ObjectiveTo explore the risk factors of stroke-associated pneumonia in stroke inpatients at rehabilitation stage.MethodsA retrospective survey was conducted to collect the general clinical data of 271 patients with stroke who were hospitalized for the first time between January 2017 and December 2018. They were divided into two groups according to the presence or absence of pneumonia. The general clinical data of the two groups were observed and analyzed, including sex, age, length of stay, course of disease, Brunnstrom Stage, Barthel Index, scores of Kubota’s Water Drinking Test, indwelling gastric tube, cognitive impairment, aphasia, hypertension history, diabetes history, history of smoking and drinking, albumin content, and hemoglobin content. Statistically significant factors were screened out from single factor analysis, and then multivariate logistic regression analysis was conducted.ResultsThere were significant differences in age, length of stay, Barthel Index, Brunnstrom Stage (upper limb, hand and lower limb), scores of Kubota’s Water Drinking Test, indwelling gastric tube, albumin content, hemoglobin content, cognitive impairment, and aphasia between the two groups (P<0.05). Multivariate logistic regression analysis showed that indwelling gastric tube [odds ratio=52.463, 95% confidence interval (4.154, 662.658), P=0.002] was an independent risk factor for pneumonia.ConclusionsIndwelling gastric tube is an independent risk factor for pneumonia. In view of the risk factor, taking active and effective preventive measures can help prevent pneumonia.
ObjectiveTo observe the effect of Baduanjin on the motor function and balance function in patients within 6 months after stroke.Methods Between July 2018 and March 2019, a total of 40 stroke patients were randomly divided into the Baduanjin group and the control group. Twenty patients in the Baduanjin group received the treatment of Baduanjin training and conventional rehabilitation, while the other 20 patients in the control group were treated with conventional rehabilitation only. The duration of the treatment was 3 weeks; then the motor function, balance ability and the ability of daily life in the two groups were assessed by the Fugl-Meyer Assessment (FMA), the 6-minute Walking Test (6MWT), the Berg Balance Scale (BBS), the balance tester and the Barthel Index (BI) respectively before and after treatment.ResultsAfter the 3-week treatment, the motor function, balance ability and the ability of daily life assessed by FMA, 6MWT, BBS, the balance tester, and BI were improved significantly in both groups (P<0.05). The post-treatment scores of FMA, BI, BBS and 6MWT distance in the Baduanjin group were more than those in the control group [72.25±20.91 vs. 57.90±20.25, 89.75±12.08 vs. 77.75±15.68, 53.25±5.74 vs. 47.80±9.77, (251.03±79.43) vs. (186.92±100.09) m; P<0.05]. In the sit-to-stand balance test, compared with those in the control group, the total trajectory length of center of gravity, average swing speed of center of gravity, and unit area trajectory length of center of gravity in standing stance in the Baduanjin group reduced significantly [(235.86±76.08) vs. (303.60±123.01) cm, (11.67±3.37) vs. (15.76±7.05) cm/s, (2.53±0.99) vs. (3.40±1.28) cm/cm2; P<0.05], and the total trajectory length of center of gravity, average swing speed of center of gravity, and unit area trajectory length of center of gravity in sitting stance in the Baduanjin group also reduced significantly [(246.59±98.79) vs. (334.05±155.87) cm, (7.69±2.29) vs. (11.13±6.41) cm/s, (4.10±1.38) vs. (6.25±4.21) cm/cm2; P<0.05].ConclusionConventional rehabilitation with or without Baduanjin can improve the motor function, balance function and the ability of daily life in patients after stroke, but the effect of rehabilitation with Baduanjin is better than conventional rehabilitation.
ObjectiveTo evaluate the physical and chemical properties, immunogenicity, and osteogenesis of two antigen-extracted xenogeneic bone scaffolds—decalcified bone matrix (DBM) and calcined bone.MethodsBy removing the inorganic and organic components of adult pig femus, xenogeneic DBM and calcined bone were prepared respectively. The density and pH value of the two materials were measured and calculated, the material morphology and pore diameter were observed by scanning electron microscope, and the surface contact angle was measured by automatic contact angle measuring instrument. The safety, osteogenic activity, and immunogenicity of the two materials were evaluated by cytotoxicity test, osteoblast proliferation test, DNA residue test, and human peripheral blood lymphocyte proliferation test. The two materials were implanted into the 5 mm full-thickness skull defect of 6-week-old male Sprague Dawley rats (the blank control group was not implanted with materials). The materials were taken at 4 and 8 weeks after operation, the repair effect of the materials on the rat skull was observed and evaluated by gross observation, Micro-CT scanning, and HE staining observation.ResultsCompared with calcined bone, DBM has lower density and poor hydrophilicity; the pH value of the two materials was 5.5-6.1, and the pore diameter was 160-800 μm. The two materials were non-cytotoxic and could promote the proliferation of osteoblasts. The absorbance (A) values of osteoblast proliferation at 1, 4, and 7 days in the DBM group were significantly higher than those in the calcined bone group (P<0.05). The DNA residues of the two materials were much lower than 50 ng/mg dry weight, and neither of them could stimulate the proliferation and differentiation of human peripheral blood lymphocytes. The results of animal experiments in vivo showed that the bone volume/total volume (BV/TV) in DBM group and calcined bone group were significantly higher than that in blank control group at 4 weeks after operation (P<0.05), and that in calcined bone group was significantly higher than that in DBM group (P<0.05); at 8 weeks after operation, there was no significant difference in BV/TV between groups (P>0.05). HE staining showed that at 4 and 8 weeks after operation, the defect in the blank control group was filled with fibrous connective tissue, the defect was obvious, and no bone growth was found; the defect in DBM group and calcined bone group had been repaired to varying degrees, and a large number of new bone formation could be seen. The material degradability of DBM group was better than that of calcined bone group.ConclusionThe physical and chemical properties and degradability of the two kinds of xenogeneic bone scaffolds were slightly different, both of them have no immunogenicity and can promote the repair and reconstruction of skull defects in rats.
Objective To evaluate the reliability and validity of the three-dimensional motion capture analysis system COFT-Motion® in evaluating the active range of motion of upper limbs in healthy subjects, and provide objective basis for its clinical application. Methods From January to March 2022, healthy subjects were publicly recruited for enrollment. The evaluator applied the three-dimensional motion capture analysis system COFT-Motion® and angle ruler to evaluate the active range of motion of the shoulder joint (flexion, extension, adduction, abduction) and elbow joint (flexion, extension) in healthy subjects. Pearson correlation analysis was used to evaluate validity, and intraclass correlation coefficient (ICC) was used to evaluate reliability. Results There was a positive correlation between the measurements of COFT-Motion® and the angle ruler of the active range of motion of upper limbs in healthy subjects. The Pearson correlation coefficients for active range of motion of the shoulder joint (flexion, extension, adduction, abduction) and elbow joint (flexion, extension) were 0.913, 0.964, 0.961, 0.941, 0.864, and 0.919, respectively (P<0.05). The results of using COFT-Motion® by different evaluators to evaluate the active range of motion of healthy subjects’ shoulder joints (flexion, extension, adduction, abduction) and elbow joints (flexion, extension) showed that the ICC values were 0.892, 0.942, 0.961, 0.988, 0.989, and 0.928, respectively (P<0.05). The results of repeated evaluations by the same evaluator showed that the ICC values were 0.795, 0.916, 0.900, 0.868, 0.918, and 0.911, respectively (P<0.05). Conclusion The application of the three-dimensional motion capture analysis system COFT-Motion® in healthy subjects has good validity and reliability. However, due to the limited sample size and subject of the study, further promotion and application of the system still need to be further explored.
ObjectiveTo investigate the feasibility and effectiveness of motor imagery based brain computer interface with wrist passive movement in chronic stroke patients with wrist extension impairment.MethodsFifteen chronic stroke patients with a mean age of (47.60±14.66) years were recruited from March 2017 to June 2018. At baseline, motor imagery ability was assessed first. Then motor imagery based brain computer interface with wrist passive movement was given as an intervention. Both range of motion of paretic wrist and Barthel index was assessed before and after the intervention.ResultsAmong the 15 chronic stroke patients admitted in the study, 12 finished the whole therapy, and 3 failed to pass the initial assessment. After the therapy, the 12 participants who completed the whole sessions of the treatment and follow up had improved ability of control electroencephalogram, in whom 9 regained the ability to actively extend the affected wrist, and the other 3 failed to actively extend their wrist (the rate of active extending wrist was 75%). The activity of daily life of all the participants did not change significantly before and after intervention, and no discomfort was found after daily treatment.ConclusionIn chronic stroke patients with wrist extension impairment, motor imagery based brain computer interface with wrist passive movement training is feasible and effective.
ObjectiveTo explore the differences of rehabilitation clinical characteristics between youth stroke patients and middle and old age stroke patients, to provide references for secondary prevention and personalized rehabilitation treatment for youth stroke.MethodsFrom May 2016 to October 2019, stroke inpatient in the Department of Rehabilitation Medicine of Huashan Hospital of Fudan University were included. Patients were divided into youth group and middle and old age group according to their age. The clinical characteristics of the two groups during the rehabilitation period were analyzed.ResultsA total of 271 patients were included, including 70 in the youth group and 201 in the middle and old age group. The proportion of patients with hypertension (85.07% vs. 71.43%), diabetes (34.83% vs. 17.14%) and infection (20.90% vs. 8.57%) in the middle and old age group were higher than those in the youth group (P<0.05). The proportion of patients with hemorrhagic stroke (71.43% vs. 32.84%), history of stroke surgery (54.29% vs. 13.43%), epilepsy secondary to stroke (31.43% vs. 4.48%) and overweight/obesity (57.14% vs. 42.79%) in the youth group were higher than those in the middle and old age group (P<0.05). There was no significant difference in the proportion of gender, cognitive impairment, and thinness between the two groups (P>0.05). Among patients whose disease course was within 1 month at the time of admission, there was no significant difference in Brunnstrom stage of upper limbs-hands-lower limbs between the two groups (P>0.05). The scores of Berg Balance Scale (Z=−2.493, P=0.013) and Barthel Index (Z=−2.527, P=0.012) in the youth group were higher than those in the middle and old age group. Among patients whose disease course was between 1 month and 3 months at the time of admission, there was no significant difference in Brunnstrom stage of upper limbs-hands-lower limbs and Barthel Index between the two groups (P>0.05). The scores of Berg Balance Scale in the youth group were higher than those in the middle and old age group (Z=−2.004, P=0.045). Among patients whose disease course was more than 3 months at the time of admission, there was no significant difference in the scores of Berg Balance Scale, Barthel Index, and Brunnstrom stage of upper limbs-hands-lower limbs between the two groups (P>0.05).ConclusionsFor youth stroke patients, weight control is very important, and it is necessary to pay close attention to whether there are seizures. In the case of patients with stable vital signs in the early stage of the disease, more active rehabilitation treatment can be given.
ObjectiveTo investigate the correlation between the content of bone morphogenetic protein 2 (BMP-2) in demineralized bone matrix (DBM) and its osteogenic activity in vitro and in vivo, in order to choose a simple and convenient method to evaluate the osteogenic activity of DBM.MethodsThe left mid-femoral tissues of 9 donors were taken, and DBMs (S1-S9) were prepared by dynamic decalcification process, and inactivated DBM (control group) was prepared at the same time. Protease inhibitor method, collagenase method, guanidine hydrochloride/ethylene diamine tetraacetic acid (EDTA) method, and RIPA lysate method were used to extract BMP-2 in S1-S9 and inactivated DBMs. The BMP-2 content was measured and the differences between DBMs were compared. Then the S1-S9 and inactivated DBMs were co-cultured with mouse embryonic osteoblasts MC3T3-E1, respectively. The cell proliferation was detected by MTT method and fluorescence staining, and alkaline phosphatase (ALP) activity was detected at the same time. Thirty BALB/c male nude mice were divided into 10 groups, namely S1-S9 DBM groups (S1-S9 groups) and inactivated DBM group (control group), with 3 mice in each group. Muscle pockets of the middle thighs were prepared on both hindlimbs of mice in each group, and implanted corresponding DBM materials. At 4 weeks after operation, the samples were taken for HE staining observation and semi-quantitative evaluation, and the new bone formation score was calculated.ResultsThe BMP-2 content of DBM derived from different donor bones was distinct. The BMP-2 content obtained by different extraction methods for DBM prepared from the same donor bone was also different, and the extraction efficiency of the guanidine hydrochloride/EDTA method was the highest. In vitro cell experiments, MTT test displayed that cell proliferations and ALP activity were significantly higher in S4 and S6 groups than in other groups at each time point after co-cultivation (P<0.05). Moreover, the cell proliferation of S4 group was the most significant at 7 days (P<0.05); fluorescence staining demonstrated that the osteoblasts of each group was in good condition, but the osteoblasts of S1, S2, S3, S4, and S6 groups were significantly more than other groups. In vivo ectopic osteogenesis experiments, the cartilage and new bone formation could be seen in the bone graft area of S1-S6 groups at 4 weeks after operation, and with the increase of BMP-2 content, the more new bone formation induced by the material, the higher the score of new bone formation of the material (P<0.05). Among them, S4 and S6 groups contained a large number of chondrocytes and osteoblasts in the osteogenesis area.ConclusionThe osteogenic activity of DBM can be evaluated through BMP-2 quantitative detection combined with in vitro osteoblast proliferation and differentiation experiments.