Objective To investigate relationships between cognitive domains and white matter changes in different regions in patients with cognitive deficits after traumatic brain injury (TBI). Methods Databases including PubMed, Embase, Web of Science and CENTRAL were searched for studies published before 5 August 2017. Correlation coefficients between cognition and white matter integrity, measured by diffusion metrics, including fractional anisotropy (FA), were pooled from 49 studies including 1405 patients. The influence of demographic factors was assessed by meta-regression analysis. Results Significant pooled FA–executive correlations (p<0.001) were found across various regions, including the corpus callosum (CC) (r=0.42, 95% CI 0.30 to 0.54), superior longitudinal fasciculus (r=0.50, 95% CI 0.41 to 0.59) and internal capsule (IC) (r=0.49, 95% CI 0.37 to 0.61). The fornix (r=0.62, 95% CI 0.45 to 0.78) and cingulum (r=0.57, 95% CI 0.34 to 0.81) particularly correlated with memory (p<0.001). The CC and IC also showed significant relationships with attention and processing speed (p<0.001). Demographic factors had no influence overall, except that studies with a greater proportion of males had stronger correlations between memory and white matter (p<0.05). Conclusions FA is the most sensitive metric for detecting post-TBI cognitive decline across various domains. Representative white matter regions, such as the CC and IC, perform better than whole-brain white matter for reflecting a wide range of cognitive domains, including memory, attention and executive functions. Moreover, the fornix and cingulum particularly reflect memory function. They yield insights into particular imaging indicators that have neuropsychological value.
Objective
To establish a WeChat online system supporting continued nursing care for patients receiving enteral bladder augmentation and to evaluate its effects on continued nursing care for patients with neurogenic bladder in spinal cord injury who received enteral bladder augmentation.
Methods
Totally 60 patients with low-compliant neurogenic bladder in spinal cord injury who received enteral bladder augmentation and were discharged from Zhejiang Provincial People's Hospital between March 2016 and March 2018 were selected by convenient sampling, and divided into the observation group (n=30) and the control group (n=30) according to the random number table. Patients in the control group received conventional nursing care after discharge, while patients in the observation group received nursing care after discharge via the WeChat online support system. The follow-up duration was 3 months. Bladder self-management compliance, urinary catheter-associated complications, bladder function, quality of life and negative emotions at discharge and 3 months after discharge were compared between the two groups.
Results
The score of bladder self-management compliance, anxiety score, depression score, and scores of physical function, role function, emotional function and social function in quality of life in the observation group were better than those in the control group 3 months after discharge (P<0.05) ; the rates of urinary tract infection and urethral injury of the observation group were 3.3% and 6.7%, while those of the control group were 26.7% and 33.3%, respectively; the incidence rate of urinary catheter-associated complications of the observation group was lower than that of the control group (P<0.05) ; and the parameters of bladder function such as bladder volume, bladder compliance, residual urine volume and maximum detrusor pressure of the observation group were better than those of the control group (P<0.05) .
Conclusions
The WeChat online support system can improve patients' bladder self-management compliance, reduce the urinary catheter-associated complications, enable the recovery of bladder function, ameliorate their negative emotions, and improve their quality of life.
Key words:
Spinal cord injury; Neurogenic bladder; WeChat; Bladder augmentation; Continued nursing care
Objective
To observe the influence of spinal cord injury (SCI) in hypothalamus AMP-activated protein kinase (AMPK) expression, and explore the mechanism of SCI-induced type 2 diabetes or insulin resistance.
Methods
Eighteen SD rats were randomly divided into model group, High Fat/High Sucrose/High Cholesterol Diet group and SCI group (n=6). The animals in the model group and High Fat/High Sucrose/High Cholesterol Diet group underwent a T10 laminectomy without weight-drop injury, and SCI models were induced by MASCIS Impactor method. Blood glucose and glucose tolerance tests were performed before experiment and 8 weeks after the experiment. At 8 weeks, the levels of serum inflammatory factors, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6, were observed by ELISA; Western blotting was used to detect the expression of phosphorylated (p)-AMPK in the hypothalamus.
Results
Blood glucose levels in the rats of High Fat/High Sucrose/High Cholesterol Diet group and SCI group were significantly higher than that in the model group (P<0.05). Blood glucose levels 15 and 60 min after SCI in rats of SCI group were significantly higher than those in the model group (P<0.05); Blood glucose levels 15, 30, 60 and 120 min after SCI in rats of High Fat/High Sucrose/High Cholesterol Diet group were significantly higher than those in the model group (P<0.05). As compared with those in the model group, the expression of p-AMPK in the hypothalamus were significantly decreased, and the TNF-α, IL-1β and IL-6 levels were statistically increased in rats of High Fat/High Sucrose/High Cholesterol Diet group and SCI group (P<0.05).
Conclusion
SCI could inhibit AMPK expression in the hypothalamus, activate inflammatory signaling pathway and enhance chronic systemic inflammation, and therefore, insulin resistance is induced.
Key words:
Spinal cord injury; Hypothalamus; AMP-activated protein kinase; Insulin resistance
Background Upper and lower limb impairment is common after stroke. Electromyographic biofeedback therapy is a non-invasive treatment, and its effectiveness in functional rehabilitation of the limb after stroke still remains uncertain. Objective The objective of this study was to evaluate whether electromyographic biofeedback can improve upper and lower limb dysfunction in stroke patients. Methods PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database (PEDro) were searched from inception to 1st May 2022. Inclusion criteria were randomized controlled clinical trials of electromyographic biofeedback therapy interventions reporting changes in upper and lower limb function in post-stroke patients. Data were extracted by two independent reviewers and pooled in random-effects models using Review manager (RevMan) software. Results Our analyses included 10 studies enrolling a total of 303 participants. Electromyographic biofeedback therapy can effectively improve limb function after stroke (standardized mean difference [SMD], 0.44; 95% confidence interval [CI], 0.12–0.77; P = 0.008) and in subgroup analyses, the effect sizes of short-term effect (SMD, 0.33; 95% CI, 0.02–0.64; P = 0.04) was significant, but the long-term was not (SMD, 0.61; 95% CI, -0.11–1.33; P = 0.10). In addition, Electromyographic biofeedback therapy can improve the active range of motion of shoulder (SMD, 1.49; 95% CI, 2.22; P<0.0001) and wrist joints (SMD, 0.77; 95% CI, 0.13–1.42; P = 0.02) after stroke. Conclusion In this meta-analysis, electromyographic biofeedback therapy intervention can improve upper and lower limb function in patients with stroke. Short-term (less than one month) improvement after electromyographic biofeedback therapy was supported, while evidence for long-term (more than one month) benefits was lacking. Range of motion in the glenohumeral and wrist joints were improved. Stronger evidence for individualized parameters, such as optimal treatment parameters and intervention period, is needed in the future. Systematic review registration [ https://www.crd.york.ac.uk/prospero/display_record.php?recordID=267596 ], identifier [ CRD42022354363 ].
Objective
To investigate the effect of Jin's 3-needling therapy on executive function and spatial learning and memory abilities and their mechanism in frontal lobe injury rats.
Methods
Thirty-two male Sprague-Dawley rats were randomly divided into sham-operated group, Jin's 3-needling group, model group and medoba treatment group (n=8). The rats in the sham-operated group only underwent craniotomy to remove the bone flap and no impact was performed on the frontal lobe; the frontal lobe injury models of model group, Jin's 3-needling group and medoba treatment group were established by eCCI-6.3 device; rats in the Jin's 3-needling group were treated with Jin's 3-needling therapy, and rats in the madopa treatment group were given 2 mL of madopa suspension by perfusion once daily. The behavior of rats in each group was evaluated by GO/NO GO task and Morris water maze test, and apoptosis of cells was detected by TUNEL, dopamine receptor D1 (DRD1) expression was determined by immunohistochemistry, and the content of dopamine in frontal tissues was analyzed by high performance liquid chromatography.
Results
The accuracy rate of GO/NO GO task in Jin's 3 needling group was significantly higher than that in madopa treatment group (P<0.05); and that in madopa treatment group was significantly higher than that in model group (P<0.05). On the 3rd and 4th d of place navigation test, the escape latency in the Jin's 3 needling group and madopa treatment group was significantly decreased as compared with that in the model group (P<0.05); the escape latency in the Jin's 3 needling group was significantly decreased as compared with that in the madopa treatment group (P< 0.05). In spatial probe test, the number of times of crossing the platform in the Jin's 3 needling group and madopa treatment group was significantly larger as compared with that in the model group (P<0.05). As compared with those in the model group, the number of apoptotic neurons in the frontal lobes was significantly larger, the content of dopamine in the frontal lobes and the DRD1 expression were significantly increased in the madopa treatment group and Jin's 3-needling group (P<0.05); the number of apoptotic neurons in the Jin's 3 needling group was significantly smaller as compared with that in the madopa treatment group (P<0.05); the content of dopamine in the frontal lobes and the DRD1 expression in the Jin's 3 needling group were significantly increased as compared with those in the madopa treatment group (P<0.05).
Conclusion
Jin's 3-needling therapy can effectively improve the executive function and spatial learning and memory abilities of frontal lobe damaged rats, and their mechanism may be related to decreased apoptosis of frontal tissue cells and increased dopamine content and increased DRD1 expression.
Key words:
Jin's 3-needling therapy; Frontal lobe damage; Executive function; Spatial learning and memory ability; Cell apoptosis; Dopamine; Dopamine receptor D1
Dementia is a major health burden worldwide. As numerous pharmacological trials for dementia have failed, emerging phototherapy studies have evaluated the efficacy of alternative therapies for cognition.
Background: Frozen shoulder is a common musculoskeletal disorder, characterised by pain and movement restriction. Non-surgical approaches are the mainstay therapy for frozen shoulder. Our aim was to compare the effect of different non-surgical interventions, and to identify potential moderating variables of treatment effect.Methods: The following databases were searched, from their inception to October 18, 2018: PubMed, EMBASE, Cochrane Library, and Web of Science. The search was supplemented by manual review of relevant reference lists. Randomised controlled trials (RCTs) of non-surgical interventions, with a clear comparison group and measured outcomes, were selected. All records were screened by two independent reviewers, and the quality of studies assessed. Study characteristics and outcome data were extracted for pairwise and network meta-analyses. Measured outcomes included pain, shoulder function in activities of daily living, and range of motion (ROM). The mean change in value from baseline was the primary outcome measure, with the pooled standardised mean difference (SMD), and its 95% credible interval (CrI), used to compare outcomes between two groups.Findings: Of 2953 records identified, 92 RCTs were eligible, evaluating 32 non-surgical interventions, in 5946 patients. Of these, intraarticular injection improved pain (steroid injection, SMD 1·68 [95% CrI, 1·03-2·34]; capsular distension, SMD 2·68 [1·32-4·05]), and shoulder function (steroid injection: SMD 2·16 [1·52-2·81]; distension: SMD 2·89 [1·71-4·06]) to a greater extent than either a placebo or conventional physical therapy. Subgroup analyses revealed steroid injection combined with conventional physical therapy yielding improvement during the painful freezing phase, with joint manipulation yielding more benefits in the adhesive phase. Disease stage, female sex, and diabetes were identified as moderating factors of treatment outcome.Interpretation: Intra-articular injection is the prevailing non-surgical treatment for frozen shoulder. Factors (disease stage, sex, and diabetes) should be considered for individualised optimal options.Funding Statement: This work was funded by the grants from National Natural Science Foundation of China (No.81902278), and Zhejiang Provincial Natural Science Foundation (No. LY15H170002)Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension statement, incorporating network meta-analyses. The study protocol has been submitted to PROSPERO (registration number CRD42018112971).
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