Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective To explore the effect of vestibular rehabilitation on the balance function of patients with Parkinson's disease.Methods Sixty-one patients with Parkinson's disease were randomly divided into a treatment group of 30 and a control group of 31.Both groups were given the usual health education about fall prevention,while the treatment group was additionally provided with 50 to 70 minutes of vestibular rehabilitation training 6 times a week for 8 weeks.The training included the adaptability training,balance training and gait training.Before and after the treatment,both groups were evaluated with the unified Parkinson's disease rating scale (part Ⅲ)(UPDRS Ⅲ),the Berg balance scale (BBS),the Timed Up and Go test (TUGT) and the 39-item Parkinson's disease questionnaire (PDQ39).Results There were no significant differences in the average UPDRS Ⅲ,BBS or PDQ39 scores nor in the average TUGT times between the two groups before the treatment.After the treatment there was still no significant difference in groups' average UPDRS Ⅲ and PDQ39 scores,but the average TUGT times and BBS scores of the treatment group were then significantly improved and significantly better than the control group's averages.Conclusion Vestibular rehabilitation training can improve the balance and walking ability of those with Parkinson's disease.It can serve as an important ancillary treatment to drug therapy.

Objective To investigate the effect of a pulsed electromagnetic field ( PEMFS) on bone mineral density and bone metabolism in males with osteoporosis after a stroke. Methods Fifty male stroke survivors with os-teoporosis were randomly divided into a control group and a treatment group, both of 25. Both groups were treated with routine rehabilitation, oral calcium carbonate and vitamin D3 tablets, while the treatment group was additionally pro-vided with PEMFS treatment. The subjects′bone mineral density ( BMD) and their blood levels of bone-specific alka-line phosphatase (B-ALP), type I procollagen amino-terminal peptide (PINP) and type β-I collagen cross-linked carboxy-terminal peptide (β-CTx) were measured before and after the 12 weeks of treatment. Results After the treatment the BMD values of the lumbar spine, femoral neck, trochanter and Ward′s triangle had increased signifi-cantly in both groups, but the average BMD values of the lumbar spine and femoral neck in the treatment group were significantly higher than those of the control group. After the treatment, the average B-ALP, PINP andβ-CTx levels of both groups had also improved significantly compared with before the treatment, but the average improvement in all three among the treatment group was significantly greater than among the controls. Conclusion PEMFS treatment supplementing routine rehabilitation, oral calcium carbonate and vitamin D3 tablets can improve bone formation, re-duce bone resorption and increase bone mineral density in men after a stroke.

Objective To explore the relevance of abnormal posture to the development of shoulder pain among stroke survivors.Methods A total of 102 stroke survivors were studied.Those with shoulder impingement syndrome or shoulder pain formed a shoulder pain group,while those without shoulder pain served as controls.The upper trunk sagittal sitting postures of all of the subjects were quantified using the thoracic and craniovertebral angles measured from photographs.Results The average craniovertebral angle of the shoulder pain group was significantly smaller than that of the control group,while the average thoracic angle of the former was significantly larger.The craniovertebral angles were negatively correlated with shoulder pain,while a large thoracic angle was positively correlated.Conclusion Thoracic and craniovertebral angles can be used as a predictor of shoulder impingement syndrome among stroke survivors.Stroke patients with thoracic kyphosis and forward head posture should undergo active rehabilitation.