Objective To investigate the risk factors of stroke in nine hospitals of six cities of Shandong,and compare the differenc-es between residents of peninsula and inland areas. Methods Stroke patients in nine hospitals belonging to the Rehabilitation Medicine Alliance of Qilu Hospital of Shan-dong Universityfrom December,2022 to October,2023 were selected as the case group.The control group con-sisted of individuals undergoing health check-ups at the same hospitals during the same period.The sample size of both groups was equal,matched by age and gender,and demographic information and medical history were collected,and the risk factors of stroke were analyzed. Results A total of 438 cases were included.Residence in the inland(OR=2.07,95%CI 1.26 to 3.40,P=0.04),smoking(P=0.007),alcohol consumption(OR=6.67,95%CI 1.16 to 38.37,P=0.019),depression(OR=2.16,95%CI 1.03 to 4.53,P=0.042)and hypertension(OR=4.15,95%CI 2.34 to 7.39,P<0.001)were possible risk factors of stroke.However,smoking(OR=3.35,95%CI 1.11 to 10.10,P=0.013)and hypertension(OR=2.79,95%CI 1.12 to 6.95,P=0.004)were possible risk factors for the prevalence of stroke among residents in peninsula ar-eas,and obesity(excess waist circumference)(OR=1.08,95%CI 1.03 to 1.13,P=0.001),depression(OR=4.27,95%CI 1.38 to 13.23,P=0.013)and hypertension(OR=4.8,95%CI 2.21 to 10.43;P<0.001)were possi-ble risk factors for the prevalence of stroke among residents in the inland areas. Conclusion Hypertension is the most likely risk factor for stroke in nine hospitals of six cities of Shandong Province.Additionally,living inland,smoking and alcohol consumption may also increase the risk of stroke.There are dif-ferences in possible risk factors for stroke between peninsula and inland residents,and targeted stroke prevention and control measures should be implemented for different regions.

Brain rehabilitation is a comprehensive rehabilitation method for motor, sensory, cognitive, speech, swallowing and other functional disorders caused by brain diseases(such as stroke, Parkinson's disease, craniocerebral trauma, etc.). Timely and effective brain rehabilitation intervention can effectively improve motor, speech, cognitive and other abilities of elderly patients with cerebrovascular disease, thus improving their ability for daily living activities, improving the quality of life, reducing the burden for their families and society, and achieving the long-term goal of returning to society.In this paper, recent research progress in brain rehabilitation is summarized in order to explore more diversified rehabilitation modes for brain rehabilitation in the elderly.

Objective:To investigate the use of intravenous infusion in the rehabilitation of stroke survivors so as to further standardize and reduce the rate of use.Methods:Stroke survivors hospitalized in rehabilitation departments in Shandong Province in the first 5 months of 2021 were the study′s subjects. Data on the use of intravenous infusion were compiled including the medicine administered, the reason for the infusion, as well as the duration and the number of days of infusion. The rehabilitative effect, stroke complications and hospitalization costs were recorded, as well as the attitude toward the use of infusion and any measures taken to reduce their use.Results:The utilization rate of intravenous infusion was 31.72%. The drugs infused were mainly to improve circulation and feed the nerves. Short-term infusion had no adverse effects on functional recovery, but long-term infusion had negative effects and led to complications. The average daily cost of stroke survivors receiving intravenous infusion was significantly lower than that of patients not receiving it, and the proportion of their drug expenditure in the total cost was also significantly higher. There was no significant difference in the average length of hospital stay between patients receiving and not receiving infusion.Conclusions:Intravenous infusion predicts greater drug use, and long-term infusion has a bad effect on rehabilitation and recovery. Various measures should be taken to reduce the utilization of intravenous infusion and standardize its application.

Objective:To analyze and compare rehabilitation research funded by China′s National Natural Science Foundation (NSFC) with that funded by America′s National Institutes of Health (NIH) so as to provide references for future funding.Methods:Articles reporting rehabilitation research funded by the NSFC and the NIH were retrieved from the NSFC′s Science Output Service website and the NIH′s Project Report website and analyzed.Results:From 2009 to 2018 the NSFC funded 421 rehabilitation studies which resulted in a published report while the NIH funded 312. In 2018, the NSFC budget (US$3.89 million) was 8.46 times that of 2009 (US$460, 000), while the NIH′s grant budget (US$36.08 million) was 2.17 times that of 2009 (US$16.62 million). The number of published papers resulting from the Chinese and American studies was 1111 and 2571 respectively. Their impact factors mainly ranged between 0 and 3 points. Among the journals with an impact factor of 6 or more, published papers from the United States (297) were much more numerous than those from China (18). The number of SCI papers per million US dollars increased by 2.25 times in China and 0.05 times in the US.Conclusions:Both China and the United States have been investing more in rehabilitation medicine research, and that has resulted in more published papers. There is still a gap in funding and output between the two countries.

Objective To observe the 24-week survival status of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE) and double plasma molecular adsorption system (DPMAS) alone or in combination, and to establish a predictive model for 24-week prognosis. Methods Related clinical data were collected from 133 patients with HBV-ACLF who received PE and DPMAS alone or in combination in The Affiliated Provincial Hospital of Anhui Medical University from January 2015 to December 2019, and according to the survival status at the 24-week follow-up after treatment, they were divided into survival group with 71 patients and death group with 62 patients. A total of 55 patients with HBV-ACLF who received PE and DPMAS alone or in combination in The Second Affiliated Hospital of Anhui Medical University from January 2018 to January 2020 were enrolled as validation group to validate the performance of the model. Related clinical data included mode of artificial liver support therapy, age, sex, total bilirubin (TBil), international normalized ratio (INR), creatinine (Cr), serum sodium, platelet count (PLT), albumin (Alb), and presence or absence of ascites, hepatorenal syndrome, hepatic encephalopathy, and gastrointestinal bleeding. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. The Cox regression model was used to analyze the influencing factors for the prognosis of HBV-ACLF patients after PE and DPMAS alone or in combination and establish a predictive model; the receiver operator characteristic (ROC) curve was plotted and the DeLong method was used to compare the area under the ROC curve (AUC) between the new predictive model and Model for End-Stage Liver Disease (MELD)/MELD combined with serum sodium concentration (MELD-Na) scores. Results At 24 weeks after treatment, 71 patients survived and 62 patients died in the modeling group. The Cox regression analysis showed age (hazard ratio [ HR ]=1.030, P =0.013), TBil ( HR =1.018, P < 0.001), INR ( HR =1.517, P < 0.001), and PLT ( HR =0.993, P =0.04) were independent influencing factors for 24-week survival. According to the results of the Cox regression analysis, a prognostic model for HBV-ACLF patients treated with PE and DPMAS alone or in combination was established as ATIP=0.029×age (years)+0.018×TBil (mg/dL)+0.417×INR-0.007×PLT (10 9 /L). Both the modeling group and the validation group showed that the ATIP model had a better predictive performance than MELD and MELD-NA scores(all P < 0.05). Conclusion Age, TBil, INR, and PLT are independent influencing factors for the 24-week survival of HBV-ACLF patients treated with PE and DPMAS alone or in combination, and the ATIP model has a good performance in predicting the 24-week prognosis of HBV-ACLF patients treated with PE and DPMAS alone or in combination.

Objective:To test the effectiveness of electrical stimulation of the median nerve (MNES) for relieving post-stroke cognitive impairment (PSCI) and explore the possible mechanism.Methods:Thirty patients with PSCI were randomly divided into a routine treatment group (the control group) and an MNES group, each of 15. Both groups were given routine rehabilitation treatment, including cognitive rehabilitation training, medications and acupuncture. The MNES group additionally received 30 minutes of MNES on their right hands every day, five times a week for six weeks. One electrode was positioned over the median nerve 2cm up from the rasceta of the right wrist. The other was on the muscles of the thenar eminence. Forty seconds of stimulation were applied with intervals of 20 seconds, for 30 min daily. Before and after 3 and 6 weeks of treatment, both groups were evaluated using the mini-mental state examination (MMSE), the Montreal cognitive assessment (MoCA), the modified Barthel index (MBI) and the Fugl-Meyer assessment (FMA). In another 15 patients oxyhemoglobin levels in the brain before and during the MNES were observed using near-infrared spectroscopy.Results:After 3 weeks of treatment, a significant improvement was observed in the average MMSE, FMA and MBI scores of both groups, and the average MoCA score of the observation group. Three weeks later, the average MMSE, FMA, MBI and MoCA scores of both groups had improved significantly compared with before the treatment, with the average MMSE and MoCA improvements in the MNES group significantly greater than the control group′s averages. After 6 weeks of treatment the significant improvements persisted in both groups. Both group′s average FMA scores had also improved significantly, as had the average MBI score of the control group. After 6 weeks of treatment, the observation group′s average time orientation, location orientation, language instant memory, attention, calculation and short-term memory in MMSE had all improved significantly along with visual space capacity, executive capacity, attention, language, orientation and memory in MoCA. The spectroscopic results showed significantly improved oxyhemoglobin concentration in the bilateral frontal lobes after the MNES.Conclusions:Electrical stimulation of the median nerve can help to improve cognition after a stroke. It increases oxyhemoglobin concentration in the bilateral frontal lobes.

Objective:To investigate research into medical rehabilitation supported by China′s Natural Science Foundation (NSFC) between 2009 and 2018.Methods:Medical rehabilitation research projects supported by the NSFC between 2009 and 2018 were compiled. The project leaders, funding, awardee organization, research area and results were collected and analyzed.Results:There were 348 researchers who were supported in 421 projects during the period studied. They received ￥168.541 million and made 1395 achievements between 2009 and 2018. Neurological rehabilitation was the most popular research area, followed by musculoskeletal rehabilitation, while cardiopulmonary and pain rehabilitation were rarely covered.Conclusions:Rehabilitation medicine has been developed actively, but NSFC support has still been insufficient.

Objective To investigate the biomechanical and pathological changes in vivo in the taut bands (TB) of biceps femoris in rats after repeated low-frequency electrical stimulation.Methods Twenty-eight Wistar rats were randomly divided into a control group,an electrical intensity-dependent fatigue group,which were subject to electric intensity-dependent fatigue test,and an electrical frequency-dependent fatigue group,which were subject to electrical frequency-dependent fatigue test.After fatigue tests,the taut band of the biceps femoris and the non-taut band of the contralateral biceps femoris were harvested for pathological observation.The maximum contraction force (MCF),electrical intensity-and frequency-dependent fatigue characteristics and any pathological changes in the TBs were assessed and compared to the non-taut band region of the other biceps femoris.Results The MCF at the 15th and 20th stimulation (1.42 ± 0.28 g and 0.93 ± 0.54 g respectively) were significantly lower than that at the 1 st and 5th stimulation of the TBs.High stimulation intensity (HSI) at the 15th and 20th stimulation (3.76 ± 0.71 V and 3.44 ± 0.97 V) were also significantly lower than at the 1st TB stimulation.At the 10th,15th and 20th stimulation of the TBs,MCF and HSI were both significantly lower than in the bands which were not tight.In the frequency-dependent fatigue stimulation tests,the frequency which generated the MCF of the TBs was significantly lower than in the bands which were not tight,while the MCF of the TBs was significantly higher than that of non-TBs.After either intensity or frequency fatigue testing,more severe edema,uneven cytoplasmic death and degeneration of muscle fibers were observed in sections from TBs than from the bands which were not tight.Conclusions Taut muscle bands are significantly less fatigue-resistant than normal muscle fibers.Taut bands may contribute to the fatigue of myofascial pain syndromes.

Objective To quantify the temporal changes in the volume of blood flow to the skin of the forearm and lower leg during static maximum inspiratory breath-holding of different durations.Methods Blood flow to the skin of the forearm and lower leg were continuously measured with laser Doppler flowmetry in 12 healthy subjects.They were randomly selected to hold their breath for 10,20 or 40 seconds,or as long as possible.The volume of skin blood flow,the onset latency and the recovery latency were measured before,during and after the breath holding.Results Blood flow decreased significantly during each breath-hold with any durations.The magnitude of the decrease and its latencies were similar with all the durations.The average volume of skin blood flow and it's minimum value during each breath-hold were significantly lower in the forearms than in the lower legs.However,the average onset latency (4.41 ±0.44 s) and the average recovery latency (5.95 ±0.59 s) in the forearms were significantly shorter than in the lower legs (4.83 ± 0.70 s for onset and 7.33 ± 0.91 s for recovery).Conclusion The volume of skin blood flow decreases during a static maximum inspiratory breath-hold,and the magnitude of the increase is not related to the duration of the breath-hold.The generalized increase in skin sympathetic vasoconstrictor activity during a static breath-hold is greater in the forearm than in the lower leg.

Objective To observe the effects of intensive training at different intensities on the expressions of semaphorin 3A ( Sema 3A) and its receptor neuropilin ( NP-1 ) and the cell apoptosis in cerebrum after cerebral ischemia-reperfusion in rats,and to investigate the possible mechanism of intensive training in recovery of motor function after cerebral ischemia-reperfusion in rats.Methods To establish animal model of cerebral ischemia-reperfusion in rats,the intraluminal thread method was applied to cause left middle cerebral artery occlusion (MCAO) for 2 h and before reperfusion.After cerebral ischemia-reperfusion model were established for 24 h,60 male model Wistar rats were randomly divided into training group 1 ( swimming for 5 min once a day),training group 2 ( swimming for 10 min once a day),training group 3 (swimming for 10 min twice a day) and control group (no training) ; another 15 rats assigned to the sham-operation group were subject to no MCAO and no training.Neurological function was evaluated by Garcia scores,and terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) was performed to dectect the cortical cell apoptosis.Expressions of neural growth inhibition factor Sema 3A and its receptor NP-1 were detected by immunohistochemistry.Results The neurological function in sham-operation group was normal.The differences of Garcia scores at different time points beween sham-operation group and control group were significant (P ＜ 0.01 ).Garcia scores in all training groups,were significantly higher than those in controls at the 7th and 14th d after swimming training ( P ＜ 0.01 ),especially in training group 3 the Garcia scores were ( 12.80 ± 0.45 ),( 15.20 ± 0.45 ),( 16.80 ± 0.45 ),respectively,at the 3rd,7th and 14th d after swimming training.The rates of positive cell of Sema 3A,NP-1 and TUNEL indexes in all training groups were lower than those in controls at the 3rd,7th and 14th d after swimming training (P ＜ 0.01 ),especially in the training group 3.At the 3rd,7th and 14th d after swimming training in training group 3,the rates of TUNEL indexes positive apoptosis cells were ( 29.43 ± 1.38 ) ％,( 22.30 ± 1.21 ) ％,( 17.58 ± 1.70) ％,respectively,the positive cell rates of Sema 3A were ( 19.64 ± 1.17) ％,(9.73 ± 3.83)％,(8.24 ± 0.87)％,respectively,the positive cell rates of NP-1 were ( 33.95 ± 6.86) ％,( 27.95 ± 1.29 ) ％,( 18.90 ± 1.44 ) ％,respectively,the reduction of positive cells expressions in training group 3 was significantly more obvious compared with other training groups (P ＜ 0.01 or 0.05).Conclusions Rehabilitation training can reduce the expression of positive cell of Sema 3A,NP-1 and TUNEL indexes in rats after cerebral ischemia-reperfusion and can improve motor function recovery and facilitate neural plasticity.The more intensive the training,the better the effects.