Background: The bimodal balance-recovery model predicts that corticospinal tract (CST) integrity in the affected hemisphere influences the partterns of brain recovery after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been used to promote functional recovery of stroke patients by modulating motor cortical excitability and inducing reorganization of neural networks. This study aimed to explore how to optimize the efficiency of repetitive transcranial magnetic stimulation to promote upper limb functional recovery after stroke according to bimodal balance-recovery model. Methods: 60 patients who met the inclusion criteria were enrolled to high CST integrity group (n = 30) or low CST integrity group (n = 30), and further assigned randomly to receive high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS) or sham rTMS in addition to routine rehabilitation, with 10 patients in each group. Outcome measures included Fugl-Meyer scale for upper extremity (FMA-UE), Wolf Motor Function (WMFT) scale and Modified Barthel Index (MBI) scale which were evaluated at baseline and after 21 days of treatment. Results: For patients with high CST integrity, the LF group achieved higher FMA-UE, WMFT and MBI scores improvements after treatment when compared to the HF group and sham group. For patients with low CST integrity, after 21 days treatment, only the HF group showed significant improvements in FMA-UE and WMFT scores. For MBI assessment, the HF group revealed significantly better improvements than the LF group and sham group. Conclusions: For stroke patients with high CST integrity, low-frequency rTMS is superior to high-frequency rTMS in promoting upper limb motor function recovery. However, only high-frequency rTMS can improve upper limb motor function of stroke patients with low CST integrity.
Exercise is considered as an effective intervention in the management of patients with chronic low back pain (cLBP). However, the relative effectiveness as well as the hierarchy of exercise interventions have not been well established, although various exercise options are available. Therefore, the present protocol proposes to conduct a network meta-analysis (NMA) aiming to evaluate the effectiveness of different forms of exercise for treatment of cLBP.
Immunosuppressive drugs are routinely used to treat myasthenia gravis (MG). However, current recommendations provide limited evidence to support treatment options, leading to considerable variation in practice among healthcare specialists. Hence, we present a protocol for a systematic review and network meta-analysis (NMA) to update the evidence by comparing the efficacy and acceptability of oral immunosuppressive drugs for the treatment of MG.We will conduct a systematic review and NMA of all randomized controlled trials evaluating the following oral immunosuppressive drugs for the treatment of MG. Published studies will be searched using the following databases from inception to November 23, 2021: CENTRAL, the CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, and 3 Chinese databases (Chinese Biomedical Literatures Database, CNKI, and Wan Fang database). Assessment of study eligibility and data extraction will be conducted independently by 2 reviewers. The main outcome will be a quantitative MG scoring system. We will conduct Bayesian NMA to synthesize all evidence for each outcome and obtain a comprehensive ranking of all treatments. The quality of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations framework.The objective of this study was to assess the relative clinical efficacy and acceptability of first-line immunosuppressants for the treatment of MG, using a systematic review and NMA approach.In the absence of head-to-head trials comparing therapies, evidence from this NMA of available clinical trials will inform clinicians, patients, and families the risk-benefit profiles of different treatment options.
Purposes To evaluate the effects of low frequency whole-body vibration (WBV) on degeneration of articular cartilage and subchondral bone in mice with destabilization of the medial meniscus (DMM)induced osteoarthritis(OA) and mice with normal knee. Methods Ten-week-old C57BL/6J male mice received DMM on right knees, while the left knees performed sham operation. There were six groups: DMM, SHAM DMM, DMM+WBV,SHAM DMM+WBV, DMM+ NON-WBV and SHAM DMM+NON-WBV. After four weeks, the knees were harvested from the DMM and SHAM DMM group. The remaining groups were treated with WBV (10 Hz) or NON-WBV. Four weeks later, the knees were harvested. Genes, containing Aggrecan(Acan) and CollagenⅡ(Col2a1), Matrix Metalloproteinases 3 and 13(MMP3,13), TNFα and IL6, were measured and staining was also performed. OA was graded with OARSI scores, and tibial plateaubone volume to tissue volume ratio(BV/TV), bone surface area to bone volume ratio (BS/BV), trabecular number(Tb.N) and trabecular thickness separation(TS) between groups were analyzed. Results Increased OARSI scores and cartilage degradation were observed after WBV. BV/TV, Tb.N and TS were not significant between the groups. Significant reductions were observed in MMP3, MMP13, Col2a1, Acan, TNFα and IL6 in the DMM+WBV compared to SHAM DMM+WBV group. BV/TV, BS/BV, Tb.N, TS and OARSI scores were not significantly changed in the left knees. IL6 expression in the SHAM DMM+WBV group was significantly increased compared with the SHAM DMM+ NON-WBV group, while Col2a1, Acan and MMP13 expression decreased. Conclusion WBV accelerated cartilage degeneration and caused slight changes in subchondral bone in a DMM-induced OA model. WBV had no morphologic effect on normal joints.
Objective
To explore the effect of computer-aided cognitive training on cognitive function and auditory event-related potential P300 in patients with vascular cognitive impairment no dementia (VCIND).
Methods
Sixty VCIND patients were randomly divided into two groups namely a training group and a control group, each of 30. Both groups were given routine drug treatment and the traditional rehabilitation training. At the same time, the training group was additionally given 40min computer-aided cognitive training once a day, six times a week, lasing 4 weeks. Before and after four weeks of treatment, the cognitive function, the ability of daily life(ADL) and P300 of the two groups were assessed using mini-mental state examination(MMSE), the Montreal cognitive assessment (MoCA), Barthel Index (BI) and Motor evoked potential instrument respectively.
Results
Before treatment, no significant difference was found in the average MoCA, MMSE and BI scores of the two groups. After treatment, improvement was observed in the total MoCA scores (22.40±4.38), as well as the average score, of visual space and executive function (3.27±0.58), attention (4.30±1.60), language(2.67±0.48), delayed memory (3.67±0.80), MMSE (22.03±3.55) and BI (82.17±11.28) in the training group compared with the control group. Before treatment, there was no significant difference in the P300 latency and amplitude between the two groups. After treatment, however, the P300 latency of the training group decreased to (352.1±30.68)ms, significantly lower than the control group [(356.45±40.30)ms] and that before treatment. Meanwhile, the amplitude rose to(8.65±1.18)μV, significantly higher than the control group [(8.65±1.18)μV] and that before treatment.
Conclusion
Computer-aided cognitive training can effectively improve the cognitive function of patients with VCIND and promote their ADL.
Key words:
Computer-aided cognitive training; Vascular cognitive impairment no dementia; MoCA; Auditory event-relate potential, P300
Objective: To evaluate the efficacy and safety of short-wave therapy with sham or no intervention for the management of patients with knee osteoarthritis. Methods: We searched the following databases from their inception up to 26 October 2016: MEDLINE, CENTRAL, EMBASE, Physiotherapy Evidence Database, CINAHL and OpenGrey. Studies included randomized controlled trials compared with a sham or no intervention in patients with knee osteoarthritis. The results were calculated via standardized mean difference (SMD) and risk ratio for continuous variables outcomes as well as dichotomous variables, respectively. Heterogeneity was explored by the I 2 test and inverse-variance random effects analysis was applied to all studies. Results: Eight trials (542 patients) met the inclusion criteria. The effect of short-wave therapy on pain was found positive (SMD, −0.53; 95% CI, −0.84 to −0.21). The pain subgroup showed that patients received pulse modality achieved clinical improvement (SMD, –0.83; 95% CI, –1.14 to −0.52) and the pain scale in female patients decreased (SMD, −0.53; 95% CI, −0.98 to −0.08). In terms of extensor strength, short-wave therapy was superior to the control group ( p < 0.05, I 2 = 0%). There was no significant difference in the physical function (SMD, −0.16; 95% CI, −0.36 to 0.05). For adverse effects, there was no significant difference between the treatment and control group. Conclusion: Short-wave therapy is beneficial for relieving pain caused by knee osteoarthritis (the pulse modality seems superior to the continuous modality), and knee extensor muscle combining with isokinetic strength. Function is not improved.
AbstractObjective:To evaluate the application of a rehabilitation management protocol for urinary incontinence after robot-assisted laparoscopic prostatectomy (RALP). Methods:We conducted a retrospective cohort study of 114 patients who underwent RALP between August 2021 and November 2021 as the control group and a prospective analysis of 114 patients who underwent RALP between May 2022 and August 2022 as the experimental group.The rehabilitation management protocol focused on preoperative stage,postoperative care,day of catheter removal,1 month postoperative,3 months postoperative,6 months postoperative and 12 months or more postoperative. Results The 24h pad test was significantly lower in the experimental group compared with the control group at 2 and 6 months after RALP (both P<0.01). The scores of the international consultation on incontinence questionnaire-short form(ICIQ-SF) in the experimental group was significantly lower than the control group at 1 month after RALP (P<0.01).The scores of quality of life in the experimental group were significantly higher than the control group at 1, 2, and 6 months after RALP (all P<0.01).The scores of Broome Pelvic Muscle Self-efficacy Scale(BPMSES) was lower than the control group at 1,2,3 and 6 months after RALP(all P<0.01). Conclusion The application of the rehabilitation management protocol had significant beneficial effects on urinary functions and quality of life in patients with prostate cancer after RALP.
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