Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke

Background: Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function.

Objective: To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke.

Methods: In this randomized controlled trial, group A received 20 sessions of physical therapy (PT)?+?20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients’ motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement.

Results: Statistically significant improvements in game scores (p?p?Conclusions: To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.     

双歧杆菌四联活菌片 对重症脑卒中患者肠道功能的影响

目的探讨双歧杆菌四联活菌片对重症脑卒中患者肠道菌群及肠黏膜屏障功能的影响。方法选择重庆市人民医院2017年1月至2017年11月收治的100例重症脑卒中患者,随机将入选患者分为治疗组和对照组各50例。治疗组在常规肠内营养(EN)治疗基础上联用双歧杆菌四联活菌片治疗,对照组给予常规EN治疗。比较两组患者治疗前后营养状况、肠道菌群数量和肠黏膜屏障功能。比较两组患者治疗后消化道并发症发生率。结果治疗前,两组患者营养状况、肠道菌群数量和肠黏膜屏障功能差异无统计学意义(P0.05)。治疗后,两组患者营养状况指标白蛋白(ALB)、血红蛋白(Hb)和三头肌肌围(MAMC)水平,肠道有益菌(双歧杆菌、乳杆菌和拟杆菌)数量均有所上升,肠黏膜屏障功能指标二胺氧化酶(DAO)、D-乳酸水平及肠道有害菌数量(小梭菌和肠球菌)均降低。与对照组相比,治疗组患者ALB、Hb和MAMC水平,肠道双歧杆菌、乳杆菌和拟杆菌数量均显著升高,DAO、D-乳酸水平和小梭菌、肠球菌数量均显著降低,差异有统计学意义(P0.05)。治疗组患者消化道并发症发生率均低于对照组(P0.05)。结论双歧杆菌四联活菌片能够显著改善脑卒中患者的营养状况,有效调节菌群失衡,改善肠黏膜屏障功能,降低并发症发生。     

针刺结合功能性电刺激对急性脑卒中后吞咽困难患者吞咽功能的影响

目的:探索针刺结合功能性电刺激对急性脑卒中后吞咽困难患者吞咽功能的影响,以寻求一种更加有效的治疗方法。方法:选取2010年7月至2014年7月我院神经内科、急诊科收治的93例急性脑卒中后合并吞咽障碍的患者作为研究对象,随机分为三组,每组31例。三组在脑卒中常规药物治疗及吞咽康复训练的基础上,A组接受针刺治疗,B组接受功能性电刺激治疗,C组接受针刺联合功能性电刺激治疗。比较治疗前后洼田氏饮水试验评分及疗效。结果:治疗后三组评分均较治疗前下降,差异均具有统计学意义(均P0.05),且C组评分相比A、B组更低,差异均具有统计学意义(P0.05);C组总有效率为93.5%,明显高于A组的67.7%和B组的74.2%,差异均有统计学意义(P0.05)。结论:针刺治疗联合功能性电刺激治疗卒中后吞咽障碍疗效显著,优于单纯针刺治疗及单纯功能电刺激治疗。     

心血管领域复方创新药的范例：缬沙坦沙库比曲片 与依那普利叶酸片 ——给我国新药创制带来的启示

缬沙坦沙库比曲片与依那普利叶酸片均属于复方创新药,即其中单药在组成复方后的疗效或适应证发生新的变化。针对临床需求、 疗效以及循证依据,详细剖析这两种复方创新药的组方特点,重点探讨复方创新药与一般复方药的区别,为以临床价值为导向和基于患者 人群特点的重大新药创制提供借鉴。     

Early stages of the recovery stroke in myosin II studied by molecular dynamics simulations

The recovery stroke is a key step in the functional cycle of muscle motor protein myosin, during which pre-recovery conformation of the protein is changed into the active post-recovery conformation, ready to exersice force. We study the microscopic details of this transition using molecular dynamics simulations of atomistic models in implicit and explicit solvent. In more than 2 μs of aggregate simulation time, we uncover evidence that the recovery stroke is a two-step process consisting of two stages separated by a time delay. In our simulations, we directly observe the first stage at which switch II loop closes in the presence of adenosine triphosphate at the nucleotide binding site. The resulting configuration of the nucleotide binding site is identical to that detected experimentally. Distribution of inter-residue distances measured in the force generating region of myosin is in good agreement with the experimental data. The second stage of the recovery stroke structural transition, rotation of the converter domain, was not observed in our simulations. Apparently it occurs on a longer time scale. We suggest that the two parts of the recovery stroke need to be studied using separate computational models.     

Haplotype analysis revealed a genetic influence of osteopontin on large artery atherosclerosis

Osteopontin (OPN) is a cytokine that involves in vascular remodeling processes in cerebrovascular diseases. The association of its gene with ischemic stroke was investigated in a Korean population. Representative sequence variants covering the entire OPN gene were genotyped in 455 controls and 271 patients with ischemic stroke including large artery atherosclerosis (LAA), small vessel occlusion, and cardioembolism. Analysis with the individual tagging variants and their haplotypes revealed an evidence of association only with LAA. Significances were shown with the haplotypes, especially with the TCA at the loci C2140T, C5891T, and A7385G conferring a risk of 2.09 for LAA (P < 0.05). The CG at the loci C1013T and A7385G was the most protective haplotype (OR = 0.66, P < 0.05). Our findings suggested that several haplotypes of OPN gene contributed to determining risk factors as well as protective factors of LAA.     

Exploration of the conformational space of myosin recovery stroke via molecular dynamics

Muscle contractions are driven by cyclic conformational changes of myosin, whose molecular mechanisms of operation are being elucidated by recent advances in crystallographic studies and single molecule experiments. To complement such structural studies and consider the energetics of the conformational changes of myosin head, umbrella sampling molecular dynamics (MD) simulations were performed with the all-atom model of the scallop myosin sub-fragment 1 (S1) with a bound ATP in solution in explicit water using the crystallographic near-rigor and transition state conformations as two references. The constraints on RMSD reaction coordinates used for the umbrella sampling were found to steer the conformational changes efficiently, and relatively close correlations have been observed between the set of characteristic structural changes including the lever arm rotation and the closing of the nucleotide binding pocket. The lever arm angle and key residue interaction distances in the nucleotide binding pocket and the relay helix show gradual changes along the recovery stroke reaction coordinate, consistent with previous crystallographic and computational minimum energy studies. Thermal fluctuations, however, appear to make the switch-2 coordination of ATP more flexible than suggested by crystal structures. The local solvation environment of the fluorescence probe, Trp 507 (scallop numbering), also appears highly mobile in the presence of thermal fluctuations.     

Inhibition of the myosin light chain kinase prevents hypoxia-induced blood-brain barrier disruption

Increased mortality after stroke is associated with development of brain edema. The aim of the present study was to examine the contribution of endothelial myosin light chain (MLC) phosphorylation to hypoxia-induced blood-brain barrier (BBB) opening. Measurements of trans-endothelial electrical resistance (TEER) were performed to analyse BBB integrity in an in vitro co-culture model (bovine brain microvascular endothelial cells (BEC) and rat astrocytes). Brain fluid content was analysed in rats after stroke induction using a two-vein occlusion model. Dihydroethidium was used to monitor intracellular generation of reactive oxygen species (ROS) in BEC. MLC phosphorylation was detected using immunohistochemistry and immunoblot analysis. Hypoxia caused a decrease of TEER values by more than 40%, which was prevented by inhibition of the MLC-kinase (ML-7, 10 micromol/L). In addition, ML-7 significantly reduced the brain fluid content in vivo after stroke. The NAD(P)H-oxidase inhibitor apocynin (500 micromol/L) prevented the hypoxia-induced TEER decrease. Hypoxia-dependent ROS generation was completely abolished by apocynin. Furthermore, ML-7 and apocynin blocked hypoxia-dependent phosphorylation of MLC. Our data demonstrate that hypoxia causes a breakdown of the BBB in vitro and in vivo involving ROS and the contractile machinery.