In recent years, high-resolution magnetic resonance imaging (HRMRI) has become a useful clinical and research tool. HRMRI can be used to observe intracranial vascular wall lesions in vivo, providing more valuable pathophysiological information, and providing guidance for the diagnosis, differential diagnosis and prognosis of intracranial atherosclerosis. For stenotic intracranial atherosclerosis, the morphology of the vessel wall can effectively differentiate various vascular stenosis diseases. Further, plaque composition, vessel wall enhancement, remodel mode provide information of plaque vulnerability. For non-stenotic intracranial atherosclerosis, the location of the plaque can reveal the pathophysiological mechanism. In addition, HRMRI can show the lesion in lenticulostriate artery. Therefore, this article will summarize the clinical application of HRMRI.
Objective To analyze the influence of COPD on the structure and function of left ventricular. Methods Sixty-nine COPD patients ( mean age: 69. 0 ±7. 8 yrs) and forty healthy controls ( mean age: 67. 8 ±7. 6 yrs) were enrolled in this study. Both groups underwent Doppler echocardiography.Heart rate ( HR) were recorded. Left ventricular end-diastolic volume ( LVEDV) , left ventricular enddiastolic diameter ( LVEDD) , interventricular septum( IVS) , stroke volume ( SV) , and cardiac output ( CO)were measured. The changes of left ventricular were compared between the COPD patients and the healthy controls, and also between the COPD patients with or without chronic cor pulmonale. Results Compared with the healthy controls, movement range of IVS, LVEDD, LVEDV, and SV reduced significantly ( P lt;0. 05) , and HR raised significantly in the COPD patients ( P lt; 0. 05) . CO had no significant difference between two groups ( P gt;0. 05) . Sub-group analysis indicated that the thickness and movement range of IVSwere greater in the patients with cor pulmonale secondary to COPD than those without cor pulmonale ( P lt;0. 05) . Conclusions In COPD patients, left ventricular chamber size decreases, and left ventricular systolic function is impaired. Left ventricular function is impaired more severe in cor pulmonale secondary to COPD than COPD without cor pulmonale.
ObjectiveTo explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and provide guidance for rehabilitation assessment and functional prognosis.MethodsThe stroke patients who were hospitalized in Department of Rehabilitation Medicine of Zhongda Hospital of Southeast University between November 2020 and January 2021 were selected. Motor unit number estimation (MUNE) and F wave were examined to evaluate the functional status of motor neuron. The Fugl-Meyer Assessment (FMA) and Modified Ashworth Scale (MAS) were used to evaluate the upper limb motor function. The correlations of electrophysiological parameters with FMA score and MAS score were analyzed respectively.ResultsA total of 42 patients were enrolled, and 16 patients were complicated with carpal flexor spasm on the affected side. Among the 42 stroke patients, the MUNE of the abductor pollicis brevis on the affected side was lower than that on the unaffected side (t=−3.466, P=0.001), and the percentage of F waves with different shapes on the affected side was significantly lower than that on the unaffected side (Z=−5.583, P<0.001). Among the 16 stroke patients with carpal flexor spasm, the F wave amplitude was higher on the affected side than that on the unaffected side (t=2.764, P=0.014), while the F wave latency on the affected side was not statistically significant compared with the unaffected side (Z=−0.595, P=0.552). Among the 42 stroke patients, the affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (rs=0.377, P=0.014), while the correlation between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant (rs=0.104, P=0.513). Among the 16 stroke patients with carpal flexor spasm, the affected/unaffected side ratio of the F wave amplitude was positively correlated with the MAS score of the carpi flexor muscle (rs=0.550, P=0.027).ConclusionStroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, and which were related to motor function and muscle tone.
ObjectiveTo evaluate the comparative cost-effectiveness of thrombolysis treatment of ischemic stroke based on outcomes of CT perfusion (CTP). MethodsWe applied the methods of systematic review to evaluate the studies abroad about the cost effectiveness of CTP diagnosis outcomes used for selecting stroke patients for thrombolysis treatment. We also evaluated the domestic studies about the cost-effectiveness of CTP in China by establishing a decision tree model. ResultsA total of 2 economics studies were included. The results showed that, the cost-effectiveness ratios of CT, CTP and MRI for selecting stroke patients for thrombolysis treatment were 2 983.7 ￡/QALY, 2 951.4 ￡/QALY and 2 982.9 ￡/ QALY, respectively, in the UK; 100 483.5＄/QALY and 99 406.1＄/QALY just for CT and CTP, respectively, in the US; and the evaluation outcomes by establishing the decision tree model showed that, 113 492.4 ￥/QALY, 113 615￥/QALY and 120 831.9 ￥/QALY, respectively, in China. ConclusionAll international and domestic studies' results show that CTP is more cost-effective than CT/MRI in selecting stroke patients for thrombolysis treatment.
As an emerging non-invasive brain stimulation technique, transcranial direct current stimulation (tDCS) has received increasing attention in the field of stroke disease rehabilitation. However, its efficacy needs to be further studied. The tDCS has three stimulation modes: bipolar-stimulation mode, anode-stimulation mode and cathode-stimulation mode. Nineteen stroke patients were included in this research (10 with left-hemisphere lesion and 9 with right). Resting electroencephalogram (EEG) signals were collected from subjects before and after bipolar-stimulation, anodal-stimulation, cathodal-stimulation, and pseudo-stimulation, with pseudo-stimulation serving as the control group. The changes of multi-scale intrinsic fuzzy entropy (MIFE) of EEG signals before and after stimulation were compared. The results revealed that MIFE was significantly greater in the frontal and central regions after bipolar-stimulation (P < 0.05), in the left central region after anodal-stimulation (P < 0.05), and in the frontal and right central regions after cathodal-stimulation (P < 0.05) in patients with left-hemisphere lesions. MIFE was significantly greater in the frontal, central and parieto-occipital joint regions after bipolar-stimulation (P < 0.05), in the left frontal and right central regions after anodal- stimulation (P < 0.05), and in the central and right occipital regions after cathodal-stimulation (P < 0.05) in patients with right-hemisphere lesions. However, the difference before and after pseudo-stimulation was not statistically significant (P > 0.05). The results of this paper showed that the bipolar stimulation pattern affected the largest range of brain areas, and it might provide a reference for the clinical study of rehabilitation after stroke.
In response to the problem that the traditional lower limb rehabilitation scale assessment method is time-consuming and difficult to use in exoskeleton rehabilitation training, this paper proposes a quantitative assessment method for lower limb walking ability based on lower limb exoskeleton robot training with multimodal synergistic information fusion. The method significantly improves the efficiency and reliability of the rehabilitation assessment process by introducing quantitative synergistic indicators fusing electrophysiological and kinematic level information. First, electromyographic and kinematic data of the lower extremity were collected from subjects trained to walk wearing an exoskeleton. Then, based on muscle synergy theory, a synergistic quantification algorithm was used to construct synergistic index features of electromyography and kinematics. Finally, the electrophysiological and kinematic level information was fused to build a modal feature fusion model and output the lower limb motor function score. The experimental results showed that the correlation coefficients of the constructed synergistic features of electromyography and kinematics with the clinical scale were 0.799 and 0.825, respectively. The results of the fused synergistic features in the K-nearest neighbor (KNN) model yielded higher correlation coefficients (r = 0.921, P < 0.01). This method can modify the rehabilitation training mode of the exoskeleton robot according to the assessment results, which provides a basis for the synchronized assessment-training mode of “human in the loop” and provides a potential method for remote rehabilitation training and assessment of the lower extremity.
ObjectivesTo systematically review the efficacy of home-based telerehabilitation (HTR) for stroke survivors.MethodsPubMed, EMbase, Web of Science, Joanna Briggs Institute Library, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on HTR for stroke survivors from inception to January 1st, 2019. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 793 patients were included. The results of meta-analysis showed that: after 1 to 2 years of treatment, BI scores (MD=20.22, 95%CI 17.10 to 23.35, P<0.000 01) in HTR group were higher than those in the traditional rehabilitation group. However, there were no statistical differences between two groups in ARAT scores (SMD=0.16, 95%CI −0.14 to 0.45, P=0.30) after 1 to 2 months of treatment, as well as MBI scores (SMD=0.98, 95%CI −0.33 to 2.29, P=0.14) and FMA scores (SMD=0.57, 95%CI −0.08 to 1.23, P=0.09) after 3 months of treatment, and CSI scores (MD=−1.48, 95%CI −3.90 to 0.94, P=0.23) and BBS scores (MD=1.33, 95%CI −1.15 to 3.81, P=0.29) after 6 months of treatment. The results of descriptive analysis indicated that there was no statistically significant difference in quality of life between the two groups at 6 months after intervention. However, the HTR group was superior to the traditional rehabilitation group after 2 years of treatment.ConclusionsCurrent evidence shows that, compared with traditional rehabilitation, long-term intervention (1-2 years) with HTR can improve the ability to perform activities of daily living and quality of life of stroke survivors. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Enteral nutrition can improve patient’s nutritional status, reduce the incidence of complications, and promote the patient’s rehabilitation. For patients with stroke, enteral nutrition is the first choice for nutritional support. Nurses not only participate but also play important roles in the whole process of nutrition management in stroke. Therefore, standardizing the nursing practice in enteral nutrition and developing nursing guideline in line with Chinese clinical practice is of great significance. In the guideline, 18 key clinical questions had been established via the Delphi method, and for each question, detailed recommendations had been constructed. It is expected to provide clinical standards for enteral nutrition in patients with stroke, and to improve the nutritional management and disease prognosis of stroke patients.
ObjectiveTo systematically evaluate the related factors of constipation in patients with stroke. MethodsCochrane Library, PubMed, Web of Science, Embase, CNKI, VIP, Wanfang and China Biomedical Literature Database were searched by computer, and the retrieval time was set to May 2022. Case-control studies, cohort studies and cross-sectional studies on stroke and constipation were selected. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 13 studies involving 2 834 patients were included. Meta-analysis showed that age [odds ratio (OR) =2.54, 95% confidence interval (CI) (1.36, 3.73), P<0.001], lesion location [OR=1.98, 95%CI (1.27, 3.11), P=0.003], National Institutes of HealthStroke Scale score [OR=0.40, 95%CI (0.10, 0.70), P=0.010], hemiplegia [OR=4.31, 95%CI (2.59, 7.17), P<0.001], dysphagia [OR=2.32, 95%CI (1.27, 4.25), P=0.006], antidepressants [OR=2.33, 95%CI (1.62, 3.34), P<0.001], BI score [OR=−17.08, 95%CI (−33.07, −1.08), P=0.04], eating pattern [OR=4.18, 95%CI (1.16, 15.09), P=0.030], drinking water volume ≥800 mL [OR=0.30, 95%CI (0.19, 0.46), P<0.001] might be the influencing factors of constipation in patients after stroke. The results of sensitivity analysis showed that age, education level, diabetes, smoking, stroke type, lesion location, diuretic and BI score might be the influencing factors of constipation after stroke (P<0.05). The results of bias analysis suggest that publication bias is less likely. Conclusions There are many risk factors for constipation in patients with stroke. Current evidence shows that age, diabetes, smoking and other 11 factors may be risk factors for stroke constipation, while high education level and drinking water ≥800 mL may be protective factors, and the other influencing factors have not been determined and need further study.
ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.