Effect of repetitive transcranial magnetic stimulation-assisted training on lower limb motor function in children with hemiplegic cerebral palsy.

OBJECTIVE: To explore the effect of repetitive transcranial magnetic stimulation (rTMS)-assisted training on lower limb motor function in children with hemiplegic cerebral palsy (HCP). METHOD: Thirty-one children with HCP who met the inclusion criteria were selected and randomly divided into a control group (n = 16) and an experimental group (n = 15). The control group received routine rehabilitation treatment for 30 min each time, twice a day, 5 days a week for 4 weeks. Based on the control group, the experimental group received rTMS for 20 min each time, once a day, 5 days a week for 4 weeks. The outcome measures included a 10-metre walk test (10MWT), a 6-minute walk distance (6MWD) test, D- and E-zone gross motor function measurements (GMFM), the symmetry ratio of the step length and stance time and the muscle tone of the triceps surae and the hamstrings (evaluated according to the modified Ashworth scale), which were obtained in both groups of children before and after treatment. RESULTS: After training, the 10MWT (P < 0.05), 6MWD (P < 0.01), GMFM (P < 0.001) and the symmetry ratio of the step length and stance time of the two groups were significantly improved (P < 0.05), there was more of an improvement in the experimental group compared with the control group. There was no significant change in the muscle tone of the hamstrings between the two groups before and after treatment (P > 0.05). After treatment, the muscle tone of the triceps surae in the experimental group was significantly reduced (P < 0.05), but there was no significant change in the control group (P > 0.05). CONCLUSION: Repetitive TMS-assisted training can improve lower limb motor function in children with HCP.

Effects of robotic-assisted gait training on motor function and walking ability in children with thoracolumbar incomplete spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI.

[Output characteristics of rainfall runoff phosphorus pollution from a typical small watershed in Yimeng mountainous area].

Relationships between phosphorus pollutant concentrations and precipitation-runoff were analyzed by monitoring pollutant losses at outlets of the Menglianggu watershed in 2010. A typical small watershed was selected to examine the runoff and quality parameters such as total phosphorus (TP), particle phosphorus (PP), dissolve phosphorus (DP) and dissolve inorganic phosphorus (DIP) in rainfall-runoff of 10 rainfall events. Precipitation was above 2 mm for all the 10 rainfall events. The results showed that the peak of phosphorus concentrations occurred before the peak of water flows, whereas change processes of the phosphorus fluxes were consistent with that of the water flows and the phosphorus flux also have a strong linear relationship with the water flows. The minimums of the phosphorus concentrations in every 10 natural rainfall events have small differences with each other, but the maximum and EMCs of the phosphorus concentrations have significant differences with each rainfall event. This was mainly influenced by the precipitation, maximum rainfall intensity and mean rainfall intensity (EMCs) and was less influenced by rainfall duration. DP and TP were mainly composed of DIP and PP, respectively. There were no significant correlations between DIP/DP dynamic changes and rainfall characteristics, whereas significant correlations between PP/TP dynamic changes and maximum rainfall intensity were detected. The production of DIP, DP, AND TP were mainly influenced by the direct runoff (DR) and base flow (BF). The EMCs of DIP, DP, TP and the variations of DIP/DP were all found to have significant polynomial relationships with DR/TR., but the dynamic changes of PP/ TP and the EMCS of PP were less influenced by the DR/TR.

[Output characteristics of non-point phosphorus from a typical small watershed in Yimeng mountainous area under the special rainfall].

The relationships between pollutant concentrations and precipitation-runoff combined with the first and maximum intensity natural rainfall events were monitored at the outlets of the Menglianggu watershed in 2010. The results showed that dissolved organic phosphorus (DOP), dissolved inorganic phosphorus (DIP), total dissolved phosphorus (DP), total particle phosphorus (PP) and total phosphorus (TP) concentrations in the first rainfall were higher than those in the maximum intensity rainfall which was the largest average rainfall intensity, but the output of phosphorusin the first rainfall was all higher than that in the maximum intensity rainfall except dissolved organic phosphorus. The DOP, DIP, DP, PP and TP in two special rainfall events contributed 48%, 81%, 70%, 87% and 81% of the total output of rainy season. DP and TP were mainly composed by DIP and PP respectively. The two special rainfalls have the first flush effect and the maximum intensity rainfall was stronger than the first rainfall, so the analysis of M (V) curve showed that the priority should be given to the interception of corresponding phosphorus under special events. The regression analysis results showed that a linear relation existed between runoff and nutrient output, but there were some differences which the slope of the linear equation of the first rainfall was higher than that of the maximum intensity rainfall. Reducing agricultural practices such as tillage and fertilization during special rainfall period and building canals, ponds are effective ways for mitigating agricultural non-point source pollution.

[Soil and water losses and phosphorus output at the places between ridges in sloping peanut land under different planting modes in Yimeng mountainous area of Shandong Province, East China].

Taking the typical land use type, sloping Arachis hypogaea land, in Yimeng mountainous area of Shandong as study object, an in-situ fixed-point field experiment was conducted to study the characteristics of soil and water losses and phosphorus output at the places between ridges in the sloping land under different planting modes (Arachis hypogaea + Cynodon dactylon, I; A. hypogae + Melilotus officinalis, II; A. hypogaea + Lolium multiflorum, III; A. hypogaea + Trifolium repens, IV; A. hypogaea + blank control, V). Planting grasses at the places between ridges could effectively decrease the soil and water losses. The runoff was 55.1%-61.3% of the control, and decreased in the order of II > I > IV> III. The sediment loss was 3.4% -32.3% of the control, and decreased in the order of IV > II > I > 11. A. hypogaea + L. multiflorum was effective in storing water and retaining sediment. During the early period of planting L. multiflorum, the sediment loss was more affected by rainfall and presented a fluctuated variation, but in late period, the sediment loss decreased continuously and performed more stable, and accordingly, the sediment retention increased continuously. Planting grasses effectively decreased the output of phosphorus, with the decrease of total phosphorus (TP) output being 52.8%-75.3% of the control, and was in the order of I > II > IV > III. As compared with the control, planting grasses decreased 27.5% -67.0% of the output of particle phosphorus (PP), but relatively increased the output of dissolvable phosphorus (DP). A. hypogaea + L. multiflorum had the best effect in decreasing the output of phosphorus, with the outputs of TP and PP being 58.4% and 27.5% of the control, respectively. In the growth period of the vegetations, the losses of different phosphorus forms differed, and the dissolvable inorganic phosphorus was the main form of the output of DP during whole rain season. After the peanut harvested, the output of different phosphorus forms in the first rainfall was much higher than that in the maximum intensity rainfall.

[Comparative study of N, P output and eutrophication risk in runoff water in cross ridge and longitudinal ridge].

Field in-situ rainfall simulation tests with two rainfall intensities (40 mm x h(-1) and 70 mm x h(-1)), which were conducted at typical sloping cropland in Yimeng mountainous area, were designed to analyze the output characteristics of dissolved inorganic nitrogen, Inorganic-N (NO3(-)-N, NH4(+) -N) and dissolved phosphorus (DP) in runoff water, as well as to compare the eutrophication risk in this water by calculating three ratios of Inorganic-N/DP, NO3(-) -N/DP, and NH4(+)-N/DP, respectively, in cross ridge and longitudinal ridge tillage methods. Results showed that, under the same rainfall intensity, the DP level in runoff water was higher in cross ridge than longitudinal ridge, while the change of different Inorganic-N level between the two tillage methods were not consistent. Cross ridge could effectively reduce runoff and the output rate of Inorganic-N and DP when compared to the longitudinal ridge tillage, which would be more outstanding with the increases of rainfall intensities. The losses of Inorganic-N and DP in runoff water were 43% and 5% less, respectively, in cross ridge than longitudinal ridge at the 40 mm x h(-1) rainfall intensity, and were 68% and 55%, respectively, at 70 mm x h(-1). The higher Inorganic-N/DP and NO3(-) -N/DP ratios suggest that runoff water from either cross ridge or longitudinal ridge tillage have a certain eutrophication risk, which present an increasing trend during the precipitation-runoff process. Compared with longitudinal ridge, cross ridge can not only hinder the increasing trend of eutrophication risk, but also can significantly lower it, and thus effectively reduce the effect of sloping cropland runoff on the eutrophication processes of receiving waters.

Circulatory responses to nasotracheal intubation: comparison of GlideScope videolaryngoscope and Macintosh direct laryngoscope.

BACKGROUND: The GlideScope videolaryngoscope (GSVL) has been shown to have no special advantage over the Macintosh direct laryngoscope (MDL) in attenuating the circulatory responses to orotracheal intubation, but no study has compared the circulatory responses to nasotracheal intubation (NTI) using the two devices. This prospective randomized clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses to NTI with the GSVL and the MDL. METHODS: Seventy-six adult patients were randomly allocated equally to the GSVL group and the MDL group. After induction of anesthesia, NTI was performed. Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline values) and immediately before intubation (post-induction values), at intubation and every minute for a further five minutes. During the observation, times required to reach the maximum values of systolic BP (SBP) and HR, times required for recovery of SBP and HR to postinduction values and incidence of SBP and HR percent changes > 30% of baseline values were also noted. The product of HR and systolic BP, i.e. rate pressure product (RPP), and the areas under SBP and HR vs. time curves (AUC(SBP) and AUC(HR)) were calculated. RESULTS: The NTI with the GSVL resulted in significant increases in BP, HR and RPP compared to postinduction values, but these circulatory changes did not exceed baseline values. BPs at all measuring points, AUC(SBP), maximum values of BP and incidence of SBP percent increase > 30% of baseline value during the observation did not differ significantly between groups. However, HR and RPP at intubation and their maximum values, AUC(HR) and incidence of HR percent increase > 30% of baseline value were significantly higher in the MDL group than in the GSVL group. Times required for recovery of SBP and HR to postinduction values were significantly longer in the MDL group than in the GSVL group. CONCLUSIONS: The pressor response to NTI with the GSVL and the MDL was similar, but the tachycardiac response to NTI was lesser and of a shorter duration when using a GSVL than when using an MDL.

Hemodynamic responses to tracheal intubation with the Glidescope videolaryngoscope: a comparison of oral and nasal routes.

BACKGROUND: Although there have been numerous favorable reports on the uses of the GlideScope videolaryngoscope (GSVL) in oral and nasal intubations, no study has compared the hemodynamic responses to oral and nasal intubations with the GSVL in a single clinical trial. The purpose of this randomized clinical study was to determine whether there was a clinically relevant difference between the hemodynamic responses to oral and nasal intubations with the GSVL. METHODS: A total of 71 patients, ASA physical status I, aged 18-50 years, scheduled for elective plastic surgery under general anesthesia, were randomly allocated to the oral intubation group (OI group) and the nasal intubation group (NI group). Noninvasive blood pressure (BP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation and every minute for a further 5 minutes. Maximum values of BP and HR during the observation were noted. The product of HR and systolic blood pressure (rate pressure product, RPP), the percent changes of systolic blood pressure (SBP) and HR relative to the baseline values at every measuring point, and the areas under the SBP and HR versus time curves were calculated. RESULTS: The intubation time was significantly longer in the NI group than in the OI group. The total incidence of difficulties encountered during laryngoscopy and intubation were higher in the OI group than in the NI group (29% vs. 6%, p < 0.05). BP at all measuring points, the maximum values of BP, the area under the SBP versus time curve, and the incidence of SBP percent increase more than 30% of baseline value did not differ significantly between the two groups. However, HR and RPP at intubation and their maximum values during the observation, the area under the HR versus time curve, and the incidence of HR percent increase more than 30% of baseline value were significantly higher in the OI group than in the NI group (p < 0.05). As compared with the NI group, the times required to reach the maximum values of SBP and HR were significantly shorter and the times required for recovery of SBP and HR to postinduction values were significantly longer in the OI group (p < 0.05). CONCLUSION: In anesthetized adult patients, oral and nasal intubations with the GSVL can result in a similar pressor response. However, the tachycardic response to nasal intubation using a GSVL is smaller and of shorter duration than that to oral intubation using a GSVL.