Objective:To explore the effects of action observation training based on mirror neuron system on motor function of upper extremities in stroke patients. Methods:From June, 2016 to June, 2017, 61 stroke patients were randomly assigned to control group (n = 30) and observation group (n = 31). They all accepted routine rehabilitation, and the observation group received action observation therapy in addition, for eight weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities, modified Ashworth Scale and modified Barthel Index before and after treatment. Results:All the indexes improved in both groups after treatment (|t| > 2.651, P < 0.05), and improved more in the observation group than in the control group (|t| > 2.048, P < 0.05). Conclusion:The action observation training may further improve the upper extremity motor function in stroke patients.

Objective:To investigate the effect of virtual reality balance training on knee proprioception after anterior cruciate ligament reconstruction (ACLR). Methods:From January, 2016 to December, 2018, 72 patients after ACLR were randomly divided into control group (n = 36) and observation group (n = 36). On the basis of routine rehabilitation, they received routine balance training and balance training with virtual reality, respectively, for eight weeks. Before and after training, the center of pressure (COP) time stability, the COP speed (COPS) of closed eyes, the COPS of one leg, the knee joint reaction time, the center of pressure area (COPA) and the active joint angle recurrence deviation were measured. Results:After training, the COP time stability, the COPS of closed eyes, the COPS of one leg, knee joint reaction time, COPA and active joint angle recurrence deviation improved in both groups (|t|>5.611, P < 0.001); and the COP time stability, the COPS of closed eyes, the COPS of one leg, the knee joint reaction time and active joint angle recurrence deviation were better in the observation group than in the control group (|t| > 3.232, P < 0.01), however, no significant difference was found in COPA between two groups (t = 1.054, P = 0.296). Conclusion:Virtual reality balance training can improve the proprioception of knee joint after ACLR, which is better than routine balance training.

OBJECTIVETo observe the effect of core strength training on knee joint function and postural stability after anterior cruciate ligament reconstruction (ACLR).

METHODSA total of 80 ACLR patients were randomly allocated into conventional rehabilitation training group and core strength training group from May 2013 to May 2015 with 40 patients in each group. The patients in conventional rehabilitation training group underwent conventional ACLR rehabilitation training, in which 28 males and 12 females. The mean age was(30.5±5.2) years old(ranged, 22 to 42 years old). The mean BMI was(23.8±2.4) kg/m²(ranged, 18.2 to 25.9 kg/m²). Thirty patients had injuries on the dominant side and 10 patients had injuries on the non-dominant side. The core strength training group received conventional ACLR rehabilitation training and core strength training, in which 31 males and 9 females. The mean age was(31.1±4.8) years old(ranged, 21 to 45 years old). The mean BMI was(24.1±2.7) kg/m²(ranged, 18.5 to 26.1 kg/m²) . Twenty-seven patients had injuries on the dominant side and 13 patients had injuries on the non-dominant side. The Lysholm score, tibial anterior transition measured by KT-1000 before and after treatment, and the Star Excursion Balance Test results after treatment were compared between the two groups.

RESULTSSix months after rehabilitation training, the tibial anterior transition of the conventional rehabilitation training group and the core strength training group were(3.4±1.0) mm and(3.3±1.2) mm respectively, which were less than(12.1±1.8) mm and(12.5±2.0) mm before treatment. But there was no significant difference in anterior tibial translation between two groups(>0.05). The Lysholm score of the conventional rehabilitation training group and the core strength training group were 91.8±4.3 and 92.1±3.9 individually, which were higher than 69.2±5.8 and 70.2±5.1 before treatment. But there was no significant difference in Lysholm score between two groups(>0.05). Six months after rehabilitation training, the results of Star Excursion Balance Test showed the reach distance with the support in the injured side and healthy side in the core strength training group were greater than that of the conventional rehabilitation training group in the eight directions(<0.05).

CONCLUSIONSThe core strength training could improve the dynamic balance of ACLR patients.

"Living the old age life with multimorbidity" has become the normal life of the elderly. How to realize the management of multimorbidity in the context of the combination of medical and health care is a hot topic of geriatrics, and also one of the important measures to cope with the national health strategy of "all-round and full-cycle protection of people's health" put forward in "Healthy China 2030". On the basis of literature search, this paper summarizes the research status and progress of the multimorbidity in elderly patients, so that it is expected to play a certain promoting role in the comorbidity management of chronic disease for the elderly in China.

Objective:To investigate the effectiveness and compliance of the 2 year specific immunotherapy in patients with allergic rhinitis. Method:Two hundred and sixty-two patients of allergic rhinitis were treated with SLIT for 2 years. The symptom questionnaire about effectiveness and compliance were obtained 2 years after SLIT. The patient satisfaction was also investigated. Result:Sixty patients had complete compliance and 202 patients had poor compliance. Of the 142 children, 40 (28%) cases had complete compliance, and of the 118 adult patients, 20 cases (17%) had complete compliance. There was obvious difference between the two (P<0.05). Comparing of before and after treatment, total medication score, total nasal symptom score and every symptom score decreased obviously (P<0.05). Two years after treatment, the total effective rate was 63%,there was significant difference between the children group and the adult group (P<0.05). Conclusion:There are a lot of factors affecting the treatment compliance of sublingual immunotherapy, such as patients, family, health care workers and social support, etc. In the course of treatment, a series of strategies can be adopted to improve the treatment compliance. SLIT is an effective method for the treatment of allergic rhinitis, and the treatment effect of children is better.

Objective To explore the effects of massive open online courses (MOOC) teaching in new entry nurses standardized training of respiratory medicine. Methods A total of 33 new entry nurses of respiratory medicine at a hospital were selected as control group from 2013 to 2014 with the routine training method. A total of 34 new entry nurses were chosen as intervention group from 2015 to 2017. Nurses of intervention group accepted standardized training with the MOOC teaching method by formulating systematic online and offline training course. The training effects of two groups were evaluated. Results The specialized theoretical achievements and skill achievements of nurses were (72.68±9.44) and (75.78±10.32) in intervention group, and (67.33±8.89) and (62.64±5.8) in control group with significant differences (P< 0.05). After intervention, the degree of satisfaction of patients in intervention group was higher than that in control group with a significant difference (χ2=10.823, P< 0.05). Conclusions MOOC teaching can effectively improve the level of specialized skill in new entry nurses, contribute to linking theory with practice, fast role switching and improve the occupational satisfaction.

OBJECTIVE: To explore the clinical effect of combined fixation and interbody bone grafting through intermuscular approach with different fusion cages in the treatment of single segment lumbar diseases. METHODS: From June 2014 to December 2016, the clinical data of 123 cases of single segment lumbar diseases were analyzed retrospectively, including 44 males and 79 females, aged 22 to 60 years old, with the diseases course of 6 to 84 months. The disease types involved lumbar disc degeneration in 65 cases, lumbar spinal stenosis in 30 cases, MeyerdingⅠslip in 21 cases, giant lumbar disc herniation in 7 cases. Lesions was L in 5 cases, L in 101 cases, LS in 17 cases. According to the application of different interbody fusion cage, patients were divided into single common cage group, double common cage group and banana type cage group. The operation time, intraoperative hemorrhage, postoperative incision drainage fluid and incision length were observed in three groups; VAS score of lumbar incision and JOA score of preoperative and final follow up were recorded 72 hours after operation;the intervertebral space height, Cobb angle of lumbar coronal and sagittal plane before and after operation, and interbody fusion 12 months after operation were observed by imaging data. RESULTS: There was no significant difference in incision length, operation time, intraoperative bleeding volume, postoperative drainage volume and VAS score of lumbar incision 72 hours after operation among three groups (>0.05). All cases were followed up for 12 to 36 (23.70±4.52) months. The height of intervertebral space in three groups recovered significantly (<0.05), at the last follow-up, there were different degrees of loss, the loss degree of single common fusion cage group>banana type fusion cage group>double common fusion cage group. At the last follow-up, the Cobb angle in the coronaland sagittal planes of the three groups were significantly improved (<0.05). During the follow-up, there were 42 cases of fusion cage subsidence, including 26 cases in the single common cage group, 5 cases in the double common cage group, 11 cases in the banana cage group, the difference was statistically significant (<0.05). At 12 months after operation, the interbody fusion rate was 83% in the single common cage group, 95% in the double common cage group and 90% in the banana cage group, the interbody fusion rate in the two common cage group and the banana cage group was better than that in the single common cage group. No obvious degeneration was observed in the adjacent segments. At the last follow-up, the JOA scores of the three groups were statistically significant (<0.05). The incidence of single common fusion cage group was 10%(4 / 42), that of double common fusion cage group was 9%(4 / 43), and that of banana fusion cage group was 10%(4 / 39). There was no significant difference among the three groups. CONCLUSION Through the intermuscular approach, single pedicle screw and contralateral facet screw were used for fixation, and single common fusion cage, double common fusion cage or banana type fusion cage were used for interbody grafting to treat single segment lumbar disease. Although the application of different fusion cage could not increase the axial strength of fixed segment, the speed of fusion was accelerated by increasing the contact area, and the quality of the fusion cage reduces the settlement of the cage and the loss of the height of the intervertebral space. Therefore, two interbody fusion cages implanted in one side are of positive clinical significance for the fixation of unilateral pedicle screw combined with contralateral facet screw, without prolonging the operation time and increasing the complications.
Adult ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Degeneration ; surgery ; Lumbar Vertebrae ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the clinical value and safety of unilateral pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion by muscle-splitting approach treatment of recurrent lumbar disc herniation. METHODS: The clinical data of 51 patients with recurrent lumbar disc herniation treated from June 2012 to December 2017 were retrospectively analyzed. There were 32 males and 19 females, aged 34 to 64 years with an average of (51.11± 7.28) years. Lesions invoved L RESULTS: There was no statistical difference in operation time between two groups ( CONCLUSION Muscle-splitting approach is feasible for thetreatment of recurrent lumbar disc herniation with pedicle screw fixation combined with contralateral translaminar facet screw fixation and interbody fusion. Compared with the median incision approach, the muscle-splitting approach has the advantages of small incision, less trauma, less bleeding, rapid recovery. Also it can protect multifidus and do not increase the incidence of serious complications. Thus, it can be used as a choice for fixation and fusion of recurrent lumbar disc herniation.
Adult ; Female ; Humans ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Muscles ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion ; Treatment Outcome

OBJECTIVE: To analyze the causes of vascular injury occurred in oblique lateral interbody fusion for treating lumbar degenerative diseases, and put forward preventive measures. METHODS: There were 235 patients analyzed from October 2014 to May 2017 in five hospitals, who were treated with oblique lateral interbody fusion with or without posterior pedicle screw fixation. There were 79 males and 156 females with an average age of (61.9±13.5) years old (ranged from 32 to 83 years). There were 7 cases of vascular injury, including 4 cases of segmental vessel injury, 1 case of left common iliac artery injury, 1 case of left common iliac veininjury and 1 case of ovarian vein injury. RESULTS: The follow up time ranged from 6 to 36 months, averagely (15.6±7.5) months. There was no pedicle screw loosen or fracture. The low back pain VAS decreased from preoperative 6.7±2.3 to 1.4±0.8 at the latest follow-up, which was statistically difference( CONCLUSION Oblique lateral interbody fusion technique provides a new method for minimally invasive fusion of lumbar internal fixation. However, it has a risk of vascular injury. In order to effectively prevent the occurrence of vascular injury, the operative indications and careful and meticulous operation should be strictly grasped.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lumbar Vertebrae/surgery* ; Lumbosacral Region ; Male ; Middle Aged ; Pedicle Screws ; Retrospective Studies ; Spinal Fusion/adverse effects* ; Treatment Outcome ; Vascular System Injuries/surgery*

OBJECTIVE: To explore the feasibility and clinical effect of Stand-alone oblique lateral interbody fusion (OLIF) in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis. METHODS: A retrospective analysis was performed on 16 cases with lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis admitted to three medical centers from January 2015 to December 2018. There were 6 males and 10 females, the age ranged from 45 to 67 years old with an average of (55.48±8.07) years old, the medical history ranged from 36 to 240 months with an average of (82.40±47.68) months. The lesion sites included L_2,3 in 2 cases, L_3,4 in 5 cases, and L_4,5 in 9 cases. All patients presented with chronic low back pain with lower limb neurological symptoms in 3 cases. All patients were treated by Stand-alone oblique lateral lumbar interbody fusion. Clinical and radiological findings and complications were observed. RESULTS: There was no vascular injury, endplate injury and vertebral fracture during the operation. The mean incision length, operation time, and intraoperative blood loss were(4.06±0.42) cm, (45.12±5.43) min, (33.40±7.29) ml, respectively. The mean visual analogue scale (VAS) of the incision pain was (1.14±0.47) at 72 hours after operation. There was no incision skin necrosis, poor incision healing or infection in patients. Sympathetic chain injury occurred in 1 case, anterolateral pain and numbness of the left thigh in 2 cases, and weakness of the left iliopsoas muscle in 1 case, all of which were transient injuries with a complication rate of 25%(4/16). All 16 patients were followed up from 12 to 36 months with an average of (20.80±5.46) months. The intervertebral space height was significantly recovered after operation, with slight lost during the follow-up. Coronal and sagittal balance of the lumbar spine showed good improvement at the final follow-up. There was no obvious subsidence or displacement of the cage, and the interbody fusion was obtained. At the final follow-up, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were significantly improved. CONCLUSION As long as the selection of case is strict enough and the preoperative examination is sufficients, the use of Stand-alone OLIF in the treatment of lumbar intervertebral disc degeneration with Modic changes and endplate sclerosis has a good results, with obvious clinical advantages and is a better surgical choice.
Male ; Female ; Humans ; Child, Preschool ; Intervertebral Disc Degeneration/surgery* ; Retrospective Studies ; Sclerosis ; Treatment Outcome ; Lumbar Vertebrae/surgery* ; Spinal Fusion/methods*