Comparative analysis of sleep parameters and structures derived from wearable flexible electrode sleep patches and polysomnography in young adults.

Polysomnography (PSG) is the gold standard for clinical sleep monitoring, but its cost, discomfort, and limited suitability for continuous use present challenges. The flexible electrode sleep patch (FESP) emerges as an economically viable and patient-friendly solution, offering lightweight, simple operation, and self-applicable. Nevertheless, its utilization in young individuals remains uncertain. The objective of this study was to compare sleep data obtained by FESP and PSG in healthy young individuals and analyze agreement for sleep parameters and structure classification. Overnight monitoring with FESP and PSG recordings in 48 participants (mean age: 23 yr) was done. Correlation analysis, Bland-Altman plots, and Cohen's kappa coefficient assessed consistency. Sensitivity, specificity, and predictive values compared classification against PSG. FESP showed strong correlation and consistency with PSG for sleep monitoring. Bland-Altman plots indicated small errors and high consistency. Kappa values (0.70-0.84) suggested substantial agreement for sleep stage classification. Pearson correlation coefficient values for sleep stages (0.75-0.88) and sleep parameters (0.80-0.96) confirm that FESP has a strong application. Intraclass correlation coefficient yielded values between 0.65 and 0.97. In addition, FESP demonstrated an impressive accuracy range of 84.12-93.47% for sleep stage classification. The FESP also features a wearable self-test program with an error rate of no more than 8% for both deep sleep and wake. In young adults, FESP demonstrated reliable monitoring capabilities comparable to PSG. With its low cost and user-friendly design, FESP is a potential alternative for portable sleep assessment in clinical and research applications. Further studies involving larger populations are needed to validate its diagnostic potential.NEW & NOTEWORTHY By comparison with PSG, this study confirmed the reliability of an efficient, objective, low-cost, and noninvasive portable automatic sleep-monitoring device FESP, which provides effective information for long-term family sleep disorder diagnosis and sleep quality monitoring.

Evaluation of activities of daily living using an electronic version of the Longshi Scale in patients with stroke: reliability, consistency, and preference.

BACKGROUND: The Longshi Scale is a pictorial assessment tool for evaluating activities of daily living (ADL) in patients with stroke. The paper-based version presents challenges; thus, the WeChat version was created to enhance accessibility. Herein, we aimed to validate the inter-rater and test-retest reliabilities of the WeChat version of the Longshi Scale and explore its potential clinical applications. METHODS: We recruited 115 patients with stroke in the study. The ADL results of each patient were assessed using both the WeChat and paper-based version of the Longshi Scale; each evaluation was conducted by 28 health professionals and 115 caregivers separately. To explore the test-retest reliability of the WeChat version, 22 patients were randomly selected and re-evaluated by health professionals using the WeChat version. All evaluation criteria were recorded, and all evaluators were surveyed to indicate their preference between the two versions. RESULTS: Consistency between WeChat and the paper-based Longshi Scale was high for ADL scores by health professionals (ICC2,1 = 0.803-0.988) and caregivers (ICC2,1 = 0.845-0.983), as well as for degrees of disability (κw = 0.870 by professionals; κw = 0.800 by caregivers). Bland-Altman analysis showed no significant discrepancies. The WeChat version exhibited good test-retest reliability (κw = 0.880). The WeChat version showed similar inter-rater reliability in terms of the ADL score evaluated using the paper-based version (ICC2,1 = 0.781-0.941). The time to complete assessments did not differ significantly, although the WeChat version had a shorter information entry time (P < 0.001, 95% confidence interval: -43.463 to -15.488). Health professionals favored the WeChat version (53.6%), whereas caregivers had no significant preference. CONCLUSIONS: The WeChat version of the Longshi Scale is reliable and serves as a suitable alternative for health professionals and caregivers to assess ADL levels in patients with stroke. The WeChat version of the Longshi Scale is considered user-friendly by health professionals, although it is not preferred by caregivers. TRIAL REGISTRATION: This study was approved by the Ethics Committee of the Second People's Hospital of Shenzhen (approval number: 20210812003-FS01) and registered on the Clinical Trial Register Center website: clinicaltrials.gov on January 31, 2022 (registration no.: NCT05214638).

Validation of the Longshi scale in assessment of function in patients from different economic, educational and regional backgrounds in China.

OBJECTIVE: This study validates performance of the Longshi scale against modified Barthel index in assessment of function in patients from different economic, educational and regional backgrounds in China. DESIGN: This is a cross-sectional study. SETTING: One hundred and three hospitals and rehabilitation institutions across China. PARTICIPANTS: A total of 14,752 patients with physical and cognitive impairments were enrolled and classified to five educational levels and five family income levels; 8060 participants were further selected from five regions to study regional influences. MAIN MEASURES: Activities of daily living were assessed with two evaluation tools, the Longshi scale and modified Barthel index. Results of evaluation with Longshi scale performed by non-healthcare workers were validated against modified Barthel index performed by healthcare workers using Pearson's correlation test. RESULTS: There were significant positive correlations between the findings of the Longshi scale administered by non-healthcare professionals and the modified Barthel index administered by healthcare professionals. This was true for level of education (correlations ranged from 0.697 to 0.822), family income level (correlations ranged from 0.724 to 0.761) and region (correlations ranged from 0.737 to 0.776). CONCLUSION: In a large dataset of 14,752 patients, positive correlations were found between Longshi scale and modified Barthel index measures of function. Positive correlations persisted across subgroup analysis of groups from different social, economic and regional backgrounds, and with administration by non-healthcare professionals. CLINICAL TRIAL REGISTRATION: ChiCTR2000034067, www.chictr.org.cn.

Long-term care status for the elderly with different levels of physical ability: a cross-sectional survey in first-tier cities of China.

BACKGROUND: Long term care (LTC) services for functionally impaired senior citizens are crucial for addressing the challenges of aging. However, research on eligibility criteria and coverage of LTC in China is lacking. Our objective is to assess the current status of LTC and explore eligibility criteria and coverage for the elderly. METHODS: This is a cross-sectional study conducted in two first-tier cities in China. Residents aged 65 or over were recruited from a nursing home and four primary hospitals. Participants were divided into three groups (bedridden, domestic, and community), then six grades (grade one to six) according to the Longshi Scale, and their functional ability was assessed using the Modified Barthel Index. Information such as diseases, complications, and daily care needs were collected. Nursing staff were invited to indicate patients' needs for care. A one-way ANOVA test, Kruskal Wallis H test and Mann-Whitney U test were used to explore the differences of variables in three Longshi groups or Longshi grades. RESULTS: Among all 1157 participants, with an average age of 80.54, 69.3% were in the bedridden group. The most common diagnosis was stroke (71.4%), with the most prevalent complication being pulmonary infection (25.2%). In the nursing assessment, basic health care, disease care, activity care, complication prevention care and psychosocial care were summarized as the five main aspects of LTC for the elderly. Feeding, bathing, drinking, bowel management and bladder management were identified as the basic care which fulfills participants' basic physical needs in each Longshi group. Mouth care, artificial airway management, and body reposition, which can prevent immobility complications, were highly demanded by bedridden elderly. CONCLUSIONS: The elderly in grade one to three are the ones in need of LTC most. The content of LTC for elderly should include basic care which fulfills their basic physical needs and complication care which can prevent immobility complications. The evidence of this research may contribute to the design of LTC in China. TRIAL REGISTRATION: The study design was registered in the Chinese Clinical Trial Registry (ChiCTR-2000034067, Registered 22 Jun 2020, http://www.chictr.org.cn/showproj.aspx?proj=54770 ).

A Condition Evaluation Simplified Method for Traction Converter Power Module Based on Operating Interval Segmentation.

In the actual operation of urban rail vehicles, it is essential to evaluate the condition of the traction converter IGBT modules. Considering the fixed line and the similarity of operation conditions between adjacent stations, this paper proposes an efficient and accurate simplified simulation method to evaluate IGBT conditions based on operating interval segmentation (OIS). Firstly, this paper proposes the framework for a condition evaluation method by segmenting operating intervals based on the similarity of average power loss between neighboring stations. The framework makes it possible to reduce the number of simulations to shorten the simulation time while ensuring the state trend estimation accuracy. Secondly, this paper proposes a basic interval segmentation model that uses the operating conditions as inputs to implement the segmentation of the line and is able to simplify the operation conditions of entire line. Finally, the simulation and analysis of the temperature and stress fields of IGBT modules based on segmented intervals completes the IGBT module condition evaluation and realizes the combination of lifetime calculation with actual operating conditions and internal stresses. The validity of the method is verified by comparing the interval segmentation simulation with actual test results. The results show that the method can effectively characterize the temperature and stress trends of traction converter IGBT modules in the whole line, which could support the fatigue mechanism and lifetime assessment reliability study of IGBT modules.

Reliability of Longshi scale with remote assessment of smartphone video calls for stroke patients' activities of daily living.

OBJECTIVES: The impairment of activities of daily living (ADL) has brought a heavy burden to the life of patients after stroke. Timely and accurate assessment of patients' activities of daily living is very necessary, which determines the whole process of diagnosis, rehabilitation and prognosis of patients. However, the patients with limited mobility or transportation are difficulted to gain high quality assessment services. This study aimed to explore the reliability of remote Longshi Assessment Scale of Activities of Daily Life (Longshi Scale) with smartphone video calls by comparing the consistency of remote assessment and bedside assessment, as well as the test-retest reliability of the remote assessment. The evaluation duration of these two methods was recorded and the level of satisfaction of patients was investigated. METHODS: In this prospective study, a total of 129 stroke survivors were recruited and accepted a bedside face-to-face assessment and a remote assessment by video calls. The Longshi Scale was used for both bedside and remote assessment and conducted with the inquiry between patients and evaluators. A satisfaction questionnaire was also launched. RESULTS: The result of disability level evaluated from the bedside and remote assessments was highly consistent. The intraclass correlation coefficient with weighted kappa (wK) value was 0.86 (95% confidence interval, 0.80∼0.92). And test-retest of the remote assessment indicated an excellent agreement beyond chance, and its correlation coefficient with wK value was 0.96 (95% confidence interval, 0.92∼1.00). It took 74.44±55.3 s to complete the bedside assessment and 90.86±63.30 s to complete the remote assessment of Longshi Scale. There was no statistical significance in the assessment duration between these two methods (P = 0.056). Satisfaction surveys showed more than 85% of participants were satisfied or very satisfied with remote Longshi scale assessment. CONCLUSIONS: The remote assessment of Longshi Scale with smartphone video calls is reliable and has high acceptance. This method can be readily implemented to evaluate the ADL of stroke patients to improve the capacity of rehabilitation and health services in remote areas.

Functional status and its related factors among stroke survivors in rehabilitation departments of hospitals in Shenzhen, China: a cross-sectional study.

BACKGROUND: Many stroke survivors have multiple chronic diseases and complications coupled with various other factors which may affect their functional status. We aimed to investigate the factors associated with poor functional status in hospitalized patients with stroke in Shenzhen, China. METHODS: In this cross-sectional study, four urban hospitals were selected using convenient sampling, and all stroke patients in these four hospitals were included using cluster sampling. The functional status of stroke survivors was evaluated using Longshi Scale. Explanatory variables (factors affecting functional status comprising age, sex, body mass index, smoking, alcohol consumption, complications, and chronic conditions) were collected. Ordinal logistic regression was used to examine which factors were associated with poor functional status. RESULTS: Stroke survivors with poor functional status accounted for 72.14% and were categorised as the bedridden group based on Longshi scale, 21.67% of patients with moderate functional limitation were categorised as the domestic group, and 6.19% of the patients with mild functional restriction were categorised as the community group. The highest dependence scores were noted for feeding (73.39%), bowel and bladder management (69.74%) and entertainment (69.53%) among the bedridden group, and housework (74.29%) among the domestic group. In the adjusted model, the odds of poor functional status were higher among stroke patients with older age (odds ratio [OR] = 2.39, 95% CI: 1.55-3.80), female sex (OR = 1.73, 95% CI: 1.08-2.77), duration of stroke more than 12 months (OR = 1.94, 95% CI: 1.28-2.95), with pulmonary infection (OR = 10.91, 95% CI: 5.81-20.50), and with deep venous thrombosis (OR = 3.00, 95% CI: 1.28-7.04). CONCLUSIONS: Older adults (age ≥ 60 years) and women were more likely to exhibit poor functional status post-stroke. Pulmonary infection and deep venous thrombosis were related to an increased risk of being dependent on activities of daily living. Therefore, clinical and rehabilitation interventions aimed at preventing or treating these common complications should be addressed to deal with subsequent dysfunction post-stroke. Since all data were obtained in metropolitan areas where the economy is well developed, future studies should be conducted in rural areas and economically less developed cities.

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China.

BACKGROUND: Multiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients. METHODS: A multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60-90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability. RESULTS: A total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89-64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89-64.69) for moderate disability than those without social isolation and MCDs. CONCLUSIONS: MCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs. TRIAL REGISTRATION: NO: ChiCTR2000034067 .

Relationship of Barthel Index and its Short Form with the Modified Rankin Scale in acute stroke patients.

BACKGROUND: Modified Rankin Scale and Barthel Index are the most common scales for assessing stroke outcomes in clinical practice and trials. Concordance between the Barthel Index scores and the modified Rankin Scale grades is important to define favorable outcome in clinical practice and stroke trials consistently. The purpose of this study was to examine the relationship between the scores of Barthel Index and 3-item Barthel Index Short Form with the modified Rankin Scale grades of acute stroke patients. METHODS: Barthel Index, Barthel Index Short Form scores and modified Rankin Scale grades of 516 stroke patients were obtained from a follow-up study of the Longshi Scale in China. A study showed that the assignment of modified Rankin Scale grades to stroke patients was prone to misclassification. Therefore, the recorded modified Rankin Scale grades were compared with the Barthel Index scores of each patient to produce the adjusted modified Rankin Scale grades. Receiver operating characteristics curve analyses were performed to determine the optimal cutoff scores, respective sensitivities and specificities of Barthel Index and Barthel Index Short Form with the corresponding adjusted modified Rankin Scale grades ≤1, ≤2 and ≤3. FINDINGS: About 44% of the recorded modified Rankin Scale grades of patients required adjustment. The optimal cutoff scores were ≥100 (sensitivity 100%; specificity 95.3%), ≥100 (sensitivity 98.1%; specificity 100%) and ≥75 (sensitivity 93.8%; specificity, 91.9%) for the Barthel Index and ≥40 (sensitivity 100%; specificity 78.9%), ≥40 (sensitivity 98.1%; specificity 82.8%), and ≥35 (sensitivity 99.3%; specificity, 91.6%) for the Barthel Index Short Form corresponding to the adjusted modified Rankin Scale grade ≤1, ≤2, and ≤3 respectively. The areas under the receiver operating characteristic curves were nearly all above 0.9. CONCLUSIONS: The optimal cutoff scores of Barthel Index and Barthel Index Short Form corresponding to the modified Rankin Scale grades ≤1, ≤2 and ≤3 were recommended to be ≥100 and ≥40, ≥100 and ≥40, and ≥75 and ≥35 respectively for determining the favorable and unfavorable outcome of stroke patients within three months of onset in clinical practice and trials.

A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients.

OBJECTIVE: To evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients. DESIGN: A single-blind randomized controlled trial using computer-generated simple randomization. SETTING: Participants recruited from inpatients at the Guangdong Provincial Hospital of Chinese Medicine. SUBJECTS: A total of 120 patients with stroke were divided into two groups. INTERVENTIONS: All subjects underwent basic rehabilitation training and wheelchair assistance with eight weeks follow-up period. Patients in the treatment group additionally received modified wheelchair arm-support for at least 60 minutes a day, six days a week, for four weeks. OUTCOME MEASURES: Primary outcome was measured by the Visual Analogue Pain Scale or Numeric Pain Rating Scale. Secondary outcome was measured using the Upper Extremity Fugl-Meyer Assessment scale, Modified Barthel Index and Quality of Life Index. Measurements were made at 4 weeks and 12 weeks, following the intervention. RESULTS: Patients age from 21 to 83 years (mean ± SD = 62.41 ± 12.26). The average duration of disease was 1.9 ± 1.3 months. At four weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.75 vs. 2, 3.75; P = 0.059). At 12 weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.00 vs. 0, 1.00; P < 0.001). At 12 weeks, patients with shoulder pain were higher in the control group (6 vs. 1; P < 0.05). CONCLUSION: Using the modified wheelchair arm-support could lead to the mitigation of hemiplegic shoulder pain and reduction in pain incidence in stroke patients. It may also improve the patients' quality of life.

Buyang Huanwu decoction facilitates neurorehabilitation through an improvement of synaptic plasticity in cerebral ischemic rats.

BACKGROUND: Loss of neural function is a critical but unsolved issue after cerebral ischemia insult. Neuronal plasticity and remodeling are crucial for recovery of neural functions after brain injury. Buyang Huanwu decoction, which is a classic formula in traditional Chinese medicine, can positively alter synaptic plasticity. This study assessed the effects of Buyang Huanwu decoction in combination with physical exercise on neuronal plasticity in cerebral ischemic rats. METHODS: Cerebral ischemic rats were administered Buyang Huanwu decoction and participated in physical exercise after the induction of a permanent middle cerebral artery occlusion. The neurobehavioral functions and infarct volumes were evaluated. The presynaptic (SYN), postsynaptic (GAP-43) and cytoskeletal (MAP-2) proteins in the coronal brain samples were evaluated by immunohistochemistry and western blot analyses. The ultrastructure of the neuronal synaptic junctions in the same region were analyzed using transmission electron microscopy. RESULTS: Combination treatment of Buyang Huanwu decoction and physical exercise ameliorated the neurobehavioral deficits (p < 0.05), significantly enhanced the expression levels of SYN, GAP-43 and MAP-2 (p < 0.05), and maintained the synaptic ultrastructure. CONCLUSIONS: Buyang Huanwu decoction facilitated neurorehabilitation following a cerebral ischemia insult through an improvement in synaptic plasticity. Graphical abstract The Buyang Huanwu decoction (BYHWD) combined with physical exercise (PE) attenuates synaptic disruption and promotes synaptic plasticity following cerebral ischemia (stroke).

[Effect of Comprehensive Protocol of Integrative Medicine on Motor Function, Activity of Daily Living and Quality of Life in Hemiplegia Patients after Stroke].

OBJECTIVE: To explore the effects of integrative medicine (IM) rehabilitation protocolon motor function, activity of daily living, and quality of life (QOL) in hemiplegia patients after stroke. METHODS: Totally 120 patients with post-stroke hemiplegia were allocated to four groups using sealed envalope drawing, i.e., the rehabilitation group, the Chinese medical treatment group, the acupuncture group, and the comprehensive rehabilitation group, 30 cases in each group. Based on routine rehabilitative training, patients in the Chinese medical treatment group, the acupuncture group, and the compre-hensive rehabilitation group received standardized treatment based on syndrome typing, Shi's Consciousness-Restoring Resuscitation acupuncture, Chinese herbs + acupuncture comprehensive rehabilitatino protocol, respectively. The treatmet cycle consisted of 4 weeks with 24-week follow-ups. Fugl-Meyer motor assessment (FMA), Modified Barthel Index (MBI), and Stroke-Specific Quality of Life Scale(SS-QQL), and safety assessment were taken as main effect indices before treatment, at week 4 of treatment, at week 12 and 24 of follow-ups, respectively. RESULTS: There was no statistical difference in FMA score, MBI score, SS-QOL score among the four groups before treatment (P > 0.05). These scores were significantly improved in the four groups at week 4 of treatment, week 12 and 24 of follow-ups, respectively (P < 0.05). Besides, FMA score and SS-QOL score were significantly improved in the comprehensive rehabilitation group at each corresponding time point, as compared with other treatment groups (P < 0.05). CONCLUSIONS: The comprehensive protocol could significantly improve motor function, activity of daily living in hemiplegia patients after stroke, and further improve their QOL. Its effect was better than other single treatment.

Comparative effectiveness of exercise on cardiorespiratory function or exercise efficiency after stroke: A network meta-analysis of randomized control trials.

OBJECTIVE: The network meta-analysis (NMA) was to compare and rank the effectiveness of different exercises on cardiorespiratory function or exercise efficiency in post-stroke patients. DESIGN: A NMA of randomized controlled trials (RCTs) was conducted. PubMed, Embase, Cochrane Library, and Web of Science were searched. The impact of exercises including individual and combination of aerobic exercise (AE), resistance exercise (RE), task-oriented training (TOT), gait training (GT), breathing exercise (BE), and regular rehabilitation training (RRT) on 6-min walk test (6MWT), peak oxygen consumption (VO2peak), maximum oxygen consumption (VO2max), resting heart rate (HRrest), resting systolic blood pressure (SBPrest), and resting diastolic blood pressure (DBPrest) were assessed. RESULTS: In total, 36 studies were included in the meta-analysis. AEGT (AE + GT) (63.06%) had the highest likelihood of improving 6MWT performance in post-stroke patients. RRTRE (RRT + RE) was the most favourable exercise in terms of 6MWT performance assessing by minimum clinically significant difference (MCID). AERE (AE + RE) had the highest likelihood of improving VO2peak and reducing HRrest in post-stroke patients. CONCLUSION: Different types of exercise demonstrated the benefits of improving cardiorespiratory function in stroke patients. Further research is needed to determine the best exercise regimen to maximize the benefits of rehabilitation interventions for post-stroke patients.

Association between N-terminal pro-B-type natriuretic peptide and clinical outcomes in bedridden patients with stroke: a cross-sectional study.

OBJECTIVES: Patients with stroke often remain bedridden despite rehabilitation. Serum N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels increase after stroke. Our study aimed to investigate the difference in NT-pro-BNP levels between bedridden and non-bedridden patients with stroke and to explore the factors influencing NT-pro-BNP levels in bedridden patients. DESIGN: A single-centre, cross-sectional study. SETTING: This study was conducted in a hospital, Shenzhen, China. PARTICIPANTS: Between January 2019 and December 2022, 465 participants were included in this study. OUTCOME MEASURES: The collected data included basic information, laboratory data and echocardiographic parameters. Binary logistic regression analysis and receiver operating characteristic curves were used to identify factors associated with high NT-pro-BNP levels. RESULTS: Bedridden patients with stroke had higher levels of NT-pro-BNP, D-dimer, high-sensitivity C reactive protein (hs-CRP) and lower levels of creatinine, high-density lipoprotein cholesterol, albumin and haemoglobin, as well as lower left ventricular ejection fraction, fractional shortening and the ratio between the peak velocities of early and late diastolic filling than non-bedridden patients. In bedridden patients, age ≥75 years, high levels of hs-CRP and creatinine, and low levels of albumin were associated with high NT-pro-BNP levels. In non-bedridden patients, age ≥75 years and high creatinine levels were associated with high NT-pro-BNP levels. In bedridden patients with stroke, the area under the curve (AUC) of hs-CRP was 0.700 (p<0.001, 95% CI 0.638 to 0.762) with a cut-off value of 5.12 mg/L. The AUC of albumin was 0.671 (p<0.001, 95% CI 0.606 to 0.736) with a cut-off value of 37.15 g/L. CONCLUSIONS: NT-pro-BNP levels were higher in bedridden patients with stroke than in non-bedridden patients. Decreased albumin and elevated hs-CRP levels were associated with high levels of NT-pro-BNP in bedridden patients. Further studies are needed to explore the risk stratification and potential treatments for elevated NT-pro-BNP in bedridden patients with stroke.

Inverted U-shaped relationship between Barthel Index Score and falls in Chinese non-bedridden patients: a cross-sectional study.

BACKGROUND: Performing activities of daily living comprise an important risk factor for falls among non-bedridden stroke inpatients in rehabilitation departments. OBJECTIVES: To explore the correlation between Barthel Index score and the occurrence of falls in non-bedridden stroke rehabilitation inpatients. METHODS: In this cross-sectional study, information of patients grouped as non-bedridden patients by the Longshi Scale was collected. RESULTS: A total of 3097 patients were included in this study, with a fall incidence of 10.43%. After adjusting covariates, the total score of Barthel Index and falls in non-bedridden inpatients after stroke presented an inverted U-shaped curve relationship, in which inflection point was 60. The effect sizes on the left and right sides of infection point were 1.02 (95%CI 1.00-1.04) and 0.97 (95%CI 0.96-0.99), respectively. CONCLUSIONS: Non-bedridden stroke patients with moderate activities of daily living (ADL) capacity may be at particularly increased risk of falls in rehabilitation departments.

Unravelling oncosis: morphological and molecular insights into a unique cell death pathway.

Programmed cell death (PCD) is a fundamental biological process for maintaining cellular equilibrium and regulating development, health, and disease across all living organisms. Among the various types of PCD, apoptosis plays a pivotal role in numerous diseases, notably cancer. Cancer cells frequently develop mechanisms to evade apoptosis, increasing resistance to standard chemotherapy treatments. This resistance has prompted extensive research into alternative mechanisms of programmed cell death. One such pathway is oncosis, characterized by significant energy consumption, cell swelling, dilation of the endoplasmic reticulum, mitochondrial swelling, and nuclear chromatin aggregation. Recent research suggests that oncosis can impact conditions such as chemotherapeutic cardiotoxicity, myocardial ischemic injury, stroke, and cancer, mediated by specific oncosis-related proteins. In this review, we provide a detailed examination of the morphological and molecular features of oncosis and discuss various natural or small molecule compounds that can induce this type of cell death. Additionally, we summarize the current understanding of the molecular mechanisms underlying oncosis and its role in both normal physiology and pathological conditions. These insights aim to illuminate future research directions and propose innovative strategies for leveraging oncosis as a therapeutic tool against human diseases and cancer resistance.

Effect of five different body positions on lung function in stroke patients with tracheotomy.

BACKGROUND: In stroke patients with tracheotomy, reduced lung function heightens pulmonary infection risk. Body position can affect lung function; however, its impact in stroke patients with tracheostomy remains unclear. OBJECTIVE: To investigate the influence of five body positions on pulmonary function in stroke patients with tracheotomy. METHODS: Pulmonary function was assessed in five body positions (supine, supine 30°, supine 60°, sitting, and prone) in 47 stroke patients who underwent tracheotomy. Diaphragmatic excursion during quiet breathing (DEQ), diaphragmatic thickening fraction during quiet breathing (DTFQ), and diaphragmatic excursion during coughing (DEC) were measured using ultrasound. Peak cough flow (PCF) was measured using an electronic peak flow meter. RESULTS: Different positions had a significant impact on DEQ, DEC, and PCF in stroke patients with tracheotomy, although not on DTFQ. DEQ showed no significant differences between supine 60°, sitting, and prone positions. Both DEC and PCF reached their maximum values in the sitting position. In the sub-group analysis, DEQ in females did not show significant differences across different positions. Both males and females exhibited significantly higher PCF in the sitting compared to supine position. The lung function of obese patients was significantly better in the sitting than in the supine and supine 30° position. Regardless of the patient's level of consciousness and whether the brainstem was injured, lung function in the sitting position was significantly higher than in the supine position. CONCLUSIONS: Body posture influences lung function in stroke patients with tracheotomy. Patients should adopt a sitting position to enhance pulmonary function.

Exploring the association between activities of daily living ability and injurious falls in older stroke patients with different activity ranges.

Injurious falls pose a significant threat to the safety of stroke patients, particularly among older adults. While the influence of activities of daily living (ADL) on falls is acknowledged, the precise connection between ADL ability and fall-related injuries in older stroke patients undergoing rehabilitation, particularly those with varying mobility levels, remains unclear. This multicenter cross-sectional study in China recruited 741 stroke patients aged 65 years and above, categorized into bedridden, domestic, and community groups based on their mobility levels using the Longshi Scale. ADL ability was assessed using the Barthel Index. Logistic regression models, generalized additive models, smoothed curve-fitting, and threshold effect analysis were employed to explore the relationship between ADL ability and injurious falls across the three mobility groups. Results revealed an inverted U-shaped relationship between ADL ability and injurious falls among patients in the domestic group (p = 0.011). Below the inflection point of 35 on the Barthel Index, the likelihood of injurious falls increased by 14% with each unit increase in ADL ability (OR = 1.14, 95% CI 1.010-1.29, p = 0.0331), while above the inflection point, it decreased by 3% per unit increase (OR = 0.97, 95% CI 0.95-0.99, p = 0.0013). However, no significant association between ADL ability and injurious falls was observed in either the bedridden or community groups (p > 0.05). These findings suggest that only older stroke patients capable of engaging in activities at home demonstrate a correlation between ADL ability and injurious falls. The identified inverted U-shaped relationship may aid in identifying fall injury risk in this population.

Comparison of Diagnosis-Related Group Rehabilitation Reimbursement Payments With Those of a Novel Patient Classification-Based Payment System.

Objective: To compare the difference of reimbursement payments between diagnosis-related group (DRG) and a novel patient classification-based payment system, diagnosis-intervention packet (DIP), among rehabilitation inpatients in tertiary hospitals. Design: Retrospective cohort study. Setting: TTertiary hospitals in Shenzhen, China. Participants: We assessed the records of 268,362 individuals who visited tertiary hospitals providing rehabilitation services. Interventions: Not applicable. Main Outcome Measures: The outcome variable was the patients' rehabilitation hospitalization cost of in our study. A quantile regression analysis was conducted to estimate the effects of DIP payment on the rehabilitation hospitalization cost. Results: The results showed that the predicted marginal hospitalization cost with DRG payment were 9%, 7%, 14%, and 10% higher than that with DIP payments in 2019, 2020, 2021, and 2022. The total difference in predicted marginal hospitalization cost between DRG and DIP was -1269 RMB (-193 USD). This difference in 2019, 2020, 2021, and 2022 was -1419 RMB (-228 USD), -1088 RMB (-158 USD), -1585 RMB (-246 USD), and -1034 RMB (-154 USD), respectively. All differences in predicted marginal hospitalization cost between DRG and DIP was significant (P<.001), after controlling for patients' age, sex, public or private hospital, the type of disease, and the length of stay of hospitalization. Conclusions: The findings of DIP payment reduced the rehabilitation hospitalization cost would be helpful in developing more effectively and efficiently tailored interventions for rehabilitation health care in China. Furthermore, the results of this study could provide advice on building more effective strategies and intervention options for other countries that struggle with controlling rehabilitation hospitalization costs.

Reliability and validity of a graphical computerized adaptive test Longshi scale for rapid assessment of activities of daily living in stroke survivors.

Stroke survivors frequently experience difficulties in daily activities, such as bathing, feeding, and mobility. This study aimed to evaluate the reliability and validity of a computer-adaptive test-Longshi scale (CAT-LS) for assessing activities of daily living (ADL) in stroke survivors. This cross-sectional study collected data using an electronic application. The ADL function of stroke survivors in rehabilitation departments of hospitals was assessed using both the CAT-LS and BI. Correlations between the CAT-LS and Barthel index (BI) and concurrent validity were evaluated using Pearson's correlation test and multiple linear regression. Interrater reliability was evaluated using the intraclass correlation coefficient based on a two-way random effect. The internal consistency of the CAT-LS was assessed using Cronbach's coefficient (α) and corrected item-total correlations. Overall, 103 medical institutions in China were used in this study. In total, 7151 patients with stroke were included in this study. The CAT-LS classified patients into three ADL groups (bedridden, domestic, and community) with significantly different BI scores (P < 0.05). The CAT-LS results obtained using the decision-tree scoring model were consistent with the scores for each BI item. A strong correlation was observed between CAT-LS and BI (Pearson's r: 0.6-0.894, P < 0.001). The CAT-LS demonstrated good internal consistency (Cronbach's α, 0.803-0.894) and interrater reliability (ICC, 0.928-0.979). CAT-LS is time-efficient and requires < 1 min to administer. The CAT-LS is a reliable and valid tool for assessing ADL function in stroke survivors and can provide rapid and accurate assessments that reduce the burden on healthcare professionals. Further validation of this tool in other populations and settings is necessary.Study registration number: No.: ChiCTR2000034067; http://www.chictr.org.cn/showproj.aspx?proj=54770 .