CD1d protects against hepatocyte apoptosis in non-alcoholic steatohepatitis.

BACKGROUND & AIMS: Hepatocyte apoptosis, a well-defined form of cell death in non-alcoholic steatohepatitis (NASH), is considered the primary cause of liver inflammation and fibrosis. However, the mechanisms underlying the regulation of hepatocyte apoptosis in NASH remain largely unclear. We explored the anti-apoptotic effect of hepatocyte CD1d in NASH. METHODS: Hepatocyte CD1d expression was analyzed in patients with NASH and mouse models. Hepatocyte-specific gene overexpression or knockdown and anti-CD1d crosslinking were used to investigate the anti-apoptotic effect of hepatocyte CD1d on lipotoxicity-, Fas-, and concanavalin (ConA)-mediated liver injuries. A high-fat diet, a methionine-choline-deficient diet, a Fas agonist, and ConA were used to induce lipotoxic and/or apoptotic liver injuries. Palmitic acid was used to mimic lipotoxicity-induced apoptosis in vitro. RESULTS: We identified a dramatic decrease in CD1d expression in hepatocytes of patients with NASH and mouse models. Hepatocyte-specific CD1d overexpression and knockdown experiments collectively demonstrated that hepatocyte CD1d protected against hepatocyte apoptosis and alleviated hepatic inflammation and injuries in NASH mice. Furthermore, decreased JAK2-STAT3 signaling was observed in NASH patient livers. Mechanistically, anti-CD1d crosslinking on hepatocytes induced tyrosine phosphorylation of the CD1d cytoplasmic tail, leading to the recruitment and phosphorylation of JAK2. Phosphorylated JAK2 activated STAT3 and subsequently reduced apoptosis in hepatocytes, which was associated with an increase in anti-apoptotic effectors (Bcl-xL and Mcl-1) and a decrease in pro-apoptotic effectors (cleaved-caspase 3/7). Moreover, anti-CD1d crosslinking effectively protected against Fas- or ConA-mediated hepatocyte apoptosis and liver injury in mice. CONCLUSIONS: Our study uncovered a previously unrecognized anti-apoptotic CD1d-JAK2-STAT3 axis in hepatocytes that conferred hepatoprotection and highlighted the potential of hepatocyte CD1d-directed therapy for liver injury and fibrosis in NASH, as well as in other liver diseases associated with hepatocyte apoptosis. IMPACT AND IMPLICATIONS: Excessive and/or sustained hepatocyte apoptosis is critical in driving liver inflammation and injury. The mechanisms underlying the regulation of hepatocyte apoptosis in non-alcoholic steatohepatitis (NASH) remain largely unclear. Here, we found that CD1d expression in hepatocytes substantially decreases and negatively correlates with the severity of liver injury in patients with NASH. We further revealed a previously unrecognized anti-apoptotic CD1d-JAK2-STAT3 signaling axis in hepatocytes, which confers significant protection against liver injury in NASH and acute liver diseases. Thus, hepatocyte CD1d-targeted therapy could be a promising strategy to manipulate liver injury in both NASH and other hepatocyte apoptosis-related liver diseases.

Activity and participation in haemophiliacs: Item response modelling based on international classification of functioning, disability and health.

BACKGROUND AND OBJECTIVES: There is scant research investigating the user-friendly functional assessment tool conceptualized by the International Classification of Functioning, Disability and Health (ICF) among persons with haemophilia (PWH). This study aims to accomplish two goals: (1) quantifying comprehensive functioning measures of haemophilia through Item Response Theory (IRT); (2) discussing patient-centred care based on the Wright map of personal ability and item difficulty. METHODS: A cross-sectional study was carried out in 70 PWH (mean age, 33.09 ± 11.04) via convenience sampling. All patients completed the 45 ICF categories of haemophilic-specific activity and participation. Psychometric properties of the categories were examined using Mokken scale analysis and parametric item response modelling. RESULTS: We extracted a unidimensional scale with 31 categories, and constructed a Rasch model with good fitness. The Cronbach's α of the scale was .9713, with the Guttman's λ2  = .9730, Molenaar Sijtsma ρ = .9802, and latent class reliability coefficient = .9769, indicating great internal reliability. The estimated individual social competence by the Rasch model was highly related to the index score of the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L) (p < .001, r = .62), and had a moderate correlation (p < .001, r = .54) with the score of Haemophilia Activities List (HAL). CONCLUSIONS: The ICF scale of haemophilic activity and participation with 31 categories (HAPPY-ICF) has good construct validity and internal consistency. The person-item threshold distribution map might be helpful in research and clinical practices for patient-oriented care.

A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): a randomised controlled trial.

OBJECTIVES: To investigate superiority of a telerehabilitation programme for COVID-19 (TERECO) over no rehabilitation with regard to exercise capacity, lower limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL) and dyspnoea. DESIGN: Parallel-group randomised controlled trial with 1:1 block randomisation. SETTING: Three major hospitals from Jiangsu and Hubei provinces, China. PARTICIPANTS: 120 formerly hospitalised COVID-19 survivors with remaining dyspnoea complaints were randomised with 61 allocated to control and 59 to TERECO. INTERVENTION: Unsupervised home-based 6-week exercise programme comprising breathing control and thoracic expansion, aerobic exercise and LMS exercise, delivered via smartphone, and remotely monitored with heart rate telemetry. OUTCOMES: Primary outcome was 6 min walking distance (6MWD) in metres. Secondary outcomes were squat time in seconds; pulmonary function assessed by spirometry; HRQOL measured with Short Form Health Survey-12 (SF-12) and mMRC-dyspnoea. Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up). RESULTS: Adjusted between-group difference in change in 6MWD was 65.45 m (95% CI 43.8 to 87.1; p<0.001) at post-treatment and 68.62 m (95% CI 46.39 to 90.85; p<0.001) at follow-up. Treatment effects for LMS were 20.12 s (95% CI 12.34 to 27.9; p<0.001) post-treatment and 22.23 s (95% CI 14.24 to 30.21; p<0.001) at follow-up. No group differences were found for lung function except post-treatment maximum voluntary ventilation. Increase in SF-12 physical component was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24 to 6.35; p=0.004) at post-treatment and 2.69 (95% CI 0.06 to 5.32; p=0.045) at follow-up. CONCLUSIONS: This trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and physical HRQOL. TRIAL REGISTRATION NUMBER: ChiCTR2000031834.

Prediction of Prolonged Length of Stay for Stroke Patients on Admission for Inpatient Rehabilitation Based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set: A Study from 50 Centers in China.

BACKGROUND This study aimed to develop a risk prediction model for prolonged length of stay (LOS) in stroke patients in 50 inpatient rehabilitation centers in 20 provinces across mainland China based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set case mix on admission. MATERIAL AND METHODS In this cohort study, 383 stroke patients were included from inpatient rehabilitation settings of 50 hospitals across mainland China. Independent predictors of prolonged LOS were identified using multivariate logistic regression analysis. A prediction model was established and then evaluated by receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test. RESULTS Multivariate logistic regression analysis showed that the type of medical insurance and the performance of daily activities (ICF, d230) were associated with prolonged LOS (P<0.05). Age and mobility level measured by the ICF Generic Set demonstrated no significant predictive value. The prediction model showed acceptable discrimination shown by an area under the curve (AUC) of 0.699 (95% CI, 0.646-0.752) and calibration (χ²=11.66; P=0.308). CONCLUSIONS The risk prediction model for prolonged LOS in stroke patients in 50 rehabilitation centers in China, based on the ICF Generic Set, showed that the scores for the type of medical insurance and the performance of daily activities (ICF, d230) on admission were independent predictors of prolonged LOS. This prediction model may allow stakeholders to estimate the risk of prolonged LOS on admission quantitatively, facilitate the financial planning, treatment regimens during hospitalization, referral after discharge, and reimbursement.

Effects of the introduction of objective criteria for referral and discharge in physical therapy for ischemic stroke in China: a randomized controlled trial.

OBJECTIVE: To examine the effectiveness of a set of rules for referral and therapy input in a three-tiered physiotherapy program on activities of daily living (ADL), motor function, and quality of life of stroke survivors. DESIGN: Randomized controlled study. SETTING: Rehabilitation departments of 11 teaching hospitals. SUBJECTS: A total of 285 participants with stroke. OUTCOME MEASURES: Primary outcome was ADL independence measured with the Modified Barthel Index (MBI) at weeks 3, 6, 9, 13, and 17. Secondary outcomes were motor function and quality of life measured with Fugel-Meyer Assessment (FMA) and Stroke-Specific Quality-of-Life (SSQOL) scale. INTERVENTION: Two complementary sets of rules governing rehabilitation delivery were introduced: a set of criteria that determined when someone ought to move from tier 1 onto tier 2, and from tier 2 onto tier 3, and a second set of rules that determined the amount and type of physiotherapy input given in each tier. Control group participants received conventional rehabilitation without any specified guidelines. RESULTS: With a difference of 3.97 (95% confidence interval (CI): 1.59-6.36), MBI increased stronger in the study group than in controls between baseline and week 3 (P = 0.001). This difference could be sustained until study end-point. No significant differences were found for FMA. Differences in increase of SSQOL were higher in the intervention than control at week 9 (P < 0.05). CONCLUSION: Introduction of a set of rules for referral and therapy input at different stages of rehabilitation partially improved patients' ADL and quality of life, but did not improve motor function.

System-wide Clinical Assessment of Functioning Based on the International Classification of Functioning, Disability and Health in China: Interrater Reliability, Convergent, Known Group, and Predictive Validity of the ICF Generic-6.

OBJECTIVE: To validate the International Classification of Functioning, Disability and Health (ICF) Generic-6 in daily routine clinical practice in Mainland China. Specific objectives were to analyze (1) interrater reliability, (2) convergent validity, (3) known group validity, and (4) predictive validity of the ICF Generic-6. DESIGN: Multicenter prospective cohort study. SETTING: Fifty hospitals from 20 provinces of Mainland China. PARTICIPANTS: A total of 4510 patients from departments of rehabilitation, orthopedics, neurology, cardiology, pneumology, and cerebral surgery of the participating hospitals with different health conditions were included in this study. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The assessment was undertaken by nurses with ICF Generic-6 in combination with a numeric rating scale. Interrater reliability was evaluated with intraclass correlation coefficients (ICC). Convergent validity was evaluated with Spearman correlation coefficients between ICF Generic-6 and Medical Outcomes Short Form (SF)-12 items. Known group validity was examined by comparing discharge scores between different discharge destinations. Predictive validity was determined by using ICF Generic-6 baseline scores for estimating length of hospital stay with a loglogistic survival model with gamma shared frailty and cost of in-hospital treatment with a mixed effects generalized linear regression model of the gamma family. RESULTS: The interrater reliability of items and score of ICF Generic-6 was good with ICCs ranging from 0.67-0.87. ICF Generic-6 items were further correlated with respective SF-12 items. Discharge scores of patients differed significantly by discharge destination. The ICF Generic-6 admission score was a significant predictor of length of stay and treatment cost. CONCLUSIONS: The ICF Generic-6 administered in combination with a 0-10 numeric rating scale is a reliable and valid tool for the collection of minimal information on functioning across various clinical settings.

Application of the international classification of functioning, disability, and health to disability assessment for older people in China.

Background: In the previous research, the Disability Assessment Scale based on ICF had been constructed for LTC insurance in China. To apply this scale in further studies, it is essential to establish assessment standards for disability levels. Objective: To establish standardized disability classification criteria and identify the disability statuses and levels in older people. Methods: This is a cross-sectional study, in which 1,610 older individuals in 15 long-term care institutions in China were assessed by the disability assessment scale based on ICF. Cluster analysis was used for classification of the disability levels. Mean (SD) and median (IQR) were used to describe the scores for each item and each dimension. Results: The total scores of the disability assessment scale were classified into six disability levels. The overall disability level of the 1,610 participants was moderate-to-severe. The disability in the dimension of "self-care ability and activity" was the most obvious and severe. Conclusion: The Disability Assessment Scale is capable of identifying disability statuses and levels of older people, and it can serve as a valuable tool for investigating the disabilities among old people and for conducting cross-national comparisons of disability levels.

Importance of plant and fruit traits on the structure of bird seed dispersal networks in different disturbed habitats.

Species functional traits can influence seed dispersal processes and consequently affect species' role in the mutualistic network. Although the effect of animal traits on the structure of the seed dispersal network is well explored, it remains poorly understood how plant and fruit traits contribute to the structure. We here studied the effects of plant and fruit traits on the structure of bird seed dispersal networks across different disturbed habitats in the Meihua Mountain National Nature Reserve, Southeastern China. During the study period, 16, 20, 13, and 15 bird species were recorded foraging on 10, 11, 12, and 8 plant species, resulting in 511, 312, 265, and 201 foraging events in the protected forest, natural forest, village, and bamboo forest, respectively. The composition of these seed dispersal networks is not primarily influenced by a specific group of bulbul species, but rather by the presence of an endangered plant species, Taxus chinensis. As we expected, the structure of the four networks was different among the four disturbed habitats. Furthermore, our results also showed tree height and canopy density were the most important plant traits for structuring the seed dispersal network, while sugar, amylase, dry matter, and alkaloids were identified as significant fruit traits. Overall, our findings highlight the value of integrating trait-based ecology into the framework of the seed dispersal network and provide new insights for mutualistic network conservation in disturbed habitats.

Graph modeling of relational structures among functioning variables with low back pain: an exploratory analysis based on international classification of functioning, disability and health.

BACKGROUND: Given the complex etiology, multidimensional impact, and widespread prevalence of low back pain (LBP), it is crucial to prioritize intervention targets based on understanding the relationships between functional impairments in patients. This prioritization maximizes the physical and psychological benefits for patients, and graph modeling holds promise in achieving these objectives. AIM: The aim of this study was establishing a graphical model of functioning variables for LBP based on the International Classification of Functioning, Disability, and Health (ICF) to identify the most influential items (i.e., functioning variables) on the physical and mental well-being of patients. Exploring feasible intervention measures by understanding the dysfunction correlations among these variables. DESIGN: Cross-sectional survey. SETTING: Nine hospitals in Jiangsu Province, China. POPULATION: Three hundred and six persons with LBP aged ≥18 years. METHODS: All patients were assessed using the Comprehensive ICF Core Sets for LBP. The scoring system was converted to dichotomous data, with 1 indicating dysfunction and 0 indicating no dysfunction. In the graphical model, network parameters and the results of Item Response Theory modeling (as detailed in our other article) were used to determine the importance of items, while partial correlations were utilized to estimate the dysfunction correlations between functioning variables. RESULTS: 1) A total of 56 ICF items were located in the backbone structure of LBP, among which d430 (Lifting and carrying objects) occupied the most central position, followed by b126 (Temperament and personality functions). 2) In the main component of backbone structure, d430 has moderate dysfunction correlation with looking after one's health (0.6027), social norms, practices and ideologies (0.597), stability of joint functions (0.5759), and emotional functions (0.4078). b126 has moderate dysfunction correlation with basic interpersonal interactions (0.6595). CONCLUSIONS: d430 and b126 significantly impact the physical and mental well-being of LBP patients. To improve d430, maintaining exercise habits, reducing working hours, enhancing lumbar stability, and overcoming fear-related emotions are recommended. Similarly, improving b126 can be achieved through enhancing interpersonal relationships. CLINICAL REHABILITATION IMPACT: Through the identification of crucial functioning variables and the associated dysfunctional correlation relationships, graphical model of Comprehensive ICF Core Set for LBP can offer healthcare decision-makers valuable insights into potential treatment targets and pathways aimed at improving the condition of LBP patients.

Haemophilia item bank based on International Classification of Functioning, Disability and Health: a systematic review.

BACKGROUND AND OBJECTIVES: Haemophilia comprises a continuum of blood disorders that often include joint and muscular dysfunction, which may lead to a constellation of activity limitations and participation restrictions. However, there is scant research incorporating functional assessment scales into the common language provided by the International Classification of Functioning, Disability and Health (ICF). This study aims to identify the ICF categories to include in an item bank of functioning aspects relevant for haemophilia. DESIGN AND METHODS: A systematic search was carried out in July 2021 based on the PubMed MEDLINE, CLINICAL, and Cochrane databases for qualified articles, investigating haemophilia-specific scales and the scales recommended by the World Federation of Haemophilia (WFH) linked to ICF categories between 2001 and 2021. Well-trained healthcare professionals in the haemophilia field and ICF evaluation conducted group discussions to determine the ICF items for haemophilia. RESULTS: A total of 112 out of 176 items measuring function were collected for the haemophilia ICF item bank, including 32 items for body function (b), 45 items for activity and participation (d), 27 items for environmental factors (e), and 8 items for body structure(s). INTERPRETATION AND CONCLUSIONS: We recommend that future haemophilia research use the haemophilia-specific ICF item bank, which could capture a whole spectrum of functional measurements and facilitate multidisciplinary and worldwide communication. This study also indicates that further development and analysis of the psychometric properties of the 112 haemophilia-related ICF items is warranted.

Simplified functioning assessment for low back pain: ICF-based item response theory modelling.

BACKGROUND: Despite the growing interest of the item response theory (IRT) in assessment of person abilities and functioning difficulties in screening tools, there is scarcity of research using IRT on ICF-based tools for persons with low back pain (LBP). AIM: To generate and validate a parsimonious core set of ICF (PCSI) for LBP based on the IRT modelling. DESIGN: A cross-sectional study. SETTING: Nine hospitals in Jiangsu Province, China. POPULATION: We recruited patients with LBP. METHODS: All participants completed the 78 items of the comprehensive ICF Core Set for LBP. The five-point scoring system was converted to dichotomous data with 1 as functioning/independent and 0 as impairment/dependent. Psychometric properties of the data were examined using Mokken Scale analysis and parametric item response modelling. RESULTS: This study recruited 306 participants (185 females and 121 males) with LBP. The overall median age of the study participants was 50.28 (95% CI 23.34; 82.05) years. We constructed a three-parameter logistic model with 28 ICF categories (8 of body function, 18 of activities and participation, and two of body structures). The internal consistency was good with Cronbach's alpha = 0.927 and latent class reliability coefficient (LCRC) = 0.955. The model was validated by significant correlations (P<0.001) of its estimated person abilities with the Oswestry Disability Index (ODI, r=-0.41), the Roland-Morris Disability Questionnaire (RMDQ, r=-0.57), the Physical Component Summary (PCS, r=0.63), and the Mental Component Summary (MCS, r = 0.46) of 12-Item Short Form Survey (SF-12). The person abilities and item difficulties were integrated into a Wright map that offered a background for making individualized clinical decisions. CONCLUSIONS: The PCSI of LBP with 28 categories has good construct validity and internal consistency, and is a convenient instrument for assessing functioning among persons with LBP. The IRT model provided theoretical and algorithmic support for deriving a simplified model for functioning assessment hence serving a basis for formulating rehabilitation plans in clinical practice and research. CLINICAL REHABILITATION IMPACT: A parsimonious core set of ICF (PCSI) for LBP based on the IRT modelling provides a background for making individualized clinical decisions based on item difficulties.

Validation of a Disability Assessment Tool Based on the International Classification of Functioning, Disability, and Health in the Chinese Context.

Background: The common standards of disability assessment for long-term care (LTC) insurance are currently absent. The International Classification of Functioning, Disability and Health (ICF) was designed for a better description of health and functioning, which could fill the demand gap for the standards of disability assessment and be a promising tool for the development of LTC insurance system. Objectives: To validate a disability assessment scale for disabled elderly individuals based on the ICF for LTC in the Chinese context. Methods: The present study is a cross-sectional study. A disability assessment tool based on the ICF was developed by referring to other assessment tools and an expert consensus meeting in the initial phase of the study. The developed tool was used to evaluate 1,610 elderly individuals in the LTC institutions. The Cronbach's α coefficient and split-half reliability were applied to test the internal consistency of the tool, while the Interclass correlation coefficients (ICCs) were used to evaluate the interrater reliability (IRR). Factor analysis was performed to verify the construct validity of the tool. The scores from the Medical Outcomes Short Form-12 (SF-12) were correlated with that from the disability assessment tool, to assess the criterion-related validity. Results: The Cronbach's α coefficient and split-half reliability of the disability assessment tool were 0.969 and 0.877, respectively. The ICCs of the sum scale was 0.85, and the ICCs of each of the 20 items in the scale ranged from 0.78 to 0.94. The items were divided into three factors through analysis, which is consistent with the structure expectation. The scores of each item and the sum score of the disability assessment scale were negatively correlated with the scores of the physical and psychological fields in SF-12 (p < 0.001). Overall, the data indicated that the tool was characterized by good internal consistency, IRR, construct validity, and criterion-related validity. Conclusions: The disability assessment tool based on the ICF is a reliable and valid tool for the collection of information on functioning across various LTC settings. The information of disability provided evidence for the distribution of LTC service and guided the development of LTC insurance standards.

Tibetan Medicated Bathing Therapy for Patients With Post-stroke Limb Spasticity: A Randomized Controlled Clinical Trial.

OBJECTIVE: To determine the short- (4 weeks) and long-term (6 month) effectiveness of Tibetan medicated bathing therapy in patients with post-stroke limb spasticity. DESIGN: Prospective, blinded, randomized controlled trial. SUBJECTS: Post-stroke patients with limb spasticity were recruited between December 2013 and February 2017 and randomly assigned 1:1 to a control group that received conventional rehabilitation (n = 222) or an experimental group that received Tibetan medicated bathing therapy in combination with conventional rehabilitation (n = 222). METHODS: All patients received conventional rehabilitation. In addition, the experimental group received Tibetan medicated bathing therapy. The interventions were conducted 5 times per week for 4 weeks. The primary endpoint was changes from baseline after 4 weeks of therapy in muscle tone in the spastic muscles (elbow flexors, wrist flexors, finger flexors, knee extensors, ankle plantar flexors), as measured by the Modified Ashworth Scale (MAS). RESULTS: The mean change from baseline after 4 weeks of therapy in the MAS score for the elbow flexors (P = .017), wrist flexors (P < .001), and ankle plantar flexors (P < .001) was significantly greater in patients in the experimental group compared to the control group. The benefit was maintained for 3 muscle groups (elbow flexors P < .001, wrist flexors P = .001, and ankle plantar flexors P < .001) and 6 months (elbow flexors P < .001, wrist flexors P = .002, and ankle plantar flexors P < .001) after therapy. All adverse events were mild, and no serious adverse reactions to Tibetan medicated bathing therapy were recorded. CONCLUSIONS AND IMPLICATIONS: Tibetan medicated bathing therapy, in combination with conventional rehabilitation, has potential as a safe, effective treatment for the alleviation of post-stroke upper limb spasticity. Tibetan medicated bathing therapy was most advantageous for patients who had a baseline muscle tone score of 1+ to 2 on the MAS in the affected limb and recent onset of stroke (duration of the disease of 1-3 months).

Effect of Tui Na on upper limb spasticity after stroke: a randomized clinical trial.

OBJECTIVE: To investigate the efficacy and safety of Tui Na for treating spasticity of the upper limbs of stroke patients. DESIGN: A prospective, multicenter, blinded, randomized controlled intervention study. SUBJECTS: Stroke patients with upper limb spasticity who were treated between December 2013 and February 2017 in 16 participating institutions in China were randomly assigned to receive either Tui Na plus conventional rehabilitation (Tui Na group, n = 222,) or conventional rehabilitation only (control group, n = 222). METHODS: Eligible adult patients (aged 18-75 years) were enrolled 1-12 months after stroke and randomly allocated in a 1:1 ratio to the two groups. Outcome assessors were blinded to treatment allocation. Muscle tone in the spastic muscles was evaluated using the Modified Ashworth Scale (MAS), and the primary endpoint was the change in MAS score over 4 weeks of treatment. RESULTS: Among patients who had experienced stroke 1-3 months before treatment, the Tui Na group experienced significantly greater reductions in MAS scores for three muscle groups than did the control group after 4 weeks of treatment. These improvements were sustained at the 3- and 6-month follow-ups. However, among patients who suffered from stroke 4-6 months and 7-12 months before treatment, the change in MAS with treatment did not differ significantly between those who did and those who did not receive Tui Na. No Tui Na-related adverse events during treatment were reported the groups. CONCLUSION: Tui Na was effective and safe for alleviating poststroke spasticity within 1-3 months after stroke onset.

Factors affecting localization and dispersion of alcohol in peripheral nerve block.

OBJECTIVE: To explore the relationship between electrical current and nerve-needle distance for localization of target nerves in peripheral nerve block, and the effects of injection speed, concentration, and injectate volume on alcohol dispersion using an animal model. METHODS: Rabbit tibial nerves were selected for localization. Nerve-needle distance was ascertained using a manipulator. The minimum current eliciting motor responses was recorded at nerve-needle distances of 0, 1, 2, 3, 4 and 5 mm. Rabbit tibial nerves were assigned into 3 groups: speed group, concentration group, and volume group. Nerves were localized by a stimulator and neurolysed with alcohol/contrast medium. Helical computed tomography (CT) was performed to measure volume/dispersion patterns of injectate. RESULTS: A linear relationship was observed between nerve-needle distance (X) and minimal current (Y) (Y = 0.13X + 0.22; r2 = 0.974; p<0.05) for the localization of the target nerve. CT scan revealed that the injection speed and volume significantly influenced the dispersion of alcohol (p<0.01), but concentration had no effect (p<0.05). CONCLUSION: This study found a positive linear relationship between nerve-needle distance and minimum electrical stimulation in tibial nerve blockade. In addition, the results suggest that a low volume of alcohol with a low injection speed can help to improve nerve block in clinical practice.

ICF Generic Set as new standard for the system wide assessment of functioning in China: a multicentre prospective study on metric properties and responsiveness applying item response theory.

OBJECTIVES: To examine metric properties and responsiveness of the International Classification of Functioning, Disability and Health (ICF) Generic Set when used in routine clinical practice to assess functioning. DESIGN: Prospective multicentre study. SETTING: 50 hospitals from 20 provinces of Mainland China. PARTICIPANTS: 4510 adult inpatients admitted to the departments of Pulmonology, Cardiology, Neurology, Orthopaedics, Cerebral Surgery or Rehabilitation Medicine. MAIN OUTCOME MEASURES: The ICF Generic Set (ICF Generic 6 Set) applied with an 11-point numeric rating scale (0-no problem to 10-complete problem) was fit to the Partial Credit Model (PCM) to create an interval score of functioning. RESULTS: PCM assumptions were found to be fulfilled after accounting for Differential Item Functioning. With an average improvement by 7.86 points of the metric ICF Generic 6 score (95% CI 7.53 to 8.19), the ICF Generic 6 Set proved sensitive to change (Cohen's f2=0.41). Ceiling and floor effects on detecting change in functioning were cancelled or reduced by using the metric score. CONCLUSION: The ICF Generic 6 Set can be used for the assessment of functioning in routine clinical practice and an interval score can be derived which is sensitive to change.

Whole Body Vibration Training Improves Walking Performance of Stroke Patients with Knee Hyperextension: A Randomized Controlled Pilot Study.

OBJECTIVE: To investigate the effect of 8-week whole body vibration training on gait performance and lower extremity function in stroke patients with knee hyperextension. METHODS: Total 30 subjects with stroke were randomized into the control group (n=15) or the intervention group (n=15). The patients of intervention group were treated with whole body vibration while the control group was treated with placebo. The walking function, lower limb function and knee hyperextension times were assessed in this study. Gait performances were evaluated by 10-meter walk test. The knee hyperextension times was visually observed and counted. The lower limb function was evaluated by Fugl-Meyer motor assessment. RESULTS: The times of the knee hyperextension of the intervention group was significantly decreased compared with control groups (P=0.000, d=1.749, 95%CI[2.915,7.285]). The walking function assessed by 10-meter test of intervention group was significantly improved compared with control group (P=0.001, d=1.345, 95%CI[1.896,6.704]). The performances of all the three tests were improved after training in both groups (P=0.000/P=0.000, d=1.500/d=1.952, 95%CI[3.309,9.891]/ 95%CI[5.549,12.45]; P=0.000/P=0.000, d=2.015/d=2.952, 95%CI[5.214,11.39]/95%CI[9.423, 15.98]; P=0.000/P=0.000, d=3.537/d=5.108, 95%CI[19.05,12.35]/95%CI[16.52,22.28]). CONCLUSION: The results suggest that 8 weeks whole body vibration training can reduce knee hyperextension and increase ambulatory speed in stroke patients.

The dose and volume-response relationship of an ethanol-induced tibial nerve block in a rabbit model.

OBJECTIVE: The aim of this study was to observe the dose-response relationship in an ethanol-induced tibial nerve block in a rabbit model. DESIGN: Sixteen New Zealand white rabbits were separated into three groups that received increasing injections of 100% ethanol (0.1, 0.3, and 0.5 ml). All tibial nerves were successfully located with a nerve stimulator. Compound muscle action potentials were measured before injection; 1, 2, 4, and 7 days after injection; and 2, 3, 4, 5, 6, 7, and 8 wks after injection. Histologic studies were performed to evaluate the destruction of the nerves and surrounding muscles. RESULTS: The compound muscle action potential amplitude significantly decreased (P < 0.01) on the first day after ethanol injection in all groups. The compound muscle action potential amplitude in the 0.1-ml group recovered to baseline by week 2, whereas the 0.3-ml group recovered by week 8. The 0.5-ml group did not recover by week 4 (P < 0.01), but observations had to stop because of severe complications. The authors found that the degrees of axonal degeneration and muscle desmoplasia were related to injection volume. CONCLUSIONS: There was a positive linear relationship between ethanol injection volume and effect on compound muscle action potential. The safe and effective volume of 100% ethanol for a tibial nerve block is 0.3 ml in a rabbit model.

Functional outcomes and health-related quality of life in fracture victims 27 months after the Sichuan earthquake.

OBJECTIVE: To evaluate functional outcomes, health-related quality of life and life satisfaction in fracture victims 27 months after the 2008 Sichuan earthquake. METHODS: A total of 390 earthquake survivors from 3 earthquake areas who sustained fractures were divided into early intervention, late intervention and control groups. Functional outcomes assessed included activities of daily living using the Modified Barthel Index and pain level with a visual analogue scale. Health-related quality of life was evaluated with the Medical Outcomes Study Short-Form 36 and life satisfaction using the Life Satisfaction Questionnaire. RESULTS: Activities of daily living and life satisfaction in the intervention groups were significantly improved compared with the control group. Health-related quality of life was higher in early intervention subjects compared with controls. Group differences in pain level were not significant. In addition, the early and late intervention groups did not differ significantly in any of the measured outcomes. Good performance of activities of daily living and widowed marital status predicted high health-related quality of life, while pain level was associated with worsened outcomes. Rehabilitation therapy, remunerative employment and female gender were predictors of improved life satisfaction. CONCLUSION: Clinical effectiveness of physical rehabilitation intervention was demonstrated in fracture earthquake victims.