BACKGROUND:Stimulation of the pudendal nerve as a target can improve neurogenic bladder dysfunction after spinal cord injury, by adjusting the frequency, intensity, pulse width, as wel as regulating synergistic effect of detrusor and urethral sphincter. OBJECTIVE: To assess the research status of electrical stimulation of the pudendal nerve in the treatment of neurogenic bladder dysfunction after spinal cord injury. METHODS: We searched the folowing databases for articles addressing electrical stimulation of the pudendal nerve for neurogenic bladder dysfunction after spinal cord injury: PubMed, Cochrane Central Register of Controled Trials (CENTRAL), China National Knowledge Infrastructure, Wanfang Database, and VIP Database. The search was updated to July 2014, and the reference lists of the identified studies were manualy screened for additional studies. The study selection and data extraction were independently conducted by two reviewers. RESULTS AND CONCLUSION:Fourteen studies were included in this review. We derived the folowing points by analyzing the included studies: Electrical stimulation of the pudendal nerve has positive effects on rehabilitation of neurogenic bladder dysfunction after spinal cord injury; pudendal nerve electrical stimulation can modulate the coordination of the detrusor and the external urethral sphincter, improve the bladder compliance and restore bladder function by regulating pudendal-to-bladder reflex and spinal reflexes to the bladder. Electrical stimulation of the pudendal nerve may be potentialy implemented as a feasible treatment of neurogenic bladder dysfunction after spinal cord injury. More high quality researches should be conducted to clarify the efficacy and the potential active mechanisms of pudendal nerve electrical stimulation for neurogenic bladder dysfunction after spinal cord injury because the number of clinical reports published in this study area is limited, neurophysiological mechanisms underlying biphasic regulation of frequency on bladder function are not wel known, and which intensity of pudendal nerve electrical stimulation is more effective than others for the treatment of neurogenic bladder dysfunction after spinal cord injury remains unknown.

Objective To evaluate the effectiveness of robot-assisted training on lower extremities of patients with stroke. Methods PubMed, Medline, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Knowledge, Ovid, China National Knowledge Infrastructure (CNKI), Wanfang Data and VIP Database for Chinese Technical Periodicals were searched for the randomized controlled trials (RCTs) about robot-assisted training for lower extremities of patients with stroke from the date of establishment to March 2013. The bibliographies of the retrieved studies were also searched. 2 independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library. The extracted data were analyzed by RevMan 5.1 software. Results A total of 12 trials were discovered.Compared with conventional training, the robot-assisted training increased the score of Fugl-Meyer assessment (lower extremity)(WED=3.97, 95%CI: 2.84~5.10, Z=6.89, P<0.00001) and Berg Balance Scale (WED=3.13, 95%CI: 0.80~5.45, Z=2.63, P=0.008). However,the results of stride frequency (WED=8.40, 95%CI: -0.95~17.75, Z=1.76, P=0.08) and speed (WED=0.03, 95%CI: -0.02~0.07, Z=1.18, P=0.24) were not statistically significant. According to the Jadad Score of included studies, 4 of them were of low quality and 8 of them were of high quality. Conclusion The current evidence shows that to some extent, robot-assisted training could improve the lower extremities function.

Objective To evaluate the effectiveness of mirror therapy in treating the upper limbs of patients with stroke.Methods The PUBMED,MEDLINE,EMbase,Cochrane Central Register of Controlled Trials (CENTRAL),ISI Web of Knowledge,OVID,CNKI,VIP and Wanfang Data databases were searched for reports of randomized controlled trials (RCTs) of mirror therapy in the treatment of the upper limbs of patients with stroke from the date of establishment of each database to April 2012.The bibliographies of the studies retrieved were also searched.Two independent researchers evaluated the included studies using the risk of bias provided by Cochrane Library.The extracted data were analyzed using RevMan 5.1 software and version 3.6 of the GRAED profiler.Results Reports of 9 trials were discovered.Meta-analysis showed that compared to the group that didn't have visual feedback,mirror therapy did not significantly increase Fugl-Meyer assessment (FMA) (Upper Limb) scores after 4 weeks of treatment compared with groups that did not have visual feedback.Mirror therapy also did not significantly increase average scores on the action research arm test (ARAT) after 6 weeks of treatment.Mirror therapy did,however,increase average Brunnstrom stage scores for the hand after 4 weeks of treatment and at a 6-month follow-up.Mirror therapy did not increase average scores on the modified Ashworth scale (MAS) after 4 weeks of treatment,but increased MAS scores were observed at a 6-month follow-up compared with a group which had no visual feedback.Mirror therapy increased functional independence measure (FIM) self-care scores after 4 weeks of treatment and at a 6-month follow-up,and it also increased modified Barthel index (MBI) scores after 4 weeks of treatment.In the GRADE system,the scores of Brunnstrom stages for the hand after 4 weeks of treatment were of moderate quality,but those scores and the MAS scores at the 6-month follow-up were of low quality.The FIM selfcare scores after 4 weeks and at the 6-month follow-up and the MBI scores measured after 4 weeks were of very low quality.Conclusion This evidence shows that mirror therapy can improve upper limb function and quality of daily life to some extent after stroke.However,because of the limitations of the previous studies such as poor quality,different end points,different rating scales and different courses of stroke,more high-quality,randomized,controlled trials with larger samples are needed to evaluate the effectiveness of mirror therapy in the rehabilitation of upper limb function after stroke.

Per2 gene plays one of the most critical roles of clock gene which modulates circadian rhythm both in the physiological, biochemical and behavioral processes of organisms. The distributions of per2 gene include suprachiasmatic nucleus of the hypothalamus, central nucleus of amygdala, bed nucleus of the stria terminalis, hippocampus and other components of limbic system; it affects the emotional and visceral activities through participating in the system of circadian rhythm. The central per2 gene regulates the hypothalamus-pituitaryadrenal axis through integration of light input, steroid hormones and other neurotransmitters integration, acting on the target organs, and presentes a circadian rhythm of movement. This article reviewed the morphology and biology of per2 gene, and its participation in limbic system regulating the circadian rhythm of motional and visceral activities.

Objective To evaluate the effect of virtual reality on motor function in patients with stroke. Methods PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals and Wanfang Data were searched for the randomized controlled trials (RCTs) of virtual reality on motor function in patients with stroke from the date of establishment to January 2013. The included studies were evaluated according to the method recommended by the Cochrane Collaboration. RevMan 5.0 software was used to analyze the extracted data. Results 20 trials were included (13 trials about the upper extremity function and 7 trials about the lower extremity function). Compared with conventional training, the virtual reality training significantly increased the score of Fugl-Meyer assessment (FMA) (WMD=4.27, 95%CI: 2.47~6.06, Z=4.67, P<0.00001) and Box and Block Test (BBT) (WMD=9.29, 95% CI: 5.24~13.34, Z=4.50, P<0.00001). However, the results of Berg balance scale (BBS) (WMD=1.63, 95% CI: -0.83~4.09, Z=1.30, P=0.20) and walking speed (WMD=0.01, 95%CI: -0.14~0.17, Z=0.18, P=0.86) were not statistically significance for the lower extremity function. According to the Jadad Score of included studies, 16 of them were of low quality and only 4 of them were of high quality. Conclusion The virtual reality training could improve the upper extremity function in patients with stroke, but not for the lower extremity function.

Objective:To analyze the clinical characteristics and outcomes of critically ill pregnant and parturient women in intensive care unit (ICU), and to provide clinical experience for the subspecialty construction of critical obstetrics.Methods:The clinical data of critically ill pregnant and parturient women admitted to the department of critical care medicine, the Second Affiliated Hospital of Kunming Medical University from January 2011 to December 2019 were collected. The main reasons for maternal transfer to ICU, the causes of maternal death, and organ support measures, etc. were summarized.Results:A total of 39 567 critically ill pregnant and parturient women were admitted to the department of obstetrics in our hospital, and 360 were transferred to ICU, with an average ICU transfer rate of 0.91%. Since 2016, the number of obstetric admissions, the number of ICU transfers and the ICU transfer rate had increased significantly. The average age of severe maternals admitted to ICU was (30.9±5.7) years old. The average acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score was 7 (4, 10). The average length of ICU stay was 1 (1, 2) day. The average ventilator duration was 9.0 (3.0, 17.5) hours. The main delivery mode of pregnant women in ICU was cesarean section (84.72%). Forty-eight patients (13.33%) underwent hysterectomy, of which 42 (87.5%) due to postpartum hemorrhage. The top 3 causes of ICU admission were severe postpartum hemorrhage [36.94% (133/360)], hypertensive disorders of pregnancy [21.67% (78/360)], pregnancy with cardiac disease [15.00% (54/360)]. The leading cause of postpartum hemorrhage in women transferred to ICU was placental abnormality [63.98% (103/161)], followed by uterine atony [28.57% (46/161)]. The average blood loss was (4 019±2 327) mL within 24 hours after delivery, and the number of women who underwent hysterectomy due to postpartum hemorrhage decreased year by year. During the study period, there were 2 maternal deaths, which were indirect obstetric deaths, 3 cases were discharged against-advice (expected death), including 1 indirect death and 2 direct obstetric death; the mortality in ICU was 1.39% (5/360).Conclusions:The most common reasons for pregnant and parturient women to be admitted to ICU were severe postpartum hemorrhage and hypertensive disorders of pregnancy. The leading cause of postpartum hemorrhage was placental problem. Indirect obstetric deaths exceeded direct obstetric deaths, mainly due to pregnancy complicated with cardiac disease and severe pneumonia. ICU has become an important battlefield for rescuing critically ill maternal and an important guarantee for reducing the maternal mortality.