ObjectiveTo observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole.MethodsA retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients (15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index (MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale -25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters.ResultsAt 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=−0.536, −0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001).ConclusionInternal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%).
Objective To summarize the classification, diagnosis, and treatment of iatrogenic bile duct injury. Method The clinical data of 27 cases of iatrogenic bile duct injuries who treated in Central Hospital of Huzhou City from 2008–2013 were retrospectively analyzed. Results The classification of 27 cases: 5 cases of type Ⅰ, 18 cases of type Ⅱ, 2 cases of type Ⅲ, 2 cases of type Ⅳ. Diagnosis: 11 cases were immediately discovered at the time of the initial operation, include 1 case of type Ⅰ, 8 cases of type Ⅱ, 1 case of type Ⅲ, 1 case of type Ⅳ; 10 cases were detected in early stage after the initial operation, include 2 cases of type Ⅰ, 7 cases of type Ⅱ, 1 case of type Ⅲ; 6 cases were detected in delayed stage after the initial operation, include 2 cases of type Ⅰ, 3 cases of type Ⅱ, 1 case of type Ⅳ. Treatment effect: 17 cases for excellent, 5 cases for good, 4 cases for bad, the well recover rate was 84.6% (22/26). One case died after operation. A total of 26 cases were followed up, 1 case was lost to follow up. During the follow-up period, bile leakage occurred in 3 cases, infection of incision occurred in 2 cases, cholangitis occurred in 3 cases, and bile duct stricture occurred in 2 cases. Conclusions The best time of repairing for the iatrogenic bile duct injuries is at the time of the initial operation or early stage. According to the type of injury and the time of the injury was diagnosed, timely and effective treatment by intervention and (or) surgery is the key.
To quantitatively evaluate the upper-limb spasticity of stroke patients in recovery stage, the relationship between surface electromyography (sEMG) characteristic indexes from biceps brachii and triceps brachii and the spasticity were explored, which provides the electrophysiological basis for clinical rehabilitation. Ten patients with spasticity after stroke were selected to be estimated by modified Ashworth (MAS) assessment and a passive elbow sinusoidal motion experiment was carried out. At the same time, the sEMG of biceps and triceps were recorded. The results shows that the reflex electromyographic threshold could reflect the physiological mechanism of spasticity and had significant correlation with MAS scale which showed that sEMG could be prosperous for the clinical quantitative evaluation of spasticity of stroke patients.
Human motion control system has a high degree of nonlinear characteristics. Through quantitative evaluation of the nonlinear coupling strength between surface electromyogram (sEMG) signals, we can get the functional state of the muscles related to the movement, and then explore the mechanism of human motion control. In this paper, wavelet packet decomposition and n:m coherence analysis are combined to construct an intermuscular cross-frequency coupling analysis model based on wavelet packet-n:m coherence. In the elbow flexion and extension state with 30% maximum voluntary contraction force (MVC), sEMG signals of 20 healthy adults were collected. Firstly, the subband components were obtained based on wavelet packet decomposition, and then the n:m coherence of subband signals was calculated to analyze the coupling characteristics between muscles. The results show that the linear coupling strength (frequency ratio 1:1) of the cooperative and antagonistic pairs is higher than that of the nonlinear coupling (frequency ratio 1:2, 2:1 and 1:3, 3:1) under the elbow flexion motion of 30% MVC; the coupling strength decreases with the increase of frequency ratio for the intermuscular nonlinear coupling, and there is no significant difference between the frequency ratio n:m and m:n. The intermuscular coupling in beta and gamma bands is mainly reflected in the linear coupling (1:1), nonlinear coupling of low frequency ratio (1:2, 2:1) between synergetic pair and the linear coupling between antagonistic pairs. The results show that the wavelet packet-n:m coherence method can qualitatively describe the nonlinear coupling strength between muscles, which provides a theoretical reference for further revealing the mechanism of human motion control and the rehabilitation evaluation of patients with motor dysfunction.
In order to fully explore the neural oscillatory coupling characteristics of patients with mild cognitive impairment (MCI), this paper analyzed and compared the strength of the coupling characteristics for 28 MCI patients and 21 normal subjects under six different-frequency combinations. The results showed that the difference in the global phase synchronization index of cross-frequency coupling under δ-θ rhythm combination was statistically significant in the MCI group compared with the normal control group (P = 0.025, d = 0.398). To further validate this coupling feature, this paper proposed an optimized convolutional neural network model that incorporated a time-frequency data enhancement module and batch normalization layers to prevent overfitting while enhancing the robustness of the model. Based on this optimized model, with the phase locking value matrix of δ-θ rhythm combination as the single input feature, the diagnostic accuracy of MCI patients was (95.49 ± 4.15)%, sensitivity and specificity were (93.71 ± 7.21)% and (97.50 ± 5.34)%, respectively. The results showed that the characteristics of the phase locking value matrix under the combination of δ-θ rhythms can adequately reflect the cognitive status of MCI patients, which is helpful to assist the diagnosis of MCI.
Stroke is an acute cerebrovascular disease in which sudden interruption of blood supply to the brain or rupture of cerebral blood vessels cause damage to brain cells and consequently impair the patient's motor and cognitive abilities. A novel rehabilitation training model integrating brain-computer interface (BCI) and virtual reality (VR) not only promotes the functional activation of brain networks, but also provides immersive and interesting contextual feedback for patients. In this paper, we designed a hand rehabilitation training system integrating multi-sensory stimulation feedback, BCI and VR, which guides patients' motor imaginations through the tasks of the virtual scene, acquires patients' motor intentions, and then carries out human-computer interactions under the virtual scene. At the same time, haptic feedback is incorporated to further increase the patients' proprioceptive sensations, so as to realize the hand function rehabilitation training based on the multi-sensory stimulation feedback of vision, hearing, and haptic senses. In this study, we compared and analyzed the differences in power spectral density of different frequency bands within the EEG signal data before and after the incorporation of haptic feedback, and found that the motor brain area was significantly activated after the incorporation of haptic feedback, and the power spectral density of the motor brain area was significantly increased in the high gamma frequency band. The results of this study indicate that the rehabilitation training of patients with the VR-BCI hand function enhancement rehabilitation system incorporating multi-sensory stimulation can accelerate the two-way facilitation of sensory and motor conduction pathways, thus accelerating the rehabilitation process.
Brain-computer interface (BCI) based on steady-state visual evoked potential (SSVEP) have attracted much attention in the field of intelligent robotics. Traditional SSVEP-based BCI systems mostly use synchronized triggers without identifying whether the user is in the control or non-control state, resulting in a system that lacks autonomous control capability. Therefore, this paper proposed a SSVEP asynchronous state recognition method, which constructs an asynchronous state recognition model by fusing multiple time-frequency domain features of electroencephalographic (EEG) signals and combining with a linear discriminant analysis (LDA) to improve the accuracy of SSVEP asynchronous state recognition. Furthermore, addressing the control needs of disabled individuals in multitasking scenarios, a brain-machine fusion system based on SSVEP-BCI asynchronous cooperative control was developed. This system enabled the collaborative control of wearable manipulator and robotic arm, where the robotic arm acts as a “third hand”, offering significant advantages in complex environments. The experimental results showed that using the SSVEP asynchronous control algorithm and brain-computer fusion system proposed in this paper could assist users to complete multitasking cooperative operations. The average accuracy of user intent recognition in online control experiments was 93.0%, which provides a theoretical and practical basis for the practical application of the asynchronous SSVEP-BCI system.
To better analyze the problem of abnormal neuromuscular coupling related to motor dysfunction for stroke patients, the functional coupling of the multichannel electromyography (EMG) were studied and the difference between stroke patients and healthy subjects were further analyzed to explore the pathological mechanism of motor dysfunction after stroke. Firstly, the cross-frequency coherence (CFC) analysis and non-negative matrix factorization (NMF) were combined to construct a CFC-NMF model to study the linear coupling relationship in bands and the nonlinear coupling characteristics in different frequency ratios during elbow flexion and extension movement. Furthermore, the significant coherent area and sum of cross-frequency coherence were respectively calculated to quantitatively describe the intermuscular linear and nonlinear coupling characteristics. The results showed that the linear coupling relationship between multichannel muscles was different in frequency bands and the overall coupling was stronger in low frequency band. The linear coupling strength of the stroke patients was lower than that of the healthy subjects in different frequency bands especially in beta and gamma bands. For the nonlinear coupling, the intermuscular coupling strength of stroke patients in different frequency ratios was significantly lower than that of the healthy subjects, and the coupling strength in the frequency ratio 1∶2 was higher than that in the frequency ratio 1∶3. This method can provide a theoretical basis for exploring the intermuscular coupling mechanism of patients with motor dysfunction.
To better evaluate neuromuscular function of patients with stroke related motor dysfunction, we proposed an effective corticomuscular coherence analysis and coherent significant judgment method. Firstly, the related functional frequency bands in the electroencephalogram (EEG) were extracted via wavelet decomposition. Secondly, coherence were analysed between surface electromyography (sEMG) and sub-bands extracted from EEG. Further more, a coherent significant indicator was defined to quantitatively describe the similarity in certain frequency domain and phase lock activity between EEG and sEMG. Through the analysis of corticomuscular coherence during knee flexion-extension of stroke patients and healthy controls, we found that the stroke patients exhibited significantly lower gamma-band corticomuscular coherence in performing the task with their affected leg, and there was no statistically significant difference between their unaffected lag and the healthy controls, but with the rehabilitation training, the bilateral difference of corticomuscular coherence in patients decreased gradually.