people that were invited through cluster sampling,3310 participated in the study(response rate=82%).The prevalence of retinal pigmented epithelium(RPE)change,drusen,geographic atrophy(GA),hypertensive retinopathy(HTR),nonproliferative diabetic retinopathy(NPDR),proliferative diabetic retinopathy(PDR),choroidal neovascularization(CNV),central retinal artery occlusion(CRAO),myopic retinopathy(MR),branch retinal vein occlusion(BRVO),and central retinal vein occlusion(CRVO)was 27.42%,11.08%,4.52%,3.03%,4.05%,0.54%,0.82%,0.39%,0.20%,0.49%,and 0.19%,respectively.After removing the effect of age,the odds of NPDR were 1.68 times higher in women compared to men(P=0.014).After removing the effect of sex,the odds of drusen,RPE change,GA,CNV,BRVO,and CRVO increased with age.CONCLUSION:There is a higher prevalence of RPE change,drusen,GA,CNV and a lower prevalence of MR and CRAO in the elderly population of Tehran aged over 60y compared to global average values.Considering the correlation of most of the diseases with age and their effects on vision,attention should be paid to these diseases and the related screening programs to prevent vision impairment.

How completely are randomized controlled trials of non-pharmacological interventions following concussion reported? A systematic review

Purpose:The study aimed to examine the reporting completeness of randomized controlled trials(RCTs)of non-pharmacological interventions following concussion.Methods:We searched MEDLINE,Embase,PsycInfo,CINAHL,and Web of Science up to May 2022.Two reviewers independently screened studies and assessed reporting completeness using the Template for Intervention Description and Replication(TIDieR),Consensus on Exercise Reporting Template(CERT),and international Consensus on Therapeutic Exercise aNd Training(i-CONTENT)checklists.Additional information was sought my study authors where reporting was incomplete.Risk of bias(ROB)was assessed with the Cochrane ROB-2 Tool.RCTs examining non-pharmacological interventions following concussion.Results:We included 89 RCTs(n=53 high ROB)examining 11 different interventions for concussion:sub-symptom threshold aerobic exercise,cervicovestibular therapy,physical/cognitive rest,vision therapy,education,psychotherapy,hyperbaric oxygen therapy,transcranial magnetic stimulation,blue light therapy,osteopathic manipulation,and head/neck cooling.Median scores were:TIDieR 9/12(75%;interquartile range(IQR)=5;range:5-12),CERT 17/19(89%;IQR=2;range:10-19),and i-CONTENT 6/7(86%;IQR=1;range:5-7).Percentage of studies completely reporting all items was TIDieR 35%(31/89),CERT 24%(5/21),and i-CONTENT 10%(2/21).Studies were more completely reported after publication of TIDieR(t_(87)=2.08;p=0.04)and CERT(t_(19)=2.72;p=0.01).Reporting completeness was not strongly associated with journal impact factor(TIDieR:rs=0.27;p=0.01;CERT:r_(s)=-0.44;p=0.06;i-CONTENT:r_(s)=-0.17;p=0.48)or ROB(TIDieR:rs=0.11;p=0.31;CERT:rs=0.04;p=0.86;i-CONTENT:rs=0.12;p=0.60).Conclusion:RCTs of non-pharmacological interventions following concussion demonstrate moderate to good reporting completeness,but are often missing key components,particularly modifications,motivational strategies,and qualified supervisor.Reporting completeness improved after TIDieR and CERT publication,but publication in highly cited journals and low ROB do not guarantee reporting completeness.

Aphasia rehabilitation based on mirror neuron theory: a randomized-block-design study of neuropsychology and functional magnetic resonance imaging

When watching someone performs an action, mirror neurons are activated in a way that is very similar to the activation that occurs when actually performing that action. Previous single-sample case studies indicate that hand-action observation training may lead to activation and remodeling of mirror neuron systems, which include important language centers, and may improve language function in aphasia patients. In this randomized-block-design experiment, we recruited 24 aphasia patients from, Zhongda Hospital, Southeast University, China. The patients were divided into three groups where they underwent hand-action observation and repetition, dynamic-object observation and repetition, or conventional speech therapy. Training took place 5 days per week, 35 minutes per day, for 2 weeks. We assessed language function via picture naming tests for objects and actions and the Western Aphasia Battery. Among the participants, one patient, his wife and four healthy student volunteers underwent functional magnetic resonance imaging to analyze changes in brain activation during hand-action observation and dynamic-object observation. Results demonstrated that, compared with dynamic-object observation, hand-action observation led to greater performance with respect to the aphasia quotient and affiliated naming sub-tests and a greater Western Aphasia Battery test score. The overall effect was similar to that of conventional aphasia training, yet hand-action observation had advantages compared with conventional training in terms of vocabulary extraction and spontaneous speech. Thus, hand-action observation appears to more strongly activate the mirror neuron system compared with dynamic-object observation. The activated areas included Broca's area, Wernicke's area, and the supramarginal gyrus. These results suggest that hand-action observation combined with repetition might better improve language function in aphasia patients compared with dynamic-object observation combined with repetition. The therapeutic mechanism of this intervention may be associated with activation of additional mirror neuron systems, and may have implications for the possible repair and remodeling of damaged nerve networks. The study protocol was approved by the Ethical Committee of Nanjing Medical University, China(approval number: 2011-SRFA-086) on March 11, 2011. This trial has been registered in the ISRCTN Registry(ISRCTN84827527).

How long does the recovery of corneal sensitivity in different corneal regions take after LASEK?

AIM:To determine the corneal sensitivity recovery period after laser-assisted sub-epithelial keratectomy(LASEK)refractive surgery and investigate the effects of ablation depth on it.METHODS:In this study examinations were performed on 90 right eyes of 90 people(34 males and 56 females)with an age range of 20-35 and an average of 22.26±3.8 years old.A sensation of 5 corneal regions,including the center and 4 mid-peripheral regions,i.e.,nasal,inferior,temporal,and superior,each at a distance of 2 mm from the center of the cornea were measured with a Cochet-Bonnet esthesiometer device in 3-time points including before LASEK,1 and 3mo after the surgery,respectively.LASEK was performed on individuals with stabilized myopia of -1.00 to -7.00 diopters and astigmatism of less than 2.00 diopters.Furthermore,the individuals were divided into three groups regarding ablation depth.RESULTS:The highest level of corneal sensitivity before surgery was related to the center of the cornea(59.1±7.76),and the highest level of corneal sensitivity loss was also related to this region.The sensation of all measured corneal regions significantly reduced 1mo postoperatively and returned to their preoperative levels 3mo after surgery(mean of 5 corneal regions in levels of preoperation:58.2±6.48,1mo postoperation:57.3±5.84,3mo postoperation:58.2±5.49;P<0.05).A significant relationship was found between ablation depth and corneal sensitivity changes in the center and temporal regions(P<0.05).CONCLUSION:Corneal sensitivity in myopia and low astigmatism decreases after LASEK and reaches the preoperative level within 3mo.The depth of ablation during surgery affected the recovery of corneal sensitivity.

Comparison of anterior segment parameters of the eye between type 2 diabetic with and without diabetic retinopathy and non-diabetic

AIM:To compare anterior segment parameters between two groups of type 2 diabetic with and without diabetic retinopathy(DR)and non-diabetic elderly subjects based on hemoglobin A1c(Hb A1c)levels and status of DR.METHODS:This study was conducted on 997 residents aged 60y or over in Tehran,Iran.Diabetic group had Hb A1c level≥6.4%with no other systemic problems.The non-diabetic participants had normal eye findings and no systemic diseases.K1,K2,mean K,Q-value,anterior,central,posterior,and total corneal densitometric findings,anterior chamber volume(ACV),anterior chamber depth(ACD),corneal volume(CV),and pachymetry were measured by Pentacam AXL.RESULTS:A total of 678 non-diabetic(39%male)and 319 diabetic(35%male)subjects with mean age of 66.31±5.23 and 67.22±4.96y were examined,respectively.No statistically significant difference was found in anterior segment parameters between non-diabetic and diabetic groups(all P>0.05).However,middle,posterior,and total corneal densitometric values were statistically different between two groups af ter controlling the ef fects of confounders(P=0.014,0.007,and 0.042,respectively).Corneal densitometric values in all layers,ACD,and ACV were different between diabetic subjects with and without DR(all P<0.05).In the diabetic group,only corneal densitometric values had a negative relationship with fasting blood sugar(P<0.001).ACD and ACV had a negative correlation with Hb A1c levels(all P<0.05,r=-0.129 and-0.146,respectively).However,the relationships were not observed after controlling the confounders(P=0.938,0.466,respectively).CONCLUSION:Considering the higher densitometric values of the cornea and lower ACD and ACV in diabetic subjects with DR,it is suggested that the examiners should perform comprehensive retinal examinations when faced with such conditions.

Assessment of the effects of intrastromal injection of adipose-derived stem cells in keratoconus patients

·AIM: To evaluate the efficacy and safety of intrastromal transplantation of adipose-derived stem cells(ASCs) in keratoconus patients.·METHODS: This study was conducted on 8 eyes of 8 patients with moderate to severe keratoconus. In the patients, ophthalmic assessments including visual acuity, refraction, slit lamp examination, fundoscopy, corneal topography, and confocal microscopy were performed. Autologous stem cells were used. The isolated stem cells were injected into the corneal stroma by using femtosecond laser. Surgical procedure was similar to intracorneal ring implantation. All patients were re-assessed 1, 3, and 6mo after surgery.·RESULTS: The baseline mean visual acuity was 0.48±0.18 and improved to 0.66±0.17 after surger y and final acuity increased by 1.85±0.80 lines(P=0.001).The mean spherical refraction of patients improved 0.34 ± 0.35 D(P=0.039), and the mean cylindrical refraction of patients improved 0.84±0.23 D(P=0.016). The mean flat keratometry decreased 0.78±0.71 D(P=0.017), and the mean steep keratometry decreased 0.59±0.68 D(P=0.023). The mean central corneal thickness of patients improved of 6.29±4.47 μm(P=0.03). The mean keratocyte density at the anterior and middle stroma of cornea increased(P<0.05) but remained stable at the posterior stroma after 6mo. All patients had no complications and their corneas remained transparent. ·CONCLUSION: Intrastromal transplantation of ASCs has positive effects on vision and refractive parameters in most patients with keratoconus. After six months, visual acuity improved moderately, corneal parameters reduced slightly, and stromal keratocytes density increased. This modality is safe, and patients do not have any complications.

Receded near point of convergence as a predictor of mild cognitive impairment in the general geriatric population:results from a population-based study

AIM:To investigate the relationship between near point of convergence(NPC)and mild cognitive impairment(MCI)in the general elderly population.METHODS:The present report is a part of the Tehran Geriatric Eye Study(TGES):a population-based crosssectional study conducted on individuals 60 years of age and above living in Tehran,Iran using the multi-stage stratified random cluster sampling method.Cognitive status was assessed using the Persian version of the Mini-Mental State Examination(MMSE).All study participants underwent complete ocular examination including measurement of uncorrected and best-corrected visual acuity,objective and subjective refraction,cover testing,NPC measurement,and slit-lamp biomicroscopy.RESULTS:The data of 1190 individuals were analyzed for this report.The mean age of the participants analyzed was 66.82±5.42(60-92y)and 728(61.2%)of them were female.Patients with MCI had a significantly more receded NPC compared to subjects with normal cognitive status(10.89±3.58 vs 7.76±2.71 cm,P<0.001).In the multivariable logistic regression model and in the presence of confounding variables,a receded NPC was statistically significantly associated with an increased risk of MCI(odds ratio:1.334,95%confidence interval:1.263 to 1.410,P<0.001).According to receiver operating characteristic(ROC)analysis,a cut point NPC>8.5 cm(area under the curve:0.764,P<0.001)could predict the presence of MCI with a sensitivity and specificity of 70.9%and 69.5%,respectively.CONCLUSION:A receded NPC can be clinically proposed as a predictor of MCI in older adults.It is recommended that elderly with a receded NPC>8.50 cm undergo detailed cognitive screening for a definite diagnosis of MCI.In this case,the necessary interventions can be carried out to slow down MCI progression to dementia.

The prevalence of red-green color vision deficiency and its related factors in an elderly population above 60 years of age

AIM:To determine the prevalence of red-green(RG)color vision deficiency(CVD)in an elderly population and its related factors.METHODS:This report is a part of the Tehran Geriatric Eye Study:a cross-sectional population-based study that was conducted on the elderly population(≥60y)of Tehran,Iran using multi-stage stratified random cluster sampling.All study participants underwent complete ocular examination,including the measurement of uncorrected and bestcorrected visual acuity,objective and subjective refraction,and slit-lamp biomicroscopy.The color vision was tested using Ishihara plates with the near optical correction in place.RESULTS:Of the 3791 invitees,3310 participated in the study.The data of 2164 individuals were analyzed after applying the exclusion criteria.The prevalence of R-G CVD was 3.73%(95%CI:2.37%–5.09%)in the whole sample;the prevalence of protanomaly,protanopia,and deuteranopia was 1.51%,1.76%,and 0.45%,respectively.The prevalence of R-G CVD was significantly higher in males than in females.The prevalence of RG CVD increased with advancing age from 2.91%in the age group 60–64y to 5.8%in the age group≥80y(P=0.070).According to the multiple logistic regression model,male sex,and glaucoma were significantly related to RG CVD.Older age and hypertension also had a marginally significant relationship with RG CVD.CONCLUSION:Changes in color vision occur in the elderly due to the aging process and some physiological and pathological factors.Since the change in visual perception may affect the person’s performance,this aspect of the visual system’s function should also be taken into consideration in the examinations of the elderly.

E®ect of laser acupuncture combined with electrical stimulation on recovery from exercise fatigue in mice

In sports events,the rapid recovery after high-intensity training or sport competition performance is very important for athletes'performance and health.The aim of this study is to evaluate the effect of laser acupuncture and electrical stimulation on the recovery from exercise fatigue,using mice with swimming fatigue as experimental model and the electromyography(EMG)and the Raman spectroscopy of blood as evaluation indicators.Root mean square(RMS)and mean power frequency(MPF)of EMG were analyzed after laser acupuncture and electrical stimulation.The amplitude frequency combined analysis(JASA)showed that the proportion of muscles in the fatigue recovery area of the control group,the laser acupuncture group,the multi-channel laser acupuncture group and the laser combined with electrical stimulation group were 34.78%,39.13%,39.13%and 43.48%,respectively.Raman spectroscopy of the mice blood during fatigue recovery showed there is a significant difference between the multi-channel laser acupuncture group and the laser combined with electric stimulation group compared with the recovery period and fatigue period(P<0:05)at the peak of 997 cm^(-1) and the laser combined electrical stimulation group had a statistical difference in the recovery period compared with the fatigue period(P<0.05)at the peak of 1561 cm^(-1).The results showed that laser acupuncture combined with electrical stimulation was beneficial to fatigue recovery in mice,and had the potential value in sports fatigue recovery.

Modified constraint-induced movement therapy enhances cortical plasticity in a rat model of traumatic brain injury:a resting-state functional MRI study

Modified constraint-induced movement therapy(mCIMT)has shown beneficial effects on motor function improvement after brain injury,but the exact mechanism remains unclear.In this study,amplitude of low frequency fluctuation(ALFF)metrics measured by resting-state functional magnetic resonance imaging was obtained to investigate the efficacy and mechanism of mCIMT in a control co rtical impact(CCI)rat model simulating traumatic brain injury.At 3 days after control co rtical impact model establishment,we found that the mean ALFF(mALFF)signals were decreased in the left motor cortex,somatosensory co rtex,insula cortex and the right motor co rtex,and were increased in the right corpus callosum.After 3 weeks of an 8-hour daily mClMT treatment,the mALFF values were significantly increased in the bilateral hemispheres compared with those at 3 days postoperatively.The mALFF signal valu es of left corpus callosum,left somatosensory cortex,right medial prefro ntal cortex,right motor co rtex,left postero dorsal hippocampus,left motor cortex,right corpus callosum,and right somatosensory cortex were increased in the mCIMT group compared with the control cortical impact group.Finally,we identified brain regions with significantly decreased mALFF valu es at 3 days postoperatively.Pearson correlation coefficients with the right forelimb sliding score indicated that the improvement in motor function of the affected upper limb was associated with an increase in mALFF values in these brain regions.Our findings suggest that functional co rtical plasticity changes after brain injury,and that mCIMT is an effective method to improve affected upper limb motor function by promoting bilateral hemispheric co rtical remodeling.mALFF values correlate with behavio ral changes and can potentially be used as biomarkers to assess dynamic cortical plasticity after traumatic brain injury.

Transcranial pulse current stimulation improves the locomotor function in a rat model of stroke

Previous studies have shown that transcranial pulse current stimulation(tPCS) can increase cerebral neural plasticity and improve patients' locomotor function.However, the precise mechanisms underlying this effect remain unclear.In the present study, rat models of stroke established by occlusion of the right cerebral middle artery were subjected to tPCS, 20 minutes per day for 7 successive days.tPCS significantly reduced the Bederson score, increased the foot print area of the affected limbs, and reduced the standing time of affected limbs of rats with stroke compared with that before intervention.Immunofluorescence staining and western blot assay revealed that tPCS significantly increased the expression of microtubule-associated protein-2 and growth-associated protein-43 around the ischemic penumbra.This finding suggests that tPCS can improve the locomotor function of rats with stroke by regulating the expression of microtubule-associated protein-2 and growth-associated protein-43 around the ischemic penumbra.These findings may provide a new method for the clinical treatment of poststroke motor dysfunction and a theoretical basis for clinical application of tPCS.The study was approved by the Animal Use and Management Committee of Shanghai University of Traditional Chinese Medicine of China(approval No.PZSHUTCM190315003) on February 22, 2019.

The Current Status of Physical Therapy in China

The current health system in China has evolved by embracing both traditional Chinese medicine and Western medicine. China is the only country in the world where the number of doctors is larger than the number of nurses but education programmes for other health professions like physical therapy have been slow to develop. In the case of physical therapy it was not until China won the bid for the Olympic Games that permission to establish the first physical therapy programme was granted. Since then China has undergone a period of rapid economic growth enabling many people to have a higher standard of living and improved health, but at the same time the country is faced with massive urbanization, industrialization, increasing environmental health threats, increased health disparities and an aging population. With the support of the Chinese Association of Rehabilitation Medicine, an increased investment by the Government in public health and rehabilitation and engagement of international education experts, entry-level education programmes for physical therapy have started to develop and there are now nine which are modeled, at least to some extent, on the World Confederation for Physical Therapy's international guidelines. The paper explores the development of physical therapy education in China and discusses possible options for the way forward so that as the demand for physical therapy to service 1.4 billion people grows, the profession is prepared and the standards expected of the entrylevel physical therapist will not be compromised.

Prospects for intelligent rehabilitation techniques to treat motor dysfunction

More than half of stroke patients live with different levels of motor dysfunction after receiving routine rehabilitation treatments.Therefore,new rehabilitation technologies are urgently needed as auxiliary treatments for motor rehabilitation.Based on routine rehabilitation treatments,a new intelligent rehabilitation platform has been developed for accurate evaluation of function and rehabilitation training.The emerging intelligent rehabilitation techniques can promote the development of motor function rehabilitation in terms of informatization,standardization,and intelligence.Traditional assessment methods are mostly subjective,depending on the experience and expertise of clinicians,and lack standardization and precision.It is therefore difficult to track functional changes during the rehabilitation process.Emerging intelligent rehabilitation techniques provide objective and accurate functional assessment for stroke patients that can promote improvement of clinical guidance for treatment.Artificial intelligence and neural networks play a critical role in intelligent rehabilitation.Multiple novel techniques,such as braincomputer interfaces,virtual reality,neural circuit-magnetic stimulation,and robot-assisted therapy,have been widely used in the clinic.This review summarizes the emerging intelligent rehabilitation techniques for the evaluation and treatment of motor dysfunction caused by nervous system diseases.

Prospects for the application of transcranial magnetic stimulation in diabetic neuropathy

Encouraging results have been reported for the use of transcranial magnetic stimulationbased nerve stimulation in studies of the mechanisms of neurological regulation,nerve injury repair,and nerve localization.However,to date,there are only a few reviews on the use of transcranial magnetic stimulation for diabetic neuropathy.Patients with diabetic neuropathy vary in disease progression and show neuropathy in the early stage of the disease with mild symptoms,making it difficult to screen and identify.In the later stage of the disease,irreversible neurological damage occurs,resulting in treatment difficulties.In this review,we summarize the current state of diabetic neuropathy research and the prospects for the application of transcranial magnetic stimulation in diabetic neuropathy.We review significant studies on the beneficial effects of transcranial magnetic stimulation in diabetic neuropathy treatment,based on the outcomes of its use to treat neurodegeneration,pain,blood flow change,autonomic nervous disorders,vascular endothelial injury,and depression.Collectively,the studies suggest that transcranial magnetic stimulation can produce excitatory/inhibitory stimulation of the cerebral cortex or local areas,promote the remodeling of the nervous system,and that it has good application prospects for the localization of the injury,neuroprotection,and the promotion of nerve regeneration.Therefore,transcranial magnetic stimulation is useful for the screening and early treatment of diabetic neuropathy.transcranial magnetic stimulation can also alleviate pain symptoms by changing the cortical threshold and inhibiting the conduction of sensory information in the thalamo-spinal pathway,and therefore it has therapeutic potential for the treatment of pain and pain-related depressive symptoms in patients with diabetic neuropathy.Additionally,based on the effect of transcranial magnetic stimulation on local blood flow and its ability to change heart rate and urine protein content,transcranial magnetic stimulation has potential in the treatment of autonomic nerve dysfunction and vascular injury in diabetic neuropathy.Furthermore,oxidative stress and the inflammatory response are involved in the process of diabetic neuropathy,and transcranial magnetic stimulation can reduce oxidative damage.The pathological mechanisms of diabetic neuropathy should be further studied in combination with transcranial magnetic stimulation technology.

Surface-based map plasticity of brain regions related to sensory motor and pain information processing after osteonecrosis of the femoral head

Pain is one of the manifestations of hip disorder and has been proven to lead to the remodeling of somatotopic map plasticity in the cortex.However,most studies are volume-based which may lead to inaccurate anatomical positioning of functional data.The methods that work on the cortical surface may be more sensitive than those using the full brain volume and thus be more suitable for map plasticity study.In this prospective cross-sectional study performed in Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,China,20 patients with osteonecrosis of the femoral head(12 males and 8 females,aged 56.80±13.60 years)and 20 healthy controls(9 males and 11 females,aged 54.56±10.23 years)were included in this study.Data of resting-state functional magnetic resonance imaging were collected.The results revealed that compared with healthy controls,compared with the healthy controls,patients with osteonecrosis of the femoral head(ONFH)showed significantly increased surface-based regional homogeneity(Re Ho)in areas distributed mainly in the left dorsolateral prefrontal cortex,frontal eye field,right frontal eye field,and the premotor cortex and decreased surface-based Re Ho in the right primary motor cortex and primary sensory cortex.Regions showing significant differences in surfacebased Re Ho values between the healthy controls and patients with ONFH were defined as the regions of interests.Seed-based functional connectivity was performed to investigate interregional functional synchronization.When the areas with decreased surface-based Re Ho in the frontal eye field and right premotor cortex were used as the regions of interest,compared with the healthy controls,the patients with ONFH displayed increased functional connectivity in the right middle frontal cortex and right inferior parietal cortex and decreased functional connectivity in the right precentral cortex and right middle occipital cortex.Compared with healthy controls,patients with ONFH showed significantly decreased cortical thickness in the para-insular area,posterior insular area,anterior superior temporal area,frontal eye field and supplementary motor cortex and reduced volume of subcortical gray matter nuclei in the right nucleus accumbens.These findings suggest that hip disorder patients showed cortical plasticity changes,mainly in sensorimotor-and pain-related regions.This study was approved by the Medical Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine(approval No.2018-041)on August 1,2018.

Effects of paired associative magnetic stimulation between nerve root and cortex on motor function of lower limbs after spinal cord injury:study protocol for a randomized controlled trial

Classic paired associative stimulation can improve synaptic plasticity,as demonstrated by animal expe riments and human clinical trials in spinal cord injury patients.Paired associative magnetic stimulation(dual-target peripheral and central magnetic stimulation)has been shown to promote neurologic recove ry after stroke.However,it remains unclear whether paired associative magnetic stimulation can promote recovery of lower limb motor dysfunction after spinal cord injury.We hypothesize that the curre nt caused by central and peripheral magnetic stimulation will conve rge at the synapse,which will promote synapse function and improve the motor function of the relevant muscles.Therefore,this study aimed to examine the effects of paired associative magnetic stimulation on neural circuit activation by measuring changes in motor evoked and somatosensory evoked potentials,motor and sensory function of the lower limbs,functional health and activities of daily living,and depression in patients with spinal co rd injury.We will recruit 110 thora cic spinal trauma patients treated in the Department of Spinal Cord Injury,China Rehabilitation Hospital and randomly assign them to expe rimental and control groups in a 1:1 ratio.The trial group(n=55)will be treated with paired associative magnetic stimulation and conventional rehabilitation treatment.The control group(n=55)will be treated with sham stimulation and co nventional rehabilitation treatment.Outcomes will be measured at four time points:baseline and 4,12,and 24 wee ks after the start of inte rvention(active or sham paired associative magnetic stimulation).The primary outcome measure of this trial is change in lower limb American Spinal Injury Association Impairment Scale motor function score from baseline to last follow-up.Secondary outcome measures include changes in lower limb American Spinal Injury Association sensory function sco re,motor evoked potentials,sensory evoked potentials,modified Ashwo rth scale score,Maslach Burnout Invento ry score,and Hamilton Depression Scale score over time.Motor evoked potential latency reflects corticospinal tract transmission time,while amplitude reflects recruitment ability;both measures can help elucidate the mechanism underlying the effect of paired associative magnetic stimulation on synaptic efficiency.Adve rse events will be recorded.Findings from this trial will help to indicate whether paired associative magnetic stimulation(1)promotes recove ry of lower limb sensory and motor function,reduces spasticity,and improves quality of life;(2)promotes neurologic recovery by increasing excitability of spinal cord motor neurons and stimulating synaptic plasticity;and(3)improves rehabilitation outcome in patients with spinal cord injury.Recruitment for this trial began in April 2021 and is currently ongoing.It was approved by the Ethics Committee of Yangzhi Affiliated Rehabilitation Hospital of Tongji University,China(approval No.YZ2020-018)on May 18,2020.The study protocol was registered in the Chinese Clinical Trial Registry(registration number:ChiCTR2100044794)on March 27,2021(protocol version 1.0).This trial will be completed in April 2022.

Radiographic assessment of leg alignment and grading of knee osteoarthritis:A critical review

Knee osteoarthritis(OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint,ultimately causing pain,stiffness,deformity and disability in many people.Radiographs are commonly used for the clinical assessment of knee OA incidence and progression,and to assess for risk factors.One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities(LE).The hipknee-ankle(HKA) angle,assessed from a full-length LE radiograph,is ideally used to assess LE alignment.Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle.Since full-length LE radiographs are not always available,the femoral shaft-tibial shaft(FS-TS) angle may be calculated from a knee radiograph instead.However,the FS-TS angle is more variable than the HKA angle and it should be used with caution.Knee radiographs are used to assess the severity of knee OA and its progression.There are three types of ordinal grading scales for knee OA:global,composite and individual feature scales.Each grade on a global scale describes one or more features of knee OA.The entire description must be met for a specific grade to be assigned.The KellgrenLawrence scale is the most commonly-used global scale.Composite scales grade several features of knee OA individually and sum the grades to create a total score.One example is the compartmental grading scale for knee OA.Composite scales can respond to change in a variety of presentations of knee OA.Individual feature scales assess one or more OA features individually and do not calculate a total score.They are most often used to monitor change in one OA feature,commonly joint space narrowing.The most commonly-used individual feature scale is the OA Research Society International atlas.Each type of scale has its advantages;however,composite scales may offer greater content validity.Responsiveness to change is unknown for most scales and deserves further evaluation.

Efficacy of therapeutic ultrasound vs sham ultrasound on pain and physical function in people with knee osteoarthritis: A meta-analysis of randomized controlled trials

AIM: To determine the efficacy of therapeutic ultrasound vs sham for improving pain and physical function immediately post-intervention in people with knee osteoarthritis(OA). METHODS: We hand searched meta-analyses on the topic published in 2010 and updated the search in three electronic databases(MEDLINE, EMBASE, CINAHL) January 1, 2009 to September 5, 2013 to identify relevant studies. The inclusion criteria were human randomized controlled trials published in the English language in which active therapeutic ultrasound was compared tosham ultrasound, data for people with knee OA were reported separately, participants were blinded to treatment allocation and outcomes assessed before and after treatment included pain, self-reported physical function and performance-based physical function. Two reviewers independently screened titles and abstracts retrieved in the search to identify trials suitable for full text review. Data extraction and risk of bias assessment of the identified trials were completed independently by two reviewers. Pooled analyses were conducted using inverse-variance random effects models.RESULTS: We screened 1013 titles and abstracts. Meta-analysis of pain outcomes from 5 small trials(281 participants/OA knees) showed that, compared to sham ultrasound, therapeutic ultrasound improves pain [standardized mean difference(SMD)(95%CI) =-0.39(-0.70--0.08); P = 0.01] but not physical function [self-reported in 3 trials(130 participants/OA knees): SMD(95%CI) =-0.21(-0.55-0.14), P = 0.24; walking performance in 4 trials(130 participants/OA knees): SMD(95%CI) =-0.11(-0.59-0.37), P = 0.65). For the walking performance outcome, the dispersion of the estimated effects exceeded that expected due to sampling error(χ2 = 8.37, P = 0.04, I 2 = 64%). Subgroup analyses of three trials that administered high dose ultrasound improved the consistency(I2 = 28%) but the treatment effect remained insignificant.CONCLUSION: Meta-analyzed double-blind placebocontrolled randomized trials provide low-strength evidence that therapeutic ultrasound decreases knee OA pain and very low-strength evidence that it does not improve physical function.

Study on Current Trends in the Development of Traditional Chinese Medicine in Australia and Policy Proposals of Internationalization of Traditional Chinese Medicine Education in Future

With the rapid rise of China’s economy and the deployment of the Belt and Road Initiative,traditional Chinese medicine(TCM),one of the main components of Chinese culture,has become an important aspect of foreign exchange.Therefore,recent research has focused on how to effectively spread TCM culture internationally and improve TCM acceptance.Australia is currently a representative region with decent TCM development.Taking TCM development in Australia as a starting point,this article analyzes the challenges in TCM development,discusses countermeasures to address these issues,and provides recommendations for improving the international development and dissemination of TCM.

Compression of the bilateral corticospinal tracts by bilateral pontine hemorrhage A diffusion tensor tractography study

Bilateral spontaneous pontine hemorrhage is rare. In addition, bilateral corticospinal tract （CST） involvement in the pons may accompany serious motor sequelae. A 45-year-old right-handed woman was admitted for bilateral pontine hemorrhage. The patient presented with moderate quadriparesis at stroke onset and quickly recovered to the point of being able to extend the muscles of all four extremities against resistance, at 2 weeks from onset. At 4 weeks after stroke onset, she was able to perform all fine motor activities, as well as to walk with a normal gait. Diffusion tensor tractography results showed that the CSTs of both hemispheres originated from the primary sensorimotor cortex and descended through the corona radiata, the posterior limb of the internal capsule, midbrain, anterior pons, and the anterior medulla, along the known pathway of the CST. However, at midbrain and pons, the CSTs were compressed posterolaterally. The contralateral primary sensorimotor cortex, centered on the precentral knob, was activated during movement of either hand of the patient, as shown by functional MRI, which indicates the preservation of lateral CST. Findings from this study suggest that diffusion tensor tractography may be helpful in the elucidation of the CST status in patients with pontine hemorrhage.