ObjectiveTo explore the effect of early individualized rehabilitation on patients with severe mechanical ventilation. MethodsA total of 36 patients on mechanical ventilation admitted to the ICU of the Second Affiliated Hospital of Anhui Medical University from March, 2019 to February, 2020 were randomly divided into control group (n = 18) and rehabilitation group (n = 18). All the patients completed a rehabilitation assessment within 24 hours of admission, including clinical assessment, state of consciousness and muscle strength assessment. The control group was treated with intensive care routine treatment, including symptomatic treatment of primary disease, nutritional support, placement of normal limbs, active and passive movement of limbs. The rehabilitation group received early individualized rehabilitation in addition., including active and passive limb movements, transfer training, physical factor therapy, and respiratory muscle training after the specific evaluation. The mechanical ventilation duration and ICU length of stay, the hospitalization cost, Richmond Agitation and Sedation Scale (RASS), acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ), and the content of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8 were compared. ResultsThere was no significant difference in the weaning rate and hospitalization cost between two groups (P > 0.05). The mechanical ventilation duration and ICU length of stay were less in the rehabilitation group than in the control group (t > 2.067, P < 0.05). After treatment, the score of APACHEⅡ and the content of TNF-α and IL-6 decreased in the control group (t > 2.040, P < 0.05); the score of APACHEⅡ and the content of TNF-α, IL-6 and IL-8 decreased in the rehabilitation group (t > 4.141, P < 0.001); the content of TNF-α, IL-6 and IL-8 was less in the rehabilitation group than in the control group (t > 2.217, P < 0.05). The improvement of all the indexes was better in the rehabilitation group than in the control group (|Z| > 2.104, P < 0.05). ConclusionFor patients on mechanical ventilation, early individualized rehabilitation could improve the sedation, relieve the inflammatory reaction, accelerate the process of weaning, and reduce the length of stay with no extra cost.

Objective:To investigate the influences of age-adjusted Charlson comorbidity index (ACCI) on prognosis of patients undergoing laparoscopic radical gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 242 gastric cancer patients who underwent laparoscopic radical gastrectomy in 19 hospitals of the Chinese Laparoscopic Gastrointestinal Surgery Study Group-04 study, including 54 patients in Fujian Medical University Union Hospital, 32 patients in the First Hospital of Putian City, 32 patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 31 patients in Zhangzhou Affiliated Hospital of Fujian Medical University, 17 patients in Nanfang Hospital of Southern Medical University, 11 patients in the First Affiliated Hospital with Nanjing Medical University, 8 patients in Qinghai University Affiliated Hospital, 8 patients in Meizhou People′s Hospital, 7 patients in Fujian Provincial Hospital, 6 patients in Zhongshan Hospital of Fudan University, 6 patients in Longyan First Hospital, 5 patients in the First Affiliated Hospital of Xinjiang Medical University, 5 patients in the First Hospital Affiliated to Army Medical University, 4 patients in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 4 patients in West China Hospital of Sichuan University, 4 patients in Beijing University Cancer Hospital, 3 patients in the First Affiliated Hospital of Xiamen University, 3 patients in Guangdong Provincial People′s Hospital, 2 patients in the First Affiliated Hospital of Xi′an Jiaotong University, from September 2016 to October 2017 were collected. There were 193 males and 49 females, aged 62(range, 23?74)years. Observation indicators: (1) age distribution, comorbidities and ACCI status of patients; (2) the grouping of ACCI and comparison of clinicopathological characteristics of patients in each group; (3) incidence of postoperative early complications and analysis of factors affecting postoperative early complications; (4) follow-up; (5) analysis of factors affecting the 3-year recurrence-free survival rate of patients. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative survival of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametric rank sum test. The X-Tile software (version 3.6.1) was used to analyze the best ACCI grouping threshold. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-Rank test was used for survival analysis. The Logistic regression model was used to analyze the factors affecting postoperative early complications. The COX proportional hazard model was used for univariate and multivariate analyses of factors affecting the 3-year recurrence-free survival rate of patients. Multivariate analysis used stepwise regression to include variables with P<0.05 in univariate analysis and variables clinically closely related to prognosis. Results:(1) Age distribution, comor-bidities and ACCI status of patients. Of the 242 patients, there were 28 cases with age <50 years, 68 cases with age of 50 to 59 years, 113 cases with age of 60 to 69 years, 33 cases with age of 70 to 79 years. There was 1 patient combined with mild liver disease, 1 patient combined with diabetes of end-organ damage, 2 patients combined with peripheral vascular diseases, 2 patients combined with peptic ulcer, 6 patients combined with congestive heart failure, 8 patients combined with chronic pulmonary diseases, 9 patients with diabetes without end-organ damage. The ACCI of 242 patients was 2 (range, 0-4). (2) The grouping of ACCI and comparison of clinicopathological characteristics of patients in each group. Results of X-Tile software analysis showed that ACCI=3 was the best grouping threshold. Of the 242 patients, 194 cases with ACCI <3 were set as the low ACCI group and 48 cases with ACCI ≥3 were set as the high ACCI group, respectively. Age, body mass index, cases with preoperative comorbidities, cases of American Society of Anesthesiologists classification as stage Ⅰ, stage Ⅱ, stage Ⅲ, tumor diameter, cases with tumor histological type as signet ring cell or poorly differentiated adenocarcinoma and cases with tumor type as moderately or well differentiated adenocarcinoma, cases with tumor pathological T staging as stage T1, stage T2, stage T3, stage T4, chemotherapy cycles were (58±9)years, (22.6±2.9)kg/m 2, 31, 106, 85, 3, (4.0±1.9)cm, 104, 90, 16, 29, 72, 77, 6(4,6) in the low ACCI group, versus (70±4) years, (21.7±2.7)kg/m 2, 23, 14, 33, 1, (5.4±3.1)cm, 36, 12, 3, 4, 13, 28, 4(2,5) in the high ACCI group, showing significant differences in the above indicators between the two groups ( t=-14.37, 1.98, χ2=22.64, Z=-3.11, t=-2.91, χ2=7.22, Z=-2.21, -3.61, P<0.05). (3) Incidence of postoperative early complications and analysis of factors affecting postoperative early complications. Of the 242 patients, 33 cases had postoperative early complications, including 20 cases with local complications and 16 cases with systemic complica-tions. Some patients had multiple complications at the same time. Of the 20 patients with local complications, 12 cases had abdominal infection, 7 cases had anastomotic leakage, 2 cases had incision infection, 2 cases had abdominal hemorrhage, 2 cases had anastomotic hemorrhage and 1 case had lymphatic leakage. Of the 16 patients with systemic complications, 11 cases had pulmonary infection, 2 cases had arrhythmias, 2 cases had sepsis, 1 case had liver failure, 1 case had renal failure, 1 case had pulmonary embolism, 1 case had deep vein thrombosis, 1 case had urinary infection and 1 case had urine retention. Of the 33 cases with postoperative early complications, there were 3 cases with grade Ⅰ complications, 22 cases with grade Ⅱ complications, 5 cases with grade Ⅲa complications, 2 cases with grade Ⅲb complications and 1 case with grade Ⅳ complica-tions of Clavien-Dindo classification. Cases with postoperative early complications, cases with local complications, cases with systemic complications were 22, 13, 9 in the low ACCI group, versus 11, 7, 7 in the high ACCI group, respectively. There were significant differences in cases with postoperative early complications and cases with systemic complications between the two groups ( χ2=4.38, 4.66, P<0.05), and there was no significant difference in cases with local complications between the two groups ( χ2=2.20, P>0.05). Results of Logistic regression analysis showed that ACCI was a related factor for postoperative early complications of gastric cancer patients undergoing laparoscopic radical gastrectomy [ odds ratio=2.32, 95% confidence interval ( CI) as 1.04-5.21, P<0.05]. (4) Follow-up. All the 242 patients were followed up for 36(range,1?46)months. During the follow-up, 53 patients died and 13 patients survived with tumor. The 3-year recurrence-free survival rate of the 242 patients was 73.5%. The follow-up time, cases died and cases survived with tumor during follow-up, the 3-year recurrence-free survival rate were 36(range, 2-46)months, 29, 10, 80.0% for the low ACCI group, versus 35(range, 1-42)months, 24, 3, 47.4% for the high ACCI group. There was a significant difference in the 3-year recurrence-free survival rate between the two groups ( χ2=30.49, P<0.05). (5) Analysis of factors affecting the 3-year recurrence-free survival rate of patients. Results of univariate analysis showed that preoperative comorbidities, ACCI, tumor diameter, histological type, vascular invasion, lymphatic invasion, neural invasion, tumor pathological TNM staging, postoperative early complications were related factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy [ hazard ratio ( HR)=2.52, 3.64, 2.62, 0.47, 2.87, 1.90, 1.86, 21.77, 1.97, 95% CI as 1.52-4.17, 2.22-5.95, 1.54-4.46, 0.27-0.80, 1.76-4.70, 1.15-3.12, 1.10-3.14, 3.01-157.52, 1.11-3.50, P<0.05]. Results of multivariate analysis showed that ACCI, tumor pathological TNM staging, adjuvant chemotherapy were indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy ( HR=3.65, 11.00, 40.66, 0.39, 95% CI as 2.21-6.02, 1.40-86.73, 5.41-305.69, 0.22-0.68, P<0.05). Conclusions:ACCI is a related factor for post-operative early complications of gastric cancer patients undergoing laparos-copic radical gastrectomy. ACCI, tumor pathological TNM staging, adjuvant chemotherapy are indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy.

Objective To demonstrate the changes in flexor digitorum and extensor digitorum tension in the affected hands with shear-wave elastography (SWE) before and after manual digitorum sensory stimulation (MDSS) in hemiplegic patients with stroke. Methods A total of 51 hemiplegic post-stroke inpatients in the Department of Rehabilitation Medicine in Second Hospital of Anhui Medical University from April to June, 2020, underwent MDSS completed by a researcher who used a bare thumb and index finger to squeeze each nail bed as well as the sides of each fingertip in the affected hand. The stimulation intensity was the minimum that could cause finger extension without obvious pain, and the interval between two stimulations was five to ten seconds. Muscular tension of the flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus and extensor digitorum were assessed with modified Ashworth Scale (MAS) and shear-wave velocity (SWV) of SWE on the affected side before and immediately after MDSS. MAS score was -1 as low muscular tension. Results The MAS scores of all the muscles significantly reduced after MDSS (|Z| > 2.843, P < 0.001); while the changes of SWV were not significantly in all the muscles with initially MAS score of 0 or -1 (t < 1.052, P > 0.05), and it reduced in those muscles with initial MAS scores of one to three (t > 2.672, P < 0.05). The SWV were positively correlated with the MAS scores both before and after MDSS (r > 0.334, P < 0.05). Conclusion MDSS can effectively, immediately, and safely relieves muscle spasms of the flexor digitorum and facilitate active finger extension in the affected hand for hemiplegic patients with stroke. SWE is useful for quantitatively and objectively evaluating muscular tension in the affected hand for hemiplegic patients with stroke.

Objective:To analyze retrospectively the risk factors for pulmonary infection after traumatic cervical spinal cord injury.Methods:The 154 patients with a cervical spinal cord injury studied included 120 with a pulmonary infection and 34 uninfected controls. Regressions were evaluated using data on their genders, ages, the cause of injury, affected segments, the neurological level of the injury (NLI), and the presence of a vertebral fracture or dislocation.Results:Age, complete injury, NLI at C 1 to C 4, and an injury-to-treatment time of more than 8 hours were found to be independent risk factors for secondary pulmonary infection. Conclusion:Elderly spinal cord injury patients, with a complete injury, an NLI between C 1 and C 4 or an injury-to-treatment time of more than 8 hours have a higher risk of pulmonary infection.

Objective: To observe the clinical utility of continuous passive movement (CPM) of the ankle joint in treating children with cerebral palsy and foot valgus. Methods: Thirty-six children with cerebral palsy and foot valgus were divided into a control group, a non-continuous passive exercise (NCPM) group and a CPM group with 12 children (24 feet) in each group. The NCPM and CPM groups were given conventional rehabilitation treatment for the first 20 days and then home rehabilitation for a further 10 days. The CPM group additionally received CPM treatment during the first 20 days. The control group was only given home rehabilitation for 30 days. Each subject′s plantar pressures were measured along with GMFM-88 scores for "standing" and "walking, running and jumping" before the treatment and 2 and 4 months later. Results: There was no significant difference in the average values of the output measures among the control group before and after the treatment. After four months, significantly better improvement was observed in the average percentages of medial forefoot (MMF) pressure among the NCPM group compared with the CPM group. There were also significant differences between the two groups in the [initial contact phase(ICP) + forefoot contact phase(FFCP)] and foot flat phase (FFP) percentages, as well as in the standing, running and jumping scores. Significant differences were also observed between the NCPM and CPM groups in terms of the average percentage of FFP pressure and their average standing scores, but not in the average percentage of MMF or the average jumping and running scores. Conclusions CPM usefully supplements conventional comprehensive rehabilitation therapy in improving the walking ability of children with cerebral palsy and talipes valgus.

Objective:To evaluate the effect of "simulated rehabilitation team" teaching model on the learning effect of clinical interns through retrospective analysis.Methods:A total of 124 rehabilitation undergraduate students were divided into control group ( n=58) and experimental group ( n=66) according to the order of practice. The control group received the traditional rehabilitation teaching mode. The experimental group adopted the "simulated rehabilitation team" teaching model, and the students were given theoretical and practical examinations 3 months before and after the end of the practice. Results:There was no significant difference in the theoretical test score between the experimental group and the control group ( P>0.05) three months before and after the practice, but there was significant difference in the practical test score between the experimental group and the control group ( P<0.05). After the practice, the scores of students in the experimental group were better than those in the control group ( P<0.05). Conclusion:Compared with the traditional rehabilitation teaching model, the "simulated rehabilitation team" teaching model can significantly improve the students' theoretical and practical achievements, and improve the students' mastery of theoretical knowledge and comprehensive practical ability.

Objective To observe the clinical effect of surface electrical stimulation on bladder spasm among patients with spinal cord injury,and compare it with that of therapy combining electrical stimulation with bladder function training.Methods Forty-two patients with bladder spasm after spinal cord injury were randomly divided into an experimental group (n=21) and a control group (n=21).Patients in the experimental group were further divided into three subgroups:patients with cervical spinal injury (n =7),thoracic spinal injury (n =9) and lumbar spinal injury (n =5).Both the experimental group and control group were given normal bladder function recovery exercise,while the experimental group was given the extra electrical stimulation on the surface of the sacral nerve.Urodynamic tests including the maximum detrusor pressure,bladder capacity,residual urine volume and bladder compliance were conducted for both groups before the treatment,after the first and the second 18-days of treatment and during a follow-up visit 2 months after the intervention.Results After the first course of treatment,significant differences were found in all measurements in the experimental group and most measurements of the control group except for the residual urine volume.Significant differences were found in all measurements after the second course of treatment compared to those after the first course in both groups.After the two courses of treatment and during the follow-up visit the average residual urine volume of the experiment group was significantly better than that of the control group.After the second course of treatment the average maximum detrusor pressure and bladder compliance of the experimental group were significantly better than those of the control group.Conclusion Surface electrical stimulation significantly improves the urodynamics and bladder function of patients with bladder spasm after spinal cord injury and its therapeutic effect is greater for patients with cervical and thoracic spinal injury than for those with lumber spinal injury.

Objective To observe the effect of sling exercise therapy combined with acupuncture at Jiaji acupoints on balance function of stroke patients with hemiplegia. Methods From October, 2013 to October, 2015, 40 hemiplegic stroke patients with balance dysfunction were randomized to control group and treatment group equally. Both groups accepted routine rehabilitation, while the treatment group com-bined with sling exercise therapy and acupuncture at Jiaji acupoints. They were assessed with Berg Balance Scale (BBS), 10-metre maxi-mum walking speed (10MWS), Fugl-Meyer Assessment of lower limbs (FMA-L) and modified Barthel Index (MBI) before and four weeks after treatment. Results The scores of BBS, FMA-L and MBI, and 10MWS improved in both groups (t>2.249, P<0.05), and improved more in the treatment group than in the control group (t>2.954, P<0.01). Conclusion Sling exercise therapy combined with acupuncture at Jiaji acupoints can further improve the function of balance, walking and activities of daily living in stroke patients with hemiplegia.

Objective To explore the effects of rehabilitation starting at different stages on the gross motor function of infants with high risk of cerebral palsy.Methods 214 neonates (117 boys and 97 girls) at least 14 days old and with a neonatal behavioral neurological assessment scale (NBNA) score of less than 35 were randomly divided into four groups.They received 2 to 3 weeks of rehabilitation in the hospital,followed by 4 to 6 weeks of family rehabilitation and then another 2 to 3 weeks of hospital rehabilitation.The three groups started this course of treatment at different times:beginning when the babies were not older than 3 months for group Ⅰ,3 to 6 months for group Ⅱ,6 to 12 months for group Ⅲ and 12 to 24 months for group Ⅳ.In each individual case the rehabilitation in hospital was replaced by family rehabilitation only when the baby's overall development was normal or almost normal.Another 63 infants with high risk of cerebral palsy composed group Ⅴ.They received only the family rehabilitation.The rehabilitation in hospital included taking neurotrophic drugs,receiving physical treatment,hand manipulation,kinesiotherapy,cognitive training,conductive education,and using orthoses.Family rehabilitation was implemented by the parents once or twice a day,for 35 to 45 minutes each time following detailed,individualized exercise plans made up jointly by the rehabilitation doctors and therapists.Moreover,a clinical checkup was required every 1 to 2 months.At 3,6,12 and 24 months old,all of the subjects' gross motor ability was quantified using the gross motor function measure (GMFM) scale.The hospital stays and the number of subjects diagnosed with cerebral palsy and motor retardation were recorded.Results At 3 months old,the average GMFM scores of the groups were 5.00± 1.89 for group Ⅰ,6.80± 1.55 for group Ⅱ,8.44±1.26 for group Ⅲ,11.10±1.72 for group Ⅳ and 12.70±1.64 for group Ⅴ,the controls.All of the intergroup differences were significant.At 6 months old the average GMFM scores of groups Ⅰ to Ⅳ were not significantly different,but all were significantly lower than the group Ⅳ average.At 12 months old the average GMFM scores of groups Ⅰ,Ⅱ and Ⅴ were significantly higher than the group Ⅲl and Ⅳ averages.At 24 months old the groups' average scores decreased consistently from Ⅰ to Ⅴ,with significant differences between one group and the next.Group Ⅲ had the longest hospital stays,followed by groups Ⅰ,Ⅱ and Ⅳ.Those inter-group differences were significant except for between groups Ⅰ and Ⅱ.The incidence of cerebral palsy in groups Ⅰ and Ⅱ (38.10％ and 29.79％) was significantly higher than in group Ⅲ (21.62％),Ⅳ (12.00％) or Ⅴ (3.17％).Moreover,the incidence of motor retardation in groups Ⅰ and Ⅱ (7.14％ and 10.64％) was also significantly lower than in group Ⅲ(56.76％),Ⅳ (68.00％) or Ⅴ (36.51％),but the differences between groups Ⅰ and Ⅱ and between groups Ⅲ and Ⅳ were not significant.The incidence of excellent gross motor performance ratings at 24mo decreased significantly from group Ⅰ to group Ⅴ,with all of the inter-group differences significant.Conclusion Early and formal rehabilitation is of great importance for infants with a high risk of cerebral palsy.The earlier formal rehabilitation starts,the better is its effect.

Objective To observe the treatment of continuous passive motion ( CPM) on lower motor function in pa-tients with stroke.Methods 60 patients were evenly randomized into control group and treatment group .The control group received conventional rehabilitation treatment , while the treatment group received conventional rehabilitation and CPM therapy .They were assessed with modified Ashworth scale ( MAS) ,Fugl-Meyer assessment ( FMA) ( lower limb,hip,knee and ankle) and 10-meter walking time.Results After treatment,the scores of MAS,FMA and 10-meter walking time were both improved when compared with those before treatment (P<0.05),and between the two groups ,the scores of MAS , FMA and 10-meter walking time were much better in the treatment group with signifi-cant difference ( P<0.05 ) .Conclusion CPM can alleviate muscle spasms ,and enhance the muscle group coordi-nation on foot .Furthermore,CPM can contribute to the balance and lower limb motor function , and strengthen gait of patients with stroke .