Effects of robot-assisted gait training on motor performance of lower limb in poststroke survivors: a systematic review with meta-analysis.

OBJECTIVE: This study aimed to investigate the effects of robot-assisted gait training (RAGT) on improving walking ability, and to determine the optimal dosage of task-specific training based on RAGT for stroke patients. MATERIALS AND METHODS: Two investigators independently searched electronic databases, including PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database (PEDro) from inception to 31 January 2020. The study design was a systematic review with meta-analysis of randomized controlled trials (RCTs), comparing the intervention of RAGT plus conventional therapy to conventional therapy alone. RCTs mainly focus on lower limb motor function as the primary outcomes, while the secondary outcomes involve gait speed, walking distance, cadence, balance, and activities of daily living (ADL). Pooled effect estimates were calculated by comparing the change from baseline to the end of the study in each group. RESULTS: Twenty-eight RCTs were included. The pooled analysis showed that RAGT had a significantly short-term effect on improving lower limb function [standardized mean difference (SMD) 0.32, 95% CI 0.10 to 0.55]. Additionally, there were significant improvements in gait speed (MD 0.10, 95% CI 0.06 to 0.14) and ADL (SMD 0.17, 95% CI 0.02 to 0.32). Subgroup analyses indicated that RAGT lasting for 30-60 minutes per day over 4 weeks yielded a moderate effect size (SMD 0.53, 95% CI 0.16 to 0.90). Additionally, RAGT significantly promoted lower limb function recovery in the early stage after a stroke (SMD 0.33, 95% CI 0.07 to 0.58) or in non-ambulatory patients (SMD 0.35, 95% CI 0.10 to 0.59). CONCLUSIONS: RAGT demonstrated significant positive effects on lower limb function post-stroke. Our results provide additional evidence to support that RAGT is a potentially appropriate intervention to promote lower limb recovery in individuals who have had a stroke.

[Clinical application progress of bioresorbable vascular scaffolds in lower extremities arteriosclerotic obliterans].

Endovascular technology has become the first choice for the treatment of lower extremities arteriosclerotic obliterans. Bioresorbable vascular scaffolds have attracted more and more attention as a choice of endovascular technology. In the last decade, poly(L-lactic acid) bioresorbable scaffolds with or without drug coating have shown acceptable medium and long-term safety and efficacy in lower extremities arteriosclerotic obliterans, but the lesions of the subjects were relatively simple. Magnesium alloy bioresorbable scaffolds are safe but less effective in the treatment of lower extremities arteriosclerotic obliterans. Both iron and zinc alloy bioresorbable scaffolds have shown considerable results in animal experiments. In particular, the success of implantation of drug-coated iron alloy bioresorbable scaffolds in below-the-knee artery indicated that the iron alloy bioresorbable scaffolds have officially entered the clinical trial stage. Through the comprehensive summation of the previous clinical and experimental data of bioresorbable vascular scaffolds and the pathological characteristics of lower extremities arteriosclerotic obliterans, it is shown that the drug-coated poly(L-lactic acid) bioresorbable scaffolds and iron alloy bioresorbable scaffolds will have greater development potential in the treatment of lower extremities arteriosclerotic obliterans.

[Are various theoretical models of membrane anatomy mutually exclusive or inclusive?]

The theory of membrane anatomy is now widely accepted due to the observation of fine anatomical structure with the help of laparoscopic magnifying effect. From the perspective of systematic anatomy, the mesentery is considered as an integral organ in the theory of mesenteric anatomy. Interfascial anatomy belongs to regional anatomy, which focuses on the guiding significance of fascial space for operation. The theory of membrane anatomy belongs to surgical anatomy or applied anatomy, which emphasizes the anatomy of membrane and mesangial bed, and reveals the existence of 'metastasis V' in the mesentery. It is considered that the essence of membrane anatomy operation is to prevent cancer leakage. Various theories of membrane anatomy seek common ground while reserving differences, complement each other, and upgrade iteratively. They help to explain the structure and function of membrane from different perspectives and they are of great benefit to improve the quality of operations. Thus, they should be treated in an eclectic manner.

[Association between lack of care in childhood and cognitive impairment in middle-aged and elderly population].

Objective: To investigate the association between people who were under lack of care in childhood and the development of cognitive impairment in their middle-aged and elderly life spans. Methods: Based on the baseline survey data of the third phase of "Guangzhou Biobank Cohort study" conducted from January 2007 to January 2008, 9 223 residents aged ≥50 years with records on Mini Mental State Examination (MMSE) were included in a retrospective survey on received childhood care of their early lives. Questions would include: feelings of care and support from their close relatives during childhood, the status of separation from their mothers for ≥1 year, and the current status of their parents. Linear regression, unconditional and multinomial logistic regression models were used to analyze the associations between the received childhood care and cognitive function (i.e., MMSE scores and cognitive impairment) in middle and old age, of this population under study. Results: After adjusting for age, gender, education, place of residence, marital status, physical activity, smoking, drinking, occupation, personal income, childhood socioeconomic position and depressive symptoms etc., factors as feeling lack of concern and support from close relatives (LC), status of separation from the mother for ≥1 year (SM), and the current status of their parents etc., were all negatively associated with the MMSE score when in middle and old age, with partial regression coefficient ß (95%CI) as -0.44 (-0.65- -0.23), -0.26 (-0.38- -0.14) and -0.61 (-0.96- -0.27), respectively. The presence of LC, SM or PD were associated with the increased risks of cognitive impairment, and the adjusted odds ratio OR (95%CI) appeared as 1.43 (1.15-1.78), 1.26 (1.08-1.47) and 1.64 (1.16-2.31) respectively in all the participants, but 1.27 (1.01-1.62), 1.29 (1.09-1.55) and 1.75 (1.19-2.55) respectively, in those with education level of primary school or below. In those with secondary school education or above, only the presence of item A was associated with an increased risk of cognitive impairment (OR=2.26, 95%CI: 1.41-3.50). Conclusion: We noticed that 'lack of care' in childhood was associated with cognitive impairment during middle and old age, mainly in those population with lower education.

[The impact of weight management and related diuretic medication intervention based on body weight changes on cardiac function and re-hospitalization rate in patients with chronic congestive heart failure].

Objective: To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF). Methods: Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 (n=350), were randomly divided into intervention group (n=175) and control group (n=175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively. Results: Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P>0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P<0.01). Meanwhile, the LVEF and 6 minutes walk distance were significantly increased, while NT-proBNP was significantly reduced at 6 months post discharge compared to one day before discharge in the intervention group (all P<0.01). The LVEF was also significantly improved (P=0.035), but the NT-proBNP and 6 minutes walk distance were similar (P were 0.328 and 0.807 respectively) at 6 months after discharge compared to one day before discharge in the control group. The NYHA classification was significantly lower in intervention group and in control group at 6 months after discharge compared to one day before discharge (Z=5.154, P<0.01 and Z=10.497, P<0.01), and the NYHA classification improved more in the intervention group than in control group at 6 months after discharge (Z=9.235, P<0.01). The re-hospitalization rate of CHF patients in intervention group was 11.83% (20/169), which was significantly lower than the control group (33.14% (56/169), χ(2)=21.99, P<0.01). At 6 months follow up, body weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge. Conclusion: The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.

Risk factors for the treatment outcome of retreated pulmonary tuberculosis patients in China: an optimized prediction model.

Retreatment of tuberculosis (TB) often fails in China, yet the risk factors associated with the failure remain unclear. To identify risk factors for the treatment failure of retreated pulmonary tuberculosis (PTB) patients, we analyzed the data of 395 retreated PTB patients who received retreatment between July 2009 and July 2011 in China. PTB patients were categorized into 'success' and 'failure' groups by their treatment outcome. Univariable and multivariable logistic regression were used to evaluate the association between treatment outcome and socio-demographic as well as clinical factors. We also created an optimized risk score model to evaluate the predictive values of these risk factors on treatment failure. Of 395 patients, 99 (25·1%) were diagnosed as retreatment failure. Our results showed that risk factors associated with treatment failure included drug resistance, low education level, low body mass index (6 months), standard treatment regimen, retreatment type, positive culture result after 2 months of treatment, and the place where the first medicine was taken. An Optimized Framingham risk model was then used to calculate the risk scores of these factors. Place where first medicine was taken (temporary living places) received a score of 6, which was highest among all the factors. The predicted probability of treatment failure increases as risk score increases. Ten out of 359 patients had a risk score >9, which corresponded to an estimated probability of treatment failure >70%. In conclusion, we have identified multiple clinical and socio-demographic factors that are associated with treatment failure of retreated PTB patients. We also created an optimized risk score model that was effective in predicting the retreatment failure. These results provide novel insights for the prognosis and improvement of treatment for retreated PTB patients.

[Status and related factors of self-reported pain among working-age population in Inner Mongolia Autonomous Region].

Objective: To describe the status and related factors of self-reported pain among working-age population in Inner Mongolia Autonomous Region (Inner Mongolia). Methods: A cross-sectional study was conducted. Data was from the Inner Mongolia fifth health services survey. SPSS 19.0 software package was used for data analysis and χ2 test was to compare the prevalence of self-reported pain in population with different characteristics. Unconditional logistic regression model was used to analyze the related factors on self-reported pain. Results: A total of 11 480 working-age population was involved in this survey, with prevalence of self-reported pain among working age population as 12.3%. The prevalence rates of moderate and severe pain were 11.6% and 0.7%, respectively. Results from the unconditional logistic regression analysis showed that, in the economically poor population, the risk of self-reported pain was 1.718 times of the relatively rich people (OR=1.718, 95%CI: 1.381-2.831). In the rural areas, the risk of self-reported pain was higher than that in the urban population (OR=2.506, 95%CI: 2.030-3.092) and people with chronic illnesses had 2.880 times higher risk than those who did not have the diseases (OR=2.880, 95% CI: 2.474-3.352). There was an interaction noticed between gender and age. Women at or above 45 years old were more likely to develop self-report pain (OR=1.300, 95% CI: 1.072-1.577). Again, factors as people who were current or former smokers, who were suffering from anxiety or depression, being skinny etc. appeared as independently related to the self-reported pain. Conclusion: In working age population of Inner Mongolia, a high prevalence of self-reported pain was seen. Data showed that people who were poor, age at 45 or older, having history of smoking, with chronic diseases and anxiety/depression were risk factors related to self-reported pain.

[Correlation between body fat percentage and general obesity indexes in middle aged and old people in Guangzhou].

Objective: To examine the correlation between body fat percentage (BFP) and general obesity indexes, including body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHR) and calculate the corresponding BFP cutoff values in the middle aged and old people in Guangzhou. The corresponding cut-point of optimal body fat percentage for Guangzhou older population. Methods: Based on the Guangzhou Biobank Cohort Study (GBCS), 3 490 relatively healthy Guangzhou residents aged ≥50 years were selected and were randomly divided into 2 groups. The equations between BFP and BMI, WC, WHR were set up with Curve fitting analysis in one group. The multiple regression analysis was undertaken to establish predictive equations between BFP and BMI, WC, WHR with stepwise model for adding gender, age, physical activity, drinking and smoking. Then, the optimal cut-points of BFP corresponding to BMI, WC and WHR to reflect the degree of obesity were calculated. The equations were then validated with another group. Results: BFP increased with the increase of WHR, WC and BMI. BMI was a better predictor of body fat percentage than WC and WHR. The final regression equation was BFP=(-23.47 -8.87×sex) +2.94× (BMI) - 0.024 × (BMI)2,the coefficient of determination was 0.805. Based on the equation, the BFP corresponding to overweight/obesity (24 kg/m2≤BMI<28 kg/m2) were 24.3% ≤BFP<31.1% in men and 33.2%≤BFP<40.0% in women, respectively. BMI had a better consistency with BFP in identify obesity compared with WC and WHR, obtained the area of ROC 0.909 in men and 0.919 in women respectively. The sensitivity and specificity were 70.3% and 85.5% in men; and 75.2% and 93.0% in women respectively. Conclusion: BFP has a better correlation with BMI. The study results indicated that BFP for middle aged and old males and females in Guangzhou corresponding to overweight/obesity (BMI≥24 kg/m2) were <24.0% and <33.0% respectively.

A variant in microRNA-196a2 is not associated with susceptibility to and progression of colorectal cancer in Chinese.

BACKGROUND: MicroRNAs (miRNAs) are small non-coding RNAs with regulatory functions as tumour suppressors and oncogenes. Although single nucleotide polymorphism (SNP) in miRNA regions have been reported to be rare and unlikely to be functionally important, recent evidence suggested that rs11614913 SNP in miR-196a2 was associated with the susceptibility of lung cancer, breast cancer, congenital heart disease and shortened survival time of non-small-cell lung cancer. AIMS: The aim of this study was to investigate the association between this genetic variant and the risk and/or progression of colorectal cancer (CRC). METHODS: A total of 126 CRC patients and 407 healthy controls was periodically enrolled. DNA was extracted from blood specimens, and miR-196a2 polymorphism was genotyped by polymerase chain reaction-ligation detection reaction (PCR-LDR). RESULTS: Although the frequency of CC homozygotes or miR-196a2C allele-containing genotypes (CT and CC) was lower in CRC patients than in the healthy controls, no significant association between miR-196a2 polymorphism and the risk of CRC was found. The frequency of the 'C' allele in CRC patients was also not significantly lower than in healthy controls. In a subsequent analysis of the association between this polymorphism and the progression of CRC, there was still no significant difference in both genotype and allelic frequency. CONCLUSIONS: Our results suggest that miR-196a2 polymorphism is not associated with both an increased risk and progression of CRC in Chinese.

Efficacy of albendazole combined with a marine fungal extract (m2-9) against Angiostrongylus cantonensis-induced meningitis in mice.

The pathogenesis of angiostrongyliasis, resulting from Angiostrongylus cantonensis invasion of the human central nervous system, remains elusive. Anthelmintics are usually used to kill worms, although dead worms in the brain may cause severe inflammation which will lead to central nervous system damage. Therefore, combination therapy with anthelmintics and anti-inflammatory drugs in the treatment of human angiostrongyliasis needs further study. To evaluate the efficacy of albendazole combined with a marine fungal extract (m2-9) in A. cantonensis infection, BALB/c mice infected by the third-stage larvae of A. cantonensis were divided into three groups: mice treated with albendazole or m2-9 alone or in combination from day 5 post-inoculation (PI). Several efficacy parameters were recorded, including weight change, worm recovery, neurological function, behavioural analysis, eosinophil and leucocyte counts. The results showed that combination therapy increased body weight, reduced worm burden, improved learning ability, memory and action, decreased neurological dysfunction and leucocyte response in these mice. The combination of albendazole and m2-9 treatment significantly decreased leucocyte response and increased the frequency of rearing, compared to infected mice treated with either drug alone. Therefore, m2-9 is a natural product with potentially significant therapeutic value for angiostrongyliasis and is worthy of further study.

Over-expression of the triploid white poplar PtDrl01 gene in tobacco enhances resistance to tobacco mosaic virus.

A full-length cDNA, designated as the Populus tomentosa disease resistance-like 01 (PtDrl01) gene, was isolated from triploid white poplar [(Populus tomentosa × P. bolleana) × P. tomentosa]. The protein thought to be produced by the PtDrl01 gene contains a nuclear localisation sequence (NLS), a toll/interleukin-1 receptor (TIR) homologue region, a nucleotide binding site (NBS) and a leucine-rich repeat (LRR) domain. The protein also exhibits a considerable degree of homology to N-like resistance proteins. Real-time quantitative RT-PCR analysis revealed that expression of the PtDrl01 gene in triploid white poplar leaves could be induced by two defence signalling molecules: methyl jasmonate (MeJA) and salicylic acid (SA). Over-expression of the PtDrl01 gene in transgenic tobacco induced enhanced resistance to tobacco mosaic virus (TMV). Long-term resistance from the PtDrl01 gene to TMV infection was also observed in transgenic tobacco plants. Additionally, over-expression of the PtDrl01 gene resulted in transcriptional changes in genes expressing pathogenesis-related proteins in transgenic tobacco under non-stress conditions. These data strongly suggest that the PtDrl01 gene is involved in plant defence responses to pathogen infection.

Genetic variation of chicken MC1R gene in different plumage colour populations.

1. Genetic variation in the chicken MC1R gene was analysed through bioinformatic methods after polymerase chain reaction (PCR) amplification and sequencing of the coding region of MC1R gene from 5 different populations with 4 plumage colours (black, grey plumage with black spots, yellow plumage with black spots, red). 2. A total of 11 novel variations were detected in Hebei chickens, of which 8 were non-synonymous. Allele distribution analysis showed that the wild-type e(+) (Brown Leghorn) allele was mainly found in Hy-Line Brown and Lohmann Brown, the dominant Extended black E(AY220304) allele was mainly found in Hebei chicken with black plumage, whereas the Buttercup (e(bc)) allele was rare. 3. Nucleotide diversity (π) within each colour strain of Hebei chickens (0·0047-0·0052) was significantly greater than that of Hy-Line Brown (0·0024) or Lohmann Brown (0·0043). 4. The results indicate that there is abundant polymorphism in the MC1R gene, especially in Hebei chicken, which was associated with its rich plumage colour diversity.

rSj16, a recombinant protein of Schistosoma japonicum-derived molecule, reduces severity of the complete Freund's adjuvant-induced adjuvant arthritis in rats' model.

Sj16, a 16-kDa protein produced by Schistosoma japonicum, has been demonstrated to have anti-inflammatory effect. However, the possible mechanism of these phenomena has not been discovered. Here, we tried to touch it with arthritis rats' model induced by injection of complete Freund's adjuvant (CFA). A set of pathogenic characters were observed in CFA-treated rat, including local and systematic read-out, which showed the model successfully set up. After administration of rSj16 (recombinant Sj16) in vivo, paw swelling reduced significantly and in a dose-dependent manner, the level of TNF-α, IL-1ß and NO decreased and IL-10 in the serum increased. In vitro, rSj16 reversed the augmented surface expression of CD80, CD86, CD54 and OX6 induced by lipopolysaccharide (LPS) in bone marrow-derived DCs (BMDCs), whereas endocytotic capacity of rSj16-treated dendritic cell (DC) was profoundly increased. IL-12p70 released from rSj16-treated BMDC was decreased but IL-10 increased. Further, following incubation with rSj16 primed BMDCs, the sensitized T cells exhibited increased production of anti-inflammatory IL-10 and IL-4 and decreased production of IL-12p70 and IFN-γ. Collectively, these results implied that rSj16 alleviated CFA-induced arthritis, and the possible mechanisms may be its interruption of maturation and function of DCs. rSj16 could be a potential therapeutic agent against rheumatoid arthritis.

Krüppel-like factor 5 promotes breast cell proliferation partially through upregulating the transcription of fibroblast growth factor binding protein 1.

The Krüppel-like factor 5 (KLF5) is a zinc-finger transcription factor promoting cell proliferation, cell-cycle progression and survival. A high expression level of KLF5 mRNA has been shown to be associated with shorter breast cancer patient survival. However, the mechanism of KLF5 action in breast cancer is still not clear. In this study, we found that both KLF5 and its downstream gene fibroblast growth factor binding protein 1 (FGF-BP) are co-expressed in breast cell lines and primary tumors. Manipulation of the KLF5 expression can positively regulate the FGF-BP mRNA and protein levels in multiple breast cell lines. In addition, the secreted FGF-BP protein in the conditional medium is also regulated by KLF5. Furthermore, we demonstrated that KLF5 binds and activates the FGF-BP promoter through a GC box by luciferase reporter, oligo pull down and chromatin immunoprecipitation (ChIP) assays. When FGF-BP is depleted by siRNA, KLF5 fails to promote cell proliferation in MCF10A, SW527 and TSU-Pr1. We further demonstrated that overexpression or addition of FGF-BP rescues the KLF5-knockdown-induced growth arrest in MCF10A cells. Finally, KLF5 significantly promotes MCF7 breast cancer cell xenograft growth in athymic nude mice. These findings suggest that KLF5 may promote breast cancer cell proliferation at least partially through directly activating the FGF-BP mRNA transcription. Understanding the mechanism of KLF5 action in breast cancer may result in useful diagnostic and therapeutic targets.

Characterization of resistance gene analogs with a nucleotide binding site isolated from a triploid white poplar.

The majority of cloned plant disease resistance genes (R genes) encode a nucleotide binding site (NBS) and a leucine-rich repeat (LRR) domain. In this study, to better understand the R genes in white poplar, 59 resistance gene analogues (RGAs) were identified from a triploid white poplar [(Populus tomentosa x Populus bolleana) x P. tomentosa], based on conserved NBS regions. The 59 RGAs were phylogenetically classified into 10 subfamilies, and 54 RGAs with open-reading frames (ORFs) were further grouped into two classes, toll and interleukin-1 receptor (TIR) and non-TIR. BLAST searches with reference to the genomic sequence of Populus trichocarpa found 96 highly homologous regions distributed in 37 loci, suggesting the abundance and divergence of NBS-encoding genes in the triploid poplar genome. Within subfamilies 1-3, the average non-synonymous/synonymous substitution (omega) rates were < 1, indicating purifying selection on these RGAs, but some sites were clearly under diversifying selection with omega > 1. Many intergenic exchanges were also detected among these RGAs, indicating a probable role in homogenising NBS domains. Quantitative real-time PCR analysis revealed dramatic variations in the transcript level of 18 RGAs in the mature leaves, bark and roots of the triploid poplar, and identified two RGAs that had significantly higher level of transcripts in bark, four RGAs in mature leaves, and 14 in the above-ground portion of poplars, suggesting their probable roles in resistance against diseases attacking the organs. Our results shed light on genetic resources of poplar resistance and will be useful for further resistance gene isolation and exploitation.

Amyloplast sedimentation dynamics in maize columella cells support a new model for the gravity-sensing apparatus of roots.

Quantitative analysis of statolith sedimentation behavior was accomplished using videomicroscopy of living columella cells of corn (Zea mays) roots, which displayed no systematic cytoplasmic streaming. Following 90 degrees rotation of the root, the statoliths moved downward along the distal wall and then spread out along the bottom with an average velocity of 1.7 microm min(-1). When statolith trajectories traversed the complete width or length of the cell, they initially moved horizontally toward channel-initiation sites and then moved vertically through the channels to the lower side of the reoriented cell where they again dispersed. These statoliths exhibited a significantly lower average velocity than those sedimenting on distal-to-side trajectories. In addition, although statoliths undergoing distal-to-side sedimentation began at their highest velocity and slowed monotonically as they approached the lower cell membrane, statoliths crossing the cell's central region remained slow initially and accelerated to maximum speed once they reached a channel. The statoliths accelerated sooner, and the channeling effect was less pronounced in roots treated with cytochalasin D. Parallel ultrastructural studies of high-pressure frozen-freeze-substituted columella cells suggest that the low-resistance statolith pathway in the cell periphery corresponds to the sharp interface between the endoplasmic reticulum (ER)-rich cortical and the ER-devoid central region of these cells. The central region is also shown to contain an actin-based cytoskeletal network in which the individual, straight, actin-like filaments are randomly distributed. To explain these findings as well as the results of physical simulation experiments, we have formulated a new, tensegrity-based model of gravity sensing in columella cells. This model envisages the cytoplasm as pervaded by an actin-based cytoskeletal network that is denser in the ER-devoid central region than in the ER-rich cell cortex and is linked to stretch receptors in the plasma membrane. Sedimenting statoliths are postulated to produce a directional signal by locally disrupting the network and thereby altering the balance of forces acting on the receptors in different plasma membrane regions.