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.     

Measurement of synergy and spasticity during functional movement of the post-stoke hemiplegic upper limb

The aim of the present study was to measure the muscle-contraction patterns of the hemiplegic upper limb using electromyography (EMG) and to investigate the relationship between muscle co-contraction and functional recovery in stroke patients presenting with synergy and spasticity. The muscle-contraction patterns of the upper limb of 12 chronic stroke patients and 10 normal volunteers were measured, and the co-contraction in the distal and proximal muscles was simultaneously quantified, while the participants performed hand-grasp and shoulder flexion tasks. The spasticity and hemiplegic arm function were evaluated, respectively, on a modified Ashworth scale (MAS) and by means of Fugl-Meyer motor assessment (FMA). The correlation between the MAS and FMA values was analyzed.Increased co-contraction (66–555%) was observed in both the proximal and distal upper limbs, and was positively correlated with spasticity of the elbow flexor (r = 0.944 on shoulder flexion, r = 0.741 on hand grasping, p < 0.01) and negatively correlated with functional recovery of the upper limb (r = ?0.670 ～ ?0.884, p < 0.05). Specific movement patterns influenced by synergy and spasticity were confirmed by EMG. These results might prove useful to the formulation of appropriate management plans such as those involving botulinum toxin injection or nerve block.     

Ultrasonographic and electrophysiologic evaluation of median and ulnar nerves in chronic stroke patients with upper extremity spasticity

Objective: To evaluate the upper extremity nerves of stroke patients morphologically and electrophysiologically and to determine whether there is a relationship between clinical evaluations, ultrasonographic measurements, and electrodiagnostic findings.

Methods: This cross-sectional study included 30 chronic stroke patients. After recording demographical data, clinical, ultrasonographic, and electrophysiological evaluations were performed. Clinical evaluations included Brunnstrom Recovery Stages (BRS), Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motricity index (MI), Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS). For ultrasonographic measurements, median and ulnar nerves were scanned. Median and ulnar nerve conduction studies were performed bilaterally.

Results: Mean ages of the patients were 62.2?±?13.0 years (range 24–84 years; 22 males, 8 females). There was no significant difference in median/ulnar nerve ultrasonographic measurements between paretic and non-paretic sides (p?>?.05), whereas median nerve motor conduction velocity was significantly slower and median nerve F-wave latency was prolonged on the paretic side (p?<?.05). The median and ulnar nerve compound motor action potential (CMAP) amplitudes of paretic sides were positively correlated with lower extremity BRS and FAS scores. Median CMAP amplitudes were also positively correlated with FIM scores and ulnar CMAP amplitudes were positively correlated with motricity scores. Moreover, on the paretic side, there were positive correlations of median SNAP amplitudes with FIM and FAS scores (p?<?.05).

Conclusions: Our results showed electrophysiological changes in peripheral nerves on the paretic upper extremities, however, no morphological change was determined. Further studies with larger number of patients and longer follow-up periods are needed to clarify the effect of stroke and spasticity on the peripheral nervous system.     

miRNA-148a and miRNA-30c expressions as potential biomarkers in breast cancer patients

BackgroundBreast cancer is an extensively identified malignant tumor and is a prime cause of cancer mortalities in females. It has been shown that alteration of miRNAs expression (up or down regulation) can affect the initiation and progression of many malignancies. We aimed to evaluate the role of circulating miRNA-148a and miRNA-30c in female patients with breast cancer and estimate their usage as potential biomarkers in the diagnosis, prognosis and survival of breast cancer.MethodsThis study included 75 breast cancer female patients.They were compared with 55 apparently healthy female subjects. miRNAs expression analysis was assessed via real-time PCR.ResultsTo discriminate breast cancer patients from controls, miR-30c showed the best performance at a cut off value of ≤20.6 (AUC = 0.998, 97.33% sensitivity, 96.36% specificity, p < 0.001), followed by miR-148a (AUC = 0.995, 94.67% sensitivity, 90.91% specificity, p < 0.001 at a cut off value of ≤0.1), CA 15-3 (AUC = 0.930, 88.0% sensitivity, 81.82% specificity, p < 0.001 at a cut off value of >21.3), and finally CEA (AUC = 0.751, 70.67% sensitivity, 63.64% specificity, p < 0.001 at a cut off value of >2.5).ConclusionmiRNA-148a and miRNA-30c expressions were down regulated in female patients with breast cancer and might be considered as potential blood biomarkers. Both also might have rule in disease treatment and selection of therapeutic targets. Future studies are needed to improve their role in predicting response to treatment and prognosis.     

Predictors of Prolonged Euthyroidism After Radioactive Iodine Treatment for Graves’ Disease: A Pilot Study

ObjectivePatients with Graves’ disease who remain hyperthyroid under the treatment of antithyroid drugs (ATD) or cannot tolerate ATD usually receive radioactive iodine (RAI) to control disease activity. This pilot study aimed to identify predictors of prolonged euthyroidism > 12 months after receiving RAI.MethodsDemographic, clinical, and laboratory data from 117 patients receiving RAI were retrospectively collected, including age, gender, body surface area, smoking status, free thyroxine, thyrotropin, thyrotropin binding inhibiting immunoglobulin, microsomal antibody, thyroglobulin antibody, medication history, and thyroid volume. Only 85 patients without missing values were included in statistical analysis. The calculated RAI dose was the estimated thyroid volume × 0.4. The difference and ratio between the actual and calculated RAI doses were examined. A stepwise logistic regression analysis was conducted to identify important predictors of prolonged euthyroidism > 12 months. The cut-off values for discretizing continuous covariates were estimated by fitting generalized additive models.ResultsAmong the 85 patients on RAI, 18 (21.2%) achieved prolonged euthyroidism > 12 months, 38 (44.7%) remained hyperthyroid with decreased ATD doses, but 29 (34.1%) suffered permanent hypothyroidism and needed long-term levothyroxine. Logistic regression analysis revealed that patients with age > 66 years, 33 < age ≤ 66 years, quitting smoking vs nonsmoking or current smoking, 600 < micorsomal antibody ≤ 1729 IU/mL, 47% < thyrotropin binding inhibiting immunoglobulin ≤ 81%, 7 < thyroglobulin antibody ≤ 162 IU/mL, 0.63 < ratio between actual and calculated RAI doses ≤ 1.96, or taking hydroxychloroquine would have a higher chance of reaching prolonged euthyroidism > 12 months after receiving RAI. Its area under the Receiver Operating Characteristic (ROC) curve was 0.932.ConclusionPatients with Graves’ disease who received an actual RAI dose close to the calculated RAI dose achieved prolonged euthyroidism > 12 months if they also took hydroxychloroquine during RAI treatment.     

低频电刺激联合康复训练治疗脑卒中偏瘫患者效果及运动功能、自我效能的影响

摘要 目的：分析低频电刺激联合康复训练治疗脑卒中偏瘫患者效果及运动功能、自我效能的影响。方法：选择我院自2019年5月至2022年1月收治的156例脑卒中偏瘫患者作为研究对象,随机分为对照组和观察组,每组各78例。对照组予以常规对症支持治疗,加用康复训练;观察组在对照组的基础上,加用低频电刺激治疗,持续治疗8周后评估疗效。根据患者的下肢Brunnstrom分级改善幅度,评价治疗效果;比较两组治疗前后的下肢Fugl-Meyer运动功能量表（FMA）、Berg平衡量表（BBS）、改良Barthel指数（MBI）和一般自我效能感量表（GSES）评分。结果：观察组治疗总有效率为96.15 %,高于对照组的84.62 %（P＜0.05）;对比对照组,观察组治疗后下肢FMA评分、BBS评分均更高（P＜0.05）;对比对照组,观察组治疗后MBI评分、GSES评分均更高（P＜0.05）。结论：低频电刺激联合康复训练治疗脑卒中偏瘫患者的效果明显,能够有效改善运动功能和生活质量,提高自我效能,值得进一步研究应用。     

运动想象疗法联合PNF躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响

摘要 目的：探讨运动想象疗法（MI）联合神经肌肉本体感觉促进术(PNF)躯干模式训练对脑卒中偏瘫患者上肢功能、步行功能和躯干控制能力的影响。方法：选取2015年1月-2019年6月期间中国人民解放军第九八三医院及中国中医科学院望京医院康复治疗中心收治的112例脑卒中偏瘫患者。根据按入院顺序编号的奇、偶数分为对照组（n=56）和研究组（n=56）,对照组给予常规康复训练联合MI训练,研究组在对照组基础上联合PNF躯干模式训练,两组均干预8周。对比两组干预前、干预4周后、干预8周后的Carroll手功能评定(UEFT)、Fugl-Meyer运动功能评定(FMA)、改良的Barthel指数（mBI）、功能性步行分级(FAC)、Tinetti步态评估量表(TGA)、躯干控制能力测试(TCT)、Berg平衡功能量表(BBS)、坐-站-坐时间以及躯干前倾距离。结果：两组干预4周后、干预8周后UEFT、FMA、mBI评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后FAC、TGA评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后TCT、BBS评分逐渐升高,且研究组高于对照组（P<0.05）。两组干预4周后、干预8周后坐-站-坐时间逐渐降低,且研究组低于对照组（P<0.05）,躯干前倾距离逐渐升高,且研究组高于对照组（P<0.05）。结论：MI联合PNF躯干模式训练治疗脑卒中偏瘫患者,可有效改善患者步行功能、上肢功能和躯干控制能力。     

肌内效贴联合经皮神经电刺激对脑卒中后偏瘫肩痛患者肩关节疼痛、肩关节功能和血液流变学的影响

摘要 目的：探讨肌内效贴联合经皮神经电刺激（TENS）对脑卒中后偏瘫肩痛患者肩关节疼痛、肩关节功能和血液流变学的影响。方法：选取2019年5月~2022年1月期间江苏省人民医院收治的脑卒中后偏瘫肩痛患者100例,根据随机数字表法将其分为对照组（n=50）和研究组（n=50）,在常规康复训练的基础上,对照组接受肌内效贴干预,研究组接受肌内效贴联合TENS干预。对比两组视觉模拟评分法（VAS）评分、上肢Fugl-Meyer运动功能评定量表（FMA）、改良Barthel指数（MBI）、Constant-Murley肩关节功能评分量表（CMS）评分、血液流变学指标、肩关节功能变化情况。结果：研究组干预后VAS评分低于同期对照组（P<0.05）。研究组干预后FMA、MBI、CMS评分高于同期对照组（P<0.05）。研究组干预后血浆黏度、纤维蛋白原、全血黏度、红细胞压积均低于同期对照组（P<0.05）。研究组干预后患侧肩关节的外旋、前屈、外展的主动/被动活动度（AROM/PROM）均大于对照组同期（P<0.05）。结论：肌内效贴联合TENS应用于脑卒中后偏瘫肩痛患者,可有效改善肩关节疼痛、肩关节功能和血液流变学。     

Normalizing surface electromyographic measures of the masticatory muscles: Comparison of two different methods for clinical purpose

PurposeTo compare a new normalization technique (wax pad, WAX) with the currently utilized cotton roll (COT) method in surface electromyography (sEMG) of the masticatory muscles.MethodssEMG of the masseter and anterior temporalis muscles of 23 subjects was recorded while performing two repetitions of 5 s maximum voluntary clenches (MVC) on COT and WAX. For each task, the mean value of sEMG amplitude and its coefficient of variation were calculated, and the differences between the two repetitions computed. The standard error of measurement (SEM) was calculated. For each subject and muscle, the COT-to-WAX maximum activity increment was computed. Participant preference between tasks was also recorded.ResultsWAX MVC tasks had larger maximum EMG amplitude than COT MVC tasks (P < 0.001), with COT-to-WAX maximum amplitude increments of 61% (temporalis) and 94% (masseter) (P = 0.006). WAX MVC had better test-retest repeatability than COT. For both MVC modalities, the mean amplitude (P > 0.391) and its coefficient of variation were unchanged (P > 0.180). The WAX task was the more comfortable for 18/23 subjects (P = 0.007).ConclusionWAX normalization ensures the same stability level of maximum EMG amplitude as COT normalization, but it is more repeatable, elicits larger maximum muscular contraction, and is felt to be more comfortable by subjects.     

Effects of a tongue training program in Parkinson's disease: Analysis of electrical activity and strength of suprahyoid muscles

ObjectiveTo assess the electrical activity of the suprahyoid muscle and the tongue pressure in a two-wing program of tongue strengthening in individuals with Parkinson's disease (PD).MethodsA pre-post-detraining design study included sixty PD patients assigned to two groups randomly. The experimental group (EG) performed tongue isometric pressure exercises using the Iowa Oral Performance Instrument with an increasing scheme of 5% load weekly and traditional tongue therapy for 8 weeks. The control group (CG) performed only traditional therapy. The electrical activity of suprahyoids was measured using surface electromyography (sEMG) during tongue-to-palate pressure. Four selected domains of the Swallowing Quality of Life Questionnaire (SWAL-QOL) mostly related to tongue strength were considered.ResultsThe experimental group showed increased sEMG values of suprahyoid muscles reaching statistically significant difference at the fourth week of tongue training, while the control did it at the eighth week. Experimental group showed significant improvements in tongue strength (d = 2.128; p = 0.000). Only controls showed detraining effect. Statistically significant difference within groups were found in one and three dimensions of the SWAL-QOL in the CG and EG, respectively.ConclusionAnalysis of electrical activity on suprahyoids muscles provided a better understanding of the changes underlying the outcomes of tongue strength gains obtained through a combined tongue strengthening exercises protocol in PD. Such protocol led not only to increased tongue strength but also to a better perceived swallowing function in PD subjects.     

Surface EMG pattern recognition for real-time control of a wrist exoskeleton

Background  

Surface electromyography (sEMG) signals have been used in numerous studies for the classification of hand gestures and movements and successfully implemented in the position control of different prosthetic hands for amputees. sEMG could also potentially be used for controlling wearable devices which could assist persons with reduced muscle mass, such as those suffering from sarcopenia. While using sEMG for position control, estimation of the intended torque of the user could also provide sufficient information for an effective force control of the hand prosthesis or assistive device. This paper presents the use of pattern recognition to estimate the torque applied by a human wrist and its real-time implementation to control a novel two degree of freedom wrist exoskeleton prototype (WEP), which was specifically developed for this work.     

三维旋进式振动疗法联合运动想象训练对脑卒中偏瘫患者上肢功能、平衡能力及日常生活活动能力的影响

摘要 目的：研究运动想象训练联合三维旋进式振动疗法对脑卒中偏瘫患者平衡能力、上肢功能及日常生活活动能力的影响。方法：研究对象来源于苏州市立医院康复医学科2019年4月~2022年4月期间收治的80例脑卒中偏瘫患者。入院后按照计算机产生随机数进行随机分配为对照组和研究组,每组各40例。对照组患者接受运动想象训练,研究组患者接受三维旋进式振动疗法联合运动想象训练。对比两组疗效、上肢功能、平衡能力及日常生活活动能力。结果：两组患者干预2周后、干预4周后Fugl-Meyer上肢运动功能量表（FM-uL）、上肢动作研究量表（ARAT）评分均升高,且研究组均高于对照组同期;改良Ashworth痉挛量表（MAS）评分均下降,且研究组低于对照组同期（P<0.05）。两组患者干预2周后、干预4周后Berg平衡量表（BBS）评分均升高,且研究组高于对照组同期（P<0.05）。两组患者干预2周后、干预4周后Barthel指数（BI）评分均升高,且研究组高于对照组同期（P<0.05）。结论：运动想象训练联合三维旋进式振动疗法干预脑卒中偏瘫患者,可有效改善患者的平衡能力、上肢功能及日常生活活动能力。     

Sensitivity and specificity of the flexion and extension relaxation ratios to identify altered paraspinal muscles’ flexion relaxation phenomenon in nonspecific chronic low back pain patients

BackgroundAmong the main methods used to identify an altered flexion relaxation phenomenon (FRP) in nonspecific chronic low back pain (NSCLBP), it has been previously demonstrated that flexion relaxation ratio (FRR) and extension relaxation ratio (ERR) are more objective than the visual reference method.ObjectiveTo determine the sensitivity and specificity of the different methods used to calculate the ratios in terms of their ability to identify an altered FRP in NSCLBP.MethodsForty-four NSCLBP patients performed a standing maximal trunk flexion task. Surface electromyography (sEMG) was recorded along the erector spinae longissimus (ESL) and multifidus (MF) muscles. Altered FRP based on sEMG was visually identified by three experts (current standard). Six FRR methods and five ERR methods were used both for the ESL and MF muscles. ROC curves (with areas under the curve (AUC) and sensitivity/specificity) were generated for each ratio.ResultsAll methods used to calculate these ratios had an AUC higher than 0.9, excellent sensitivity (>90 %), and good specificity (80–100 %) for both ESL and MF muscles.ConclusionBoth FRP ratios (FRR and ERR) for MF and ESL muscles, appear to be an objective, sensitive and specific method for identifying altered FRP in NSCLBP patients.     

Frequency of Thyroid Hormone Replacement After Lobectomy for Differentiated Thyroid Cancer

ObjectiveTo determine the frequency of levothyroxine (LT4) supplementation after therapeutic lobectomy for low-risk differentiated thyroid cancer (DTC).MethodsThis retrospective cohort study enrolled adult patients with low-risk DTC confirmed using surgical pathology who underwent therapeutic lobectomy at a single institution from January 2016 through May 2020. The outcome measures were postoperative serum thyroid-stimulating hormone (TSH) levels and the initiation of LT4. The predictors of a postoperative TSH level of >2 mU/L and initiation of LT4 were evaluated using Cox proportional hazards models.ResultsPostoperative TSH levels were available for 115 patients (91%), of whom 97 (84%) had TSH levels >2 mU/L after thyroid lobectomy. Over a median follow-up of 2.6 years, a postoperative TSH level of >2 mU/L was associated with older age (median 52 vs 37 years; P = .01), higher preoperative TSH level (1.7 vs 0.85 mU/L; P < .001), and primary tumor size of <1 cm (38% vs 11%, P = .03). Multivariate analysis revealed that only preoperative TSH level was an independent predictor of a postoperative TSH level of >2 mU/L (hazard ratio [HR] 1.53, P = .003). Among patients with a postoperative TSH level of >2 mU/L, 66 (68%) were started on LT4 at a median of 74 days (interquartile range 41-126) after lobectomy, with 51 (77%) undergoing at least 1 subsequent dose adjustment to maintain compliance with current guidelines.ConclusionMore than 80% of the patients who underwent therapeutic lobectomy for DTC developed TSH levels that were elevated beyond the recommended range, and most of these patients were prescribed LT4 soon after the surgery.     

Distinct tumor bacterial microbiome in lung adenocarcinomas manifested as radiological subsolid nodules

ObjectivesIncreasing evidence indicates that microbiota dysbiosis in the human body may play vital roles in carcinogenesis. However, the relationship between microbiome and lung cancer remains unclear. In this study, we aimed to characterize the microbiome in early stage of lung adenocarcinoma (LUAD), which presented as subsolid nodules (SSN) or solid nodules (SN).Materials and MethodsWe performed 16S rRNA sequencing of 35 pairs (10 SSN and 25 SN) of LUAD tumor tissues and paired adjacent normal tissues. Machine learning was used to identify microbial signatures and construct predictive models.ResultsSSN has higher microbiome richness and diversity compared with SN (richness p = 0.017, Shannon index p = 0.17), and the microbiome composition of SSN is distinct from that of SN (Bray-Curtis p = 0.013, unweighted unifrac p = 0.001). Phylum Chloroflexi (p = 0.009), Gemmatimonadetes (p = 0.018) and genus including Cloacibacterium (p = 0.003), Subdoligranulum (p = 0.002), and Mycobacterium (p = 0.034) were significantly increased in SSN. Tumor and normal tissues had similar richness and diversity, as well as overall microbiome composition. Probiotics with anti-cancer potential, like Lactobacillus, showed elevated levels in normal tissues (p = 0.018). A random forest model with 20 genera-based biomarkers achieved high accuracy for LUAD prediction (area under curve, AUC = 0.879). Meanwhile, a five genera-based signature can accurately discriminate SSN between SN (AUC = 0.950). Cross-validation of these two models also showed high predictive performance (LUAD AUC = 0.813, SSN AUC = 0.933).ConclusionsThis study demonstrates, for the first time, the tumor bacterial microbiome composition of LUAD manifested as SSN is distinct from that presented as SN, which adds new knowledge to SSN in the perspective of microbiome. Furthermore, microbiome signatures showed good performance to predict LUAD or SSN.     

智能化人机交互和场景模拟对脑卒中患者上肢运动功能的影响

摘要 目的：研究智能化人机交互和场景模拟对脑卒中患者上肢运动功能的影响,探索其在康复训练中的作用,为脑卒中患者康复提供新的治疗方法和方向。方法：选取2019年1月-2022年12月在我院接收治疗的80例脑卒中患者,按随机数字表法分为对照组和实验,每组40人,对照组接受常规康复治疗,实验组在常规康复治疗基础上增加智能化人机交互和场景模拟训练。比较两组Fugl-Meyer上肢运动功能量表评分（UE-FMA）、患者的生活自理能力Barthel指数、上肢功能测试（UEFT）,患侧上肢腕背伸肌的改良Ashworh评分（MAS）以及徒手肌力评估（MMT）。比较两组患者满意度评分。结果：治疗后,两组患者UE-FMA评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）;治疗后,两组患者MBI评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）;治疗后,两组患者UEFT评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）;治疗后,两组患者MMT评分与治疗前相比均提高,且实验组显著高于对照组（P<0.05）治疗后,两组患者MAS评分与治疗前相比均降低,且实验组显著低于对照组（P<0.05）;与对照组相比,实验组满意度95%,高于对照组80%（P<0.05）。结论：智能化人机交互和场景模拟训练对脑卒中患者的上肢运动功能有积极的影响,可以有效改善患者的康复效果。     

Idiopathic atrial fibrillation patients rapidly outgrow their low thromboembolic risk: a 10-year follow-up study

Background

Healthy atrial fibrillation (AF) patients will eventually outgrow their low thromboembolic risk. The purpose of this study is to compare the development of cardiovascular disease in healthy AF patients as compared to healthy sinus rhythm patients and to assess appropriate anticoagulation treatment.

Methods

Forty-one idiopathic paroxysmal AF patients (56 ± 10 years, 66% male) were compared with 45 healthy sinus rhythm patients. Patients were free of hypertension, antihypertensive and antiarrhythmic drugs, diabetes, congestive heart failure, coronary artery or peripheral vascular disease, previous stroke, thyroid, pulmonary and renal disease, and structural abnormalities on echocardiography.

Results

Baseline characteristics and echocardiographic parameters were the same in both groups. During 10.7 ± 1.6 years, cardiovascular disease and all-cause death developed significantly more often in AF patients as compared to controls (63% vs 31%, log rank p < 0.001). Even after the initial 5 years of follow-up, survival curves show divergent patterns (log rank p = 0.006). Mean duration to reach a CHA₂DS₂-VASc score > 1 among AF patients was 5.1 ± 3.0 years. Five of 24 (21%) patients with CHA₂DS₂-VASc > 1 did not receive oral anticoagulation therapy at follow-up. Mean duration of over- or undertreatment with oral anticoagulation in patients with CHA₂DS₂-VASc > 1 was 5 ± 3.0 years.

Conclusion

The majority of recently diagnosed healthy AF patients develop cardiovascular diseases with a consequent change in thromboembolic risk profile within a short time frame. A comprehensive follow-up of this patient category is necessary to avoid over- and undertreatment with anticoagulants.

     

通督调神针法联合穴位贴敷对老年气虚血瘀证缺血性脑卒中恢复期患者脑血流、血液流变学和血清NGF、BDNF的影响

摘要 目的：探讨通督调神针法联合穴位贴敷对老年气虚血瘀证缺血性脑卒中恢复期患者脑血流、血液流变学和血清神经生长因子（NGF）、脑源性神经营养因子（BDNF）的影响。方法：本次研究纳入我院于2021年3月~2022年5月期间收治的70例老年气虚血瘀证缺血性脑卒中恢复期患者。采用信封抽签法分为对照组（n=35）和观察组（n=35）。对照组接受常规治疗,观察组在对照组的基础上接受通督调神针法联合穴位贴敷治疗。对比两组疗效、美国国立卫生研究院卒中量表（NIHSS）评分、中医证候积分、脑卒中专用生活质量量表（SS-QOL）评分、Fugl-Meyer运动功能量表（FMA）评分、脑血流指标、血液流变学指标和NGF、BDNF水平。结果：观察组的临床总有效率为94.29%（33/35）,高于对照组的71.43%（25/35）（P<0.05）。观察组治疗4周后SS-QOL评分、FMA评分高于对照组同期,中医证候总积分、NIHSS评分低于对照组同期（P<0.05）。观察组治疗4周后血流阻力指数（RI）、搏动指数（PI）低于对照组同期,平均血流速度（Vm）高于对照组同期（P<0.05）。观察组治疗4周后全血低切黏度、血浆比黏度、全血高切黏度、纤维蛋白原均低于对照组同期（P<0.05）。观察组治疗4周后血清NGF、BDNF水平均高于对照组同期（P<0.05）。结论：通督调神针法联合穴位贴敷可有效改善老年气虚血瘀证缺血性脑卒中恢复期患者的脑血流、血液流变学,调节血清NGF、BDNF水平。     

Multi-parametric MRI lesion heterogeneity biomarkers for breast cancer diagnosis

PurposeTo identify intra-lesion imaging heterogeneity biomarkers in multi-parametric Magnetic Resonance Imaging (mpMRI) for breast lesion diagnosis.MethodsDynamic Contrast Enhanced (DCE) and Diffusion Weighted Imaging (DWI) of 73 female patients, with 85 histologically verified breast lesions were acquired. Non-rigid multi-resolution registration was utilized to spatially align sequences. Four (4) DCE (2^nd post-contrast frame, Initial-Enhancement, Post-Initial-Enhancement and Signal-Enhancement-Ratio) and one (1) DWI (Apparent-Diffusion-Coefficient) representations were analyzed, considering a representative lesion slice. 11 1^st-order-statistics and 16 texture features (Gray-Level-Co-occurrence-Matrix (GLCM) and Gray-Level-Run-Length-Matrix (GLRLM) based) were derived from lesion segments, provided by Fuzzy C-Means segmentation, across the 5 representations, resulting in 135 features. Least-Absolute-Shrinkage and Selection-Operator (LASSO) regression was utilized to select optimal feature subsets, subsequently fed into 3 classification schemes: Logistic-Regression (LR), Random-Forest (RF), Support-Vector-Machine-Sequential-Minimal-Optimization (SVM-SMO), assessed with Receiver-Operating-Characteristic (ROC) analysis.ResultsLASSO regression resulted in 7, 6 and 7 features subsets from DCE, DWI and mpMRI, respectively. Best classification performance was obtained by the RF multi-parametric scheme (Area-Under-ROC-Curve, (AUC) ± Standard-Error (SE), AUC ± SE = 0.984 ± 0.025), as compared to DCE (AUC ± SE = 0.961 ± 0.030) and DWI (AUC ± SE = 0.938 ± 0.032) and statistically significantly higher as compared to DWI. The selected mpMRI feature subset highlights the significance of entropy (1^st-order-statistics and 2^nd-order-statistics (GLCM)) and percentile features extracted from 2^nd post-contrast frame, PIE, SER maps and ADC map.ConclusionCapturing breast intra-lesion heterogeneity, across mpMRI lesion segments with 1^st-order-statistics and texture features (GLCM and GLRLM based), offers a valuable diagnostic tool for breast cancer.     

Mujeres mayores de 65 años que realizan ejercicio físico supervisado: diferencias en la capacidad física,la actividad física y la calidad de vida en función de su velocidad de la marcha

IntroductionWalking speed (WS) is an easy, quick and inexpensive measure that could be used to discern between older people with greater and lesser function and thus individualize physical exercise programs.ObjectivesTo analyze the differences in physical capacity, physical activity, and quality of life in people over 65 years of age who attended a physical exercise program according to their WS and age.Methods55 women (mean age: 76.67 ± 6.66 years) were divided into groups based on their WS (low WS: ≤ 1.59 m/s and high WS: > 1.59 m/s) and age (older-younger: ≤ 76 years and older-older: > 76 years). The following parameters were compared: 10 Meters Walk Test (10MWT), Arm Curl Test, Handgrip, Chair Stand Test, 8 Foot Up and Go Test (8FUG), 6 Minute Walk Test (6MWT), and the Minnesota and The Short Form-36 Health Survey (SF-36) questionnaires.ResultsThe level of physical activity was higher than 3000 METs/week in all groups. The high WS group had better results in the Arm Curl Test, 10MWT, 8FUG and 6MWT and in the Physical Role and Vitality dimensions of the SF-36 (P < .05). The older-older group had lower weight, BMI and Handgrip (P < .01).ConclusionsThe best results in physical capacity and quality of life are in those women with higher WS, suggesting that WS could be useful to individualize physical exercise programs.