Effect of occupational therapy on the occurrence of delirium in critically ill patients: a systematic review and meta-analysis.

Aim: Delirium poses a major challenge to global health care, yet there is currently a dearth of single effective interventions or medications. Particularly, addressing delirium induced by critical illness is a complex process. Occupational therapy is considered to have a high potential for use in the prevention of delirium, as it involves both cognitive training and training in ADL. To comprehensively analyze the effect of occupational therapy on delirium prevention, we evaluated the effects of occupational therapy vs. standard non-pharmacological prevention on incidence and duration of delirium, clinical outcomes and rehabilitation outcomes in critically ill patients. Methods: The data sources, including PubMed/Medline, Web of Science, EMBASE, and Cochrane Library, were comprehensively searched from their inception until 15 October 2023. Following the PICOS principle, a systematic screening of literature was conducted to identify relevant studies. Subsequently, the quality assessment was performed to evaluate the risk of bias in the included literature. Finally, outcome measures from each study were extracted and comprehensive analysis was conducted using Review Manager 5.4. Results: A total of four clinical trials met the selection criteria. The pooled analysis indicated no significant difference in the incidence and duration of delirium between the OT group and standard non-pharmacological interventions. A comprehensive analysis of clinical outcomes revealed that OT did not significantly reduce the length of hospital stay or ICU stay. Meanwhile, there was no significant difference in mortality rates between the two groups. It is noteworthy that although grip strength levels did not exhibit significant improvement following OT intervention, there were obvious enhancements observed in ADL and MMSE scores. Conclusion: Although occupational therapy may not be the most effective in preventing delirium, it has been shown to significantly improve ADL and cognitive function among critically ill patients. Therefore, we contend that occupational therapy is a valuable component of a comprehensive multidisciplinary approach to managing delirium. In the future, high-quality researches are warranted to optimize the implementation of occupational therapy interventions for delirium prevention and further enhance their benefits for patients.

Effectiveness of repetitive transcranial magnetic stimulation combined with intelligent Gait-Adaptability Training in improving lower limb function and brain symmetry after subacute stroke: a preliminary study.

OBJECTIVES: Persistent lower limb dysfunction is a major challenge in post-stroke recovery. Repetitive transcranial magnetic stimulation is recognized for addressing post-stroke motor deficits. Our study explores the efficacy of combining rTMS with gait-adaptive training to enhance lower limb function and regulatory mechanisms in subacute stroke. MATERIALS AND METHODS: This randomized controlled trial enrolled 27 patients with subacute hemiparesis, dividing them into experimental and control groups. Both groups underwent gait-adaptability training 5 times/week for 4 weeks, with the experimental group receiving daily low-frequency transcranial magnetic stimulation before training. Primary outcomes included the pairwise derived brain symmetry index, lower-extremity Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale. Assessments occurred before and after the four-week intervention. RESULTS: The experimental and control groups showed significant improvements in the Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale after the 4-week intervention compared to baseline (all p<0.05). However, the experimental group demonstrated significantly greater improvements compared to the control group in the Fugl-Meyer Assessment (p=0.024) and the 10-meter walk test (p=0.033). Additionally, the experimental group exhibited a more pronounced decrease in the pairwise derived brain symmetry index (p=0.026) compared to the control group. Within the experimental group, the cortical subgroup's pairwise derived brain symmetry index was significantly lower than that of the control group (p=0.006). CONCLUSIONS: Combining low-frequency transcranial magnetic stimulation with Gait-Adaptive Training effectively enhances lower limb function and Regulatory mechanisms of the cerebral hemisphere in subacute stroke recovery, and it can provide rapid and effective rehabilitation effect compared with gait adaptation training alone.

Effects of combining rTMs and augmented reality gait adaptive training on walking function of patients with stroke based on three-dimensional gait analysis and sEMG: a randomized controlled trial.

BACKGROUND: Augmented reality gait adaptive training (ARGAT) and repetitive transcranial magnetic stimulation (rTMS) have both demonstrated efficacy in improving lower limb motor function in survivors of stroke. PURPOSE: To investigate the effects of combining rTMS and ARGAT on motor function in survivors of stroke. METHODS: The experimental group received a combination of rTMS and ARGAT, while the control group received ARGAT alone. The interventions comprised a total of 20 sessions, conducted over four weeks with five consecutive daily sessions. Outcome measures included three-dimensional gait analysis (3DGA), surface electromyography (sEMG), Fugl-Meyer assessment for the lower extremity (FMA-LE), and the Berg Balance Scale (BBS). RESULTS: Following the intervention, both groups showed significant improvements in walking speed, symmetry index, affected step length, affected stride length, FMA-LE, and BBS scores (p < .05). Furthermore, the experimental group demonstrated greater improvements in walking speed (F = 4.58, p = .040), cadence (F = 5.67, p = .023), affected step length (F = 5.79, p = .022), affected stride length (F = 4.84, p = .035), FMA-LE (Z = 2.43, p = .019), and BBS (F = 4.76, p = .036) compared to the control group. The experimental group demonstrated a significant improvement in the co-contraction index (CCI) of the knee joint (F = 14.88, p < .001), a change not observed in the control group (F = 2.16, p = .151). However, neither group showed significant alterations in CCI of the ankle joint (F = 1.58, p = .218), step width (F = 0.24, p = .630), unaffected step length (F = 0.22, p = .641), or unaffected stride length (F = 2.99, p = .093). CONCLUSION: The combination of low-frequency rTMS and ARGAT demonstrated superior effects on motor function recovery compared to ARGAT alone in survivors of stroke.

Effects of robot-assisted upper limb training combined with intermittent theta burst stimulation (iTBS) on cortical activation in stroke patients: A functional near-infrared spectroscopy study.

BACKGROUND: The therapeutic effect and mechanism of robot-assisted upper limb training (RT) combined with intermittent theta burst stimulation (iTBS) for stroke patients are unclear. OBJECTIVE: The purpose of this study was to evaluate changes in brain activation after combination therapy and RT alone using functional near-infrared spectroscopy (fNIRS). METHODS: Patients were randomly assigned to two groups (iTBS + RT Group, n = 18, and RT Group, n = 18). Training was conducted five times a week for four weeks. fNIRS was used to measure changes in oxyhemoglobin in both the primary motor cortex (M1) and pre-motor and supplementary motor area (pSMA) during affected limb movement. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was employed for evaluating the function of upper limbs. RESULTS: Thirty-two patients with subacute stroke completed the study. The cortex of both hemispheres was extensively activated prior to treatment in the RT group. After training, overactivation decreased. The brain activation of the combined treatment group transferred to the affected side after the treatment. There was a notable enhancement in the FMA-UE scores for both groups, with the combined group's progress significantly surpassing that of the RT group. CONCLUSION: RT combined with iTBS can improve the motor function of stroke patients and promote the balance between cerebral hemispheres.

Three-Dimensional Gait Analysis and sEMG Measures for Robotic-Assisted Gait Training in Subacute Stroke: A Randomized Controlled Trial.

Background: The efficacy of robotic-assisted gait training (RAGT) should be considered versatilely; among which, gait assessment is one of the most important measures; observational gait assessment is the most commonly used method in clinical practice, but it has certain limitations due to the deviation of subjectivity; instrumental assessments such as three-dimensional gait analysis (3DGA) and surface electromyography (sEMG) can be used to obtain gait data and muscle activation during walking in stroke patients with hemiplegia, so as to better evaluate the rehabilitation effect of RAGT. Objective: This single-blind randomized controlled trial is aimed at analyzing the impact of RAGT on the 3DGA parameters and muscle activation in patients with subacute stroke and evaluating the clinical effect of improving walking function of RAGT. Methods: This randomized controlled trial evaluated the improvement of 4-week RAGT on patients with subacute stroke by 3DGA and surface electromyography (sEMG), combined with clinical scales: experimental group (n = 18, 20 sessions of RAGT) or control group (n = 16, 20 sessions of conventional gait training). Gait performance was evaluated by the 3DGA, and clinical evaluations based on Fugl-Meyer assessment for lower extremity (FMA-LE), functional ambulation category (FAC), and 6-minute walk test (6MWT) were used. Of these patients, 30 patients underwent sEMG measurement synchronized with 3DGA; the cocontraction index in swing phase of the knee and ankle of the affected side was calculated. Results: After 4 weeks of intervention, intragroup comparison showed that walking speed, temporal symmetry, bilateral stride length, range of motion (ROM) of the bilateral hip, flexion angle of the affected knee, ROM of the affected ankle, FMA-LE, FAC, and 6MWT in the experimental group were significantly improved (p < 0.05), and in the control group, significant improvements were observed in walking speed, temporal symmetry, stride length of the affected side, ROM of the affected hip, FMA-LE, FAC, and 6MWT (p < 0.05). Intergroup comparison showed that the experimental group significantly outperformed the control group in walking speed, temporal symmetry of the spatiotemporal parameters, ROM of the affected hip and peak flexion of the knee in the kinematic parameters, and the FMA-LE and FAC in the clinical scale (p < 0.05). In patients evaluated by sEMG, the experimental group showed a noticeable improvement in the cocontraction index of the knee (p = 0.042), while no significant improvement was observed in the control group (p = 0.196), and the experimental group was better than the control group (p = 0.020). No noticeable changes were observed in the cocontraction index of the ankle in both groups (p > 0.05). Conclusions: Compared with conventional gait training, RAGT successfully improved part of the spatiotemporal parameters of patients and optimized the motion of the affected lower limb joints and muscle activation patterns during walking, which is crucial for further rehabilitation of walking ability in patients with subacute stroke. This trial is registered with ChiCTR2200066402.

Process Modelling and Simulation of Key Volatile Compounds of Maillard Reaction Products Derived from Beef Tallow Residue Hydrolysate Based on Proxy Models.

The hydrolysis time is directly related to the flavor of the Maillard reaction, but existing proxy models cannot simulate and model the variation curves of vital volatile components. This study developed a predictive model for modelling and simulating key volatile compounds of Maillard reaction products (MRPs) derived from beef tallow residue hydrolysate. Results showed the degree of hydrolysis increased with hydrolysis time, and the most significant improvement in the roast flavor and overall acceptance was when hydrolyzing 4 h. Based on flavor dilution value and the relative odor activity value, nine key volatile components were identified, and 2-ethyl-3,5-dimethylpyrazine with roast flavor was the highest. Compared with Polynomial Curve Fitting (PCF) and Cubic Spline Interpolation (CSI), key volatile compounds of MRPs could be better modeled and simulated by the Curve Prediction Model (CPM). All results suggested that CPM could predict the changes in key volatile components produced by MRPs.

Wet deposition of nitrogen and sulfur in Guangzhou, a subtropical area in South China.

With the aim of understanding the seasonal distribution of deposition fluxes of nitrogen (N) and sulfur (S) in South China, a main acid deposition region in China, precipitation samples were collected and analyzed from Guangzhou area, between March 2005 and February 2006. The estimated wet deposition of N (including ammonium nitrogen (NH(4)-N) and nitrate nitrogen (NO(3)-N)) and S (sulfate sulfur (SO(4)-S)) during the monitoring period were 40.47 kg N ha(-1) and 65.29 kg S ha(-1), respectively. The average deposition of NH(4)-N was ∼1.5 times of the NO(3)-N deposition, suggesting that the reduced and oxidized N depositions were comparable in the study area. The S and N depositions in the rainy season were greater than those in the dry season, showing great seasonal variation, which was consistent with both the distribution of precipitation and the period of fertilizer application for agriculture. The N and S wet deposition fluxes in Guangzhou were greater than those in Beijing and Zhengzhou, located in the northern China, but comparable to the level of Chongqing, located in the southwestern China, another major acid deposition region. The atmospheric N and S depositions in these cities from north to south were affected by both intensive agricultural and industrial activities.

Enhancement of mucosal immune response against the M2eHBc+ antigen in mice with the fusion expression products of LTB and M2eHBc+ through mucosal immunization route.

M2e is the external domain of M2 protein, a conservative transmembrane protein of the avian influenza A virus. Previous research had shown that the vaccine of the formation particle of M2e and hepatitis B virus core antigen (HBcAg) can fully protect mice against a lethal H5N1 subtype avian influenza virus (AIV) infection. As an effective approach against mucosal tissue infectious agent, mucosal vaccination requires effective and safe adjuvants. Here we have first fused two M2e peptide to the N terminal and the major immunodominant region (MIR) of the HBcAg protein simultaneously to create a fusion gene, named as M2eHBc+, and then inserted B subunit of Escherichia coli heat labile enterotoxin (LTB) into the N terminal of M2eHBc+ to construct the second fusion gene, named as LBM2eHBc+. These two fusion genes can be efficiently expressed in Escherichia coli cell and the yield peptide can self-assemble into virus-like particles (VLP). The mice immunization with two types of the purified particles by intranasal dropping and oral routes revealed that LTB can significantly enhance the mucosal immune responses of mice to co-expression M2eHBc+ particle form antigen.

Chemical composition and seasonal variation of acid deposition in Guangzhou, South China: comparison with precipitation in other major Chinese cities.

With the aim of understanding the origin of acid rains in South China, we analyzed rainwaters collected from Guangzhou, China, between March 2005 and February 2006. The pH of rainwater collected during the monitoring period varied from 4.22 to 5.87; acid rain represented about 94% of total precipitation during this period. The rainwater was characterized by high concentrations of SO(4)(2-), NO(3)(-), Ca(2+), and NH(4)(+). SO(4)(2-) and NO(3)(-), the main precursors of acid rain, were related to the combustion of coal and fertilizer use/traffic emissions, respectively. Ca(2+) and NH(4)(+) act as neutralizers of acid, accounting for the decoupling between high SO(4)(2-) concentrations and relatively high pH in the Guangzhou precipitation. The acid rain in Guangzhou is most pronounced during spring and summer. A comparison with acid precipitation in other Chinese cities reveals a decreasing neutralization capacity from north to south, probably related to the role and origin of alkaline bases in precipitation.