Objective To study the effect of modified sensorimotor training (SMT) method on standing ba- lance of the stroke patients during their recovery stage. Methods Sixty stroke patients at recovery stage were ran- domly divided into an intervention group and a control group. The intervention group was trained by modified SMT method which combined Thera-band with partial body weight support (PBWS) system, while the control group was trained only with their standing balance in the parallel bars based on the neurodevelopment therapy (NDT) method. Both groups were given the same medications as well as physical therapy, acupuncture and OT. The patients in the two groups practiced standing balance in front of a mirror daily, 40 minutes every day and 6 days every week for 4 weeks. The balance abilities of patients were evaluated by Berg balance scale (BBS) , and their lower extremity func- tions were assessed by simplification Fugl-Meyer assessment (FMA). Results After training, both groups showed significant improvement in BBS and FMA ( P

Objective To study the effect of balloon dilatation therapy on dysphagia caused by cricopharyn- geal achalasia.Methods Ten cases of dysphagia were diagnosed as cricopharyngeal achalasia by videofluoroscopic swallowing study(VFSS).A 14~* urethral catheter was inserted into the esophagus and an amount of water was injec- ted into the balloon of the urethral catheter to make it turgid.Then the catheter was pulled upwards and passed through the stricture of esophagus to dilatate the cricopbarygeus muscle.Meanwhile,low frequency electrical stimula- tion was used and combined with functional training of the organs related to deglutition and ingestion.The results be- fore and after the treatment were evaluated.Results After 19.7 times of dilatation therapy,the content of water in- jected into the balloon was increased from 2.65?0.91 ml to 8.20?0.92 ml.Cricopharyngeal achalasia was alle- viated significantly(P

Objective To study the incidence and risk factors of infection caused by methicillinresistant staphylococcus aureus (MRSA) with a targeted surveillance at intensive care unit (ICU) acquired MRSA infection in Tianjin area.Methods A prospective multi-center observational analysis of consecutive patients admitted to 15 adult ICUs from March 1,2012 through March 31,2014 was carried out.The ICUs were divided into four groups according to the type of the ICU.All of the patients were cared for with routine MRSA surveillance.A number of risk markers and prognostic factors were recorded.The risk factors contributing to ICU acquired MRSA were evaluated using a logistic regression model.Comparison of survival between groups was analyzed with Kaplan-Meier method.Results A total of 1 787 patients were enrolled,and 144 cases of them were MRSA infections.The patients with MRSA infection were significantly older than those with non-MRSA infection (P =0.043),length of ICU stay,length of antimicrobial therapy,the history of repeated administration of antibiotics in recent days,history of operation in the past five years,history of MRSA infection or colonization,frequent application of and the overall length of time for mechanical ventilation and central venous catheter and catheter-associated infection were significantly higher than those with non-MRSA infection.The survival rate of patients with non-MRSA infection were higher than those with MRSA infection (x2 =9.23,P =0.004).The rate of MRSA infection and MRSA colonization in 2013 were significantly lower than that in 2012,because the rate of hand hygiene rule execution and bacterial clearance rate were significantly higher in 2013.Multivariate Logistic regression analysis demonstrated that advanced age (OR =1.05,95％ CI:1.009-1.086),length of ICU stay (OR =1.05,95％ CI:1.01-1.08),history of MRSA infection or colonization (OR =1.33,95％ CI:1.82 -3.27),glucocorticoid therapy (OR =2.85,95％ CI:1.18-6.91),antacid medicine (OR =4.92,95％ CI:1.18-20.58),history of recent or repeated application of antibiotics (OR =3.26,95％ CI:1.06-4.59) catheter-associated infections (OR =2.22,95％ CI:1.08-4.59) were associated with ICU acquired MRSA infections.Conclusions Performing the rule of hand hygiene strictly as well as strengthening prevention and control of MRSA infections can effectively reduce the incidence of ICU acquired MRSA infections.The advanced age,length of ICU stay,history of MRSA infection or colonization,glucocorticoid therapy,antacids medicine,history of recent or repeated application of antibiotics,catheterassociated infections were independent risk factors of ICU acquired MRSA infections.

Objective To evaluate the effect of errorless learning on memory processes.Methods Eight- y-four participants were randomly divided into three groups:a group which received computer-assisted memory train- ing (CAMG,n=30) ,a therapist-administered memory training group (TAMG,n=24) and a control group (CG,n =30).A 20-session training course with a Chinese cultural background was tailor-made for Chinese subjects with memory disorders.It was administered over the course of one month to the test groups with a similar course structure and content but different delivery modes.The control group had no training.The Rivermead Behavioral Memory Test- Chinese Version (RBMT-CV) and the Hong Kong List Learning Test (HKLLT) were used to assess memory ability and process at the start and end of the training,and one month later.A repeated measures analysis of variance was used to compare differences across the three groups.Results Comparing pre-training with post-training and follow- up,RBMT-CV and HKLLT scores improved significantly.The CAMG group demonstrated better progress encoding and storage on the HKLLT (including the random and blocked conditions) than the TAMG group.Conclusions Errorless learning is likely to be an effective technique for improving memory function in patients with traumatic brain injury.Its effects last for at least one month.Computer-administered training was more effective than therapist-admin- istered face to face training,especially in improving encoding and storage memory processes.

Objective To investigate the effect of local injection of Botulinum toxin type A(BTXA) on spasticity and function of the affected upper limb in stroke patients.Methods A total of 32 stroke patients were re- cruited and randomly divided into two groups:a BTXA group and a control group.All the patients had spasticity of upper limb muscles,which scored grade 2 to 3 with the Modified Ashworth Scale(MAS) ,and decreased elbow joint range of motion.The 16 patients in the BTXA group received BTXA injection in the biceps brachii muscles and flexor muscles of forearm on 10～15 points,while those in the control group did not.All the patients in both groups were treated with rehabilitation training techniques.The MAS,Fugl-Meyer upper limb function assessment and Barthel In- dex were employed to evaluate the changes of muscle tone,upper limb function and activity of living (ADL)perform- ance of the patients before injection and at 1st,2nd,6th 12th weeks after injection.Results The therapeutic effect between the BTXA group anti control group was significantly different in terms of biceps muscle tone,the scores of Fugl-Meyer upper limb function assessment and Barthel Index.Compared with preinjection,muscle tone was de- creased significantly and ADL performance was improved after injection in BTXA group.The effects of BTXA lasted more than 12 weeks.Conclusion Intramuscular muhipoint injection of BTXA was useful in reducing muscle spas- ticity,and was helpful for increasing motor ability of the affected upper limb and ADL performance of the stroke pa- tients.

Objective To examine how stroke affects muscle coordination and whether muscle function will be improved after rehabilitation.Methods Ten stroke patients with mild hemiparesis and six age-and sex-matched controls were investigated at baseline.Velocity-encoded phase-contrast magnetic resonance imaging (VE-PC MRI) and surface eleetromyography (sEMG) were performed to evaluate muscle coordination of thigh muscles during knee extension and flexion and the effect of rehabilitation. Results Using VE-PC MRI,we found that the peak velocity of rectus femoris was lower in the affected limb (P

OBJECTIVETo investigate the value of measuring the concentration of soluble CD44 splice variant 6 (sCD44v6) in peripheral blood in patients with invasive and non-invasive pituitary adenomas.

METHODSThe concentrations of sCD44v6 in peripheral blood were measured with ELISA in 68 patients with invasive pituitary adenomas and 100 patients with non-invasive pituitary adenomas.

RESULTSThe serum concentration of sCD44v6 in patients with invasive pituitary adenomas was lower than that in patients with non-invasive pituitary adenomas, while the latter was lower than that in healthy controls. The serum concentrations of sCD44v6 were (44.63 +/- 7.21), (34.53 +/- 6.41), and (26.34 +/- 4.95) ng/ml in patients with invasive microadenoma, macroadenoma, and giant adenoma, and (60.78 +/- 9.61), (57.78 +/- 10.00), and (37.22 +/- 5.17) ng/ml in patients with non-invasive microadenoma, macroadenoma, and giant adenoma, lower than that in the healthy control group (68.73 +/- 6.00) ng/ml. Significant differences were observed among groups (P < 0.005). The concentration of sCD44v6 in peripheral blood decreased as the tumor size increased (P < 0.01), which was particularly significant in invasive pituitary adenomas. The positive rate in the patients with invasive pituitary adenomas reached 89.71%.

CONCLUSIONSerum concentration of sCD44v6 in the peripheral blood is inversely correlated with tumor size and its invasive growth, which may provide certain value in the early diagnosis, treatment and prognosis of invasive pituitary macroadenoma and giant adenoma.

Adenoma ; blood ; diagnosis ; pathology ; Adult ; Biomarkers, Tumor ; Female ; Glycoproteins ; blood ; Humans ; Hyaluronan Receptors ; blood ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pituitary Neoplasms ; blood ; diagnosis ; pathology ; Prognosis

OBJECTIVESTo summarize the experiences in clinical application of neuronavigation in transsphenoidal microsurgery of specific pituitary adenomas, and to discuss its indications.

METHODSFrom January 2006 to December 2010, 138 cases of transsphenoidal microsurgery for specific pituitary adenomas under neuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery includes: recurrent or regrowth of residual pituitary adenomas after former transsphenoidal surgery in 36 cases, invasive pituitary adenomas in 45 cases, extremely laterally or deeply situated microadenomas in 45 cases, poor pneumatization of the sphenoid in 4 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, narrow space between bilateral internal carotid arteries in 4 cases, distortion of nasal septum in 1 case.

RESULTSIn the recurrence group, 12 were totally removed, 9 subtotally removed; postoperative complications included hematoma within the tumor cavity in 2 cases, cerebrospinal fluid (CSF) leakage in 4 cases among which 3 developed intracranial infection and 2 communicating hydrocephalus, oculomotor paralysis in 1 case and hypopituitarism in 3 cases; 9 were cured and 8 remission. In the invasive group, 5 were totally removed, 27 subtotally removed; postoperative complications included hematoma within the tumor cavity in 1 case, CSF leakage and intracranial infection in 1 case; 2 were cured and 22 remission. None of the 30 invasive hormone-secreting adenomas were cured or remission. The 45 cases of hormone-secreting microadenomas were all totally removed, among which 38 were cured. Among the poor sphenoid pneumatization group, total and subtotal tumor removal were achieved in 2 cases respectively with only one cured. In the skull base anomaly group, 2 were totally removed and 1 subtotally removed, with only one cured. For the cases with narrow space between bilateral internal carotid arteries and distortion of nasal septum, all were totally removed and cured.

CONCLUSIONSTranssphenoidal microsurgery under neuronavigation can be applied for pituitary adenomas in above specific indications. It is an accurate, safe and effective approach for specific pituitary adenomas, which can not only expand the indication of transsphenoidal microsurgery for pituitary adenomas, but also reduce the harmful exposure of X-rays for the operating staff.

Adenoma ; surgery ; Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Neuronavigation ; Pituitary Neoplasms ; surgery ; Retrospective Studies ; Sphenoid Sinus ; surgery ; Young Adult

Objective:To investigate the effects of a one-way tracheostomy speaking valve based on neuromuscular electrical stimulation on aspiration in patients with dysphagia after tracheotomy for cerebral hemorrhage. Methods:From January to December, 2018, 37 patients with dysphagia after tracheotomy for cerebral hemorrhage were randomly divided into control group (n = 21) and experimental group (n = 16). Both groups accepted neuromuscular electrical stimulation, while the experimental group was trained to use one-way tracheostomy speaking valve additionally, for three weeks. They were assessed with Functional Oral Food Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) before and after treatment. Results:The scores of FOIS and PAS improved in both groups after treatment (|Z| > 3.544, P < 0.001), and was better in the experimental group than in the control group (|Z| > 2.094, P < 0.05). Conclusion:One-way tracheostomy speaking valve training based on neuromuscular electrical stimulation could improve swallowing and reduce aspiration of patients with dysphagia after tracheotomy.