Commonly used antiemetics for prophylaxis of postoperative nausea and vomiting after Caesarean delivery with neuraxial morphine: a network meta-analysis.

BACKGROUND: Dopamine antagonists, 5-HT3 antagonists, and dexamethasone are frequently used in obstetrics to prevent postoperative nausea and vomiting (PONV). However, the superiority of any drug class is yet to be established. This network meta-analysis aimed to compare the efficacy of these antiemetics for PONV prophylaxis in women receiving neuraxial morphine for Caesarean delivery. METHODS: We searched PubMed, Embase, CENTRAL, Web of Science, and Wanfang Data for eligible randomised controlled trials. Primary outcomes were the incidences of postoperative nausea (PON) and postoperative vomiting (POV) within 24 h after surgery. We used a Bayesian random-effects model and calculated odds ratios with 95% credible intervals for dichotomous data. We performed sensitivity and subgroup analyses for primary outcomes. RESULTS: A total of 33 studies with 4238 women were included. In the primary analyses of all women, 5-HT3 antagonists, dopamine antagonists, dexamethasone, and 5-HT3 antagonists plus dexamethasone significantly reduced PON and POV compared with placebo, and 5-HT3 antagonists plus dexamethasone were more effective than monotherapy. In the subgroup analyses, similar results were seen in women receiving epidural morphine or intrathecal morphine alone but not in women receiving intrathecal morphine with fentanyl or sufentanil. However, most included studies had some concerns or a high risk of bias, and the overall certainty of the evidence was low or very low. CONCLUSIONS: Combined 5-HT3 antagonists plus dexamethasone are more effective than monotherapy in preventing PONV associated with neuraxial morphine after Caesarean delivery. Future studies are needed to determine the role of prophylactic antiemetics in women receiving intrathecal morphine and lipophilic opioids. SYSTEMATIC REVIEW PROTOCOL: PROSPERO CRD42023454602.

Convalescent or standard plasma versus standard of care in the treatment of COVID-19 patients with respiratory impairment: short and long-term effects. A three-arm randomized controlled clinical trial.

BACKGROUND: The efficacy of early treatment with convalescent plasma in patients with COVID-19 is debated. Nothing is known about the potential effect of other plasma components other than anti-SARS-CoV-2 antibodies. METHODS: To determine whether convalescent or standard plasma would improve outcomes for adults in early phase of Covid19 respiratory impairment we designed this randomized, three-arms, clinical trial (PLACO COVID) blinded on interventional arms that was conducted from June 2020 to August 2021. It was a multicentric trial at 19 Italian hospitals. We enrolled 180 hospitalized adult patients with COVID-19 pneumonia within 5 days from the onset of respiratory distress. Patients were randomly assigned in a 1:1:1 ratio to standard of care (n = 60) or standard of care + three units of standard plasma (n = 60) or standard of care + three units of high-titre convalescent plasma (n = 60) administered on days 1, 3, 5 after randomization. Primary outcome was 30-days mortality. Secondary outcomes were: incidence of mechanical ventilation or death at day 30, 6-month mortality, proportion of days with mechanical ventilation on total length of hospital stay, IgG anti-SARS-CoV-2 seroconversion, viral clearance from plasma and respiratory tract samples, and variations in Sequential Organ Failure Assessment score. The trial was analysed according to the intention-to-treat principle. RESULTS: 180 patients (133/180 [73.9%] males, mean age 66.6 years [IQR 57-73]) were enrolled a median of 8 days from onset of symptoms. At enrollment, 88.9% of patients showed moderate/severe respiratory failure. 30-days mortality was 20% in Control arm, 23% in Convalescent (risk ratio [RR] 1.13; 95% confidence interval [CI], 0.61-2.13, P = 0.694) and 25% in Standard plasma (RR 1.23; 95%CI, 0.63-2.37, P = 0.544). Time to viral clearance from respiratory tract was 21 days for Convalescent, 28 for Standard plasma and 23 in Control arm but differences were not statistically significant. No differences for other secondary endpoints were seen in the three arms. Serious adverse events were reported in 1.7%, 3.3% and 5% of patients in Control, Standard and Convalescent plasma arms respectively. CONCLUSIONS: Neither high-titer Convalescent nor Standard plasma improve outcomes of COVID-19 patients with acute respiratory failure. Trial Registration Clinicaltrials.gov Identifier: NCT04428021. First posted: 11/06/2020.

Norepinephrine for the prevention of spinal-induced hypotension during caesarean delivery under combined spinal-epidural anaesthesia: Randomised, double-blind, dose-finding study.

BACKGROUND: During caesarean delivery under spinal anaesthesia hypotension may be managed by norepinephrine in preference to phenylephrine due a perception of less bradycardia and fewer reductions in cardiac output. OBJECTIVE: As the optimum prophylactic dose of norepinephrine is unclear, we aimed to investigate its dose-response for preventing postspinal hypotension in caesarean delivery. DESIGN: A randomised, double-blinded, dose-finding study. SETTING: Jiaxing University affiliated Women and Children Hospital, Jiaxing, China. PATIENTS: Ninety-nine patients undergoing elective caesarean delivery from 1 February to 5 August: excluding patients with ASA III or above, preeclampsia or hypertension, pre-existing or gestational diabetes, BMI more than 35 kg m, height less than 150 cm or with more than 175 cm, or with contraindications to local anaesthesia. INTERVENTIONS: Patients received 0, 0.04, 0.05, 0.06 or 0.07 µg kg min preventive norepinephrine infusions immediately after intrathecal injection of 10 mg bupivacaine with 5 µg sufentanil. MAIN OUTCOME MEASURES: The norepinephrine (Median effective dose) or (95% effective dose) ED50 and ED95, which were estimated using Probit analysis to compare haemodynamic changes associated with the different doses. RESULTS: The incidence of hypotension was 70, 47.4, 40, 20 and 15% in the 0, 0.04, 0.05, 0.06 and 0.07 µg kg min groups, respectively. The ED50, ED80 and ED95 values were 0.029 (95% CI 0.008 to 0.042 µg kg min), 0.068 (95% CI 0.055 to 0.099 µg kg min) and 0.105 µg kg min (95% CI 0.082 to 0.172 µg kg min), respectively. Apgar scores or umbilical arterial pH were similar among groups. CONCLUSION: The ED50, ED80 and ED95 were 0.029, 0.068 and 0.105 µg kg min respectively. A 0.07 µg kg min norepinephrine infusion may be optimum for preventing postspinal hypotension after intrathecal injection of 10 mg bupivacaine combined with 5 µg sufentanil. TRIAL REGISTRATION: Chinese Clinical Trial Registry (identifier: ChiCTR-TRC-1800014614).

Development, Optimization, and Characterization of PEGylated Nanoemulsion of Prostaglandin E1 for Long Circulation.

Lipo-PGE1 is the most widely used formulation of PGE1 in clinic. However, PGE1 is easier to leak out from lipo-PGE1 and this will lead to the phlebophlogosis when intravenous injection. The stability of lipo-PGE1 in storage and in vivo is also discounted. The aim of this study is to develop a long-circulating prostaglandin E1-loaded nanoemulsion modified with 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[methoxy(polyethylene glycol)-2000] (DSPE-PEG) to improve the stability and pharmacokinetics profiles of lipo-PGE1. PEGylated PGE1 nanoemulsion was prepared using a dispersing-homogenized method. The stability of nanoemulsion in 1 month was investigated. Pharmacokinetic studies were employed to evaluate the in vivo profile of the optimized nanoemulsion. The optimized nanoemulsion PGE1-PEG2000(1%)-NE showed an oil droplet size <100 nm with a surface charge of -14 mV. Approximately, 97% of the PGE1 was encapsulated in the nanoemulsion. The particle size, zeta potential, and drug loading of PGE1-PEG2000(1%)-NE were stable in 1 month. After PGE1-PEG2000(1%)-NE was intravenously administered to rats, the area under curve (AUC) and half-life of PGE1 were, respectively, 1.47-fold and 5.98-fold higher than those of lipo-PGE1 (commercial formulation). PGE1-PEG2000(1%)-NE was an ideal formulation for prolonging the elimination time of PGE1. This novel parenteral colloidal delivery system of PGE1 has a promising potential in clinic use.

Selective and divided attention modulates auditory-vocal integration in the processing of pitch feedback errors.

Speakers rapidly adjust their ongoing vocal productions to compensate for errors they hear in their auditory feedback. It is currently unclear what role attention plays in these vocal compensations. This event-related potential (ERP) study examined the influence of selective and divided attention on the vocal and cortical responses to pitch errors heard in auditory feedback regarding ongoing vocalisations. During the production of a sustained vowel, participants briefly heard their vocal pitch shifted up two semitones while they actively attended to auditory or visual events (selective attention), or both auditory and visual events (divided attention), or were not told to attend to either modality (control condition). The behavioral results showed that attending to the pitch perturbations elicited larger vocal compensations than attending to the visual stimuli. Moreover, ERPs were likewise sensitive to the attentional manipulations: P2 responses to pitch perturbations were larger when participants attended to the auditory stimuli compared to when they attended to the visual stimuli, and compared to when they were not explicitly told to attend to either the visual or auditory stimuli. By contrast, dividing attention between the auditory and visual modalities caused suppressed P2 responses relative to all the other conditions and caused enhanced N1 responses relative to the control condition. These findings provide strong evidence for the influence of attention on the mechanisms underlying the auditory-vocal integration in the processing of pitch feedback errors. In addition, selective attention and divided attention appear to modulate the neurobehavioral processing of pitch feedback errors in different ways.

Measurement of transporter associated with antigen processing 1 and tumor necrosis factor alpha expression in hepatitis B virus-related hepatocellular carcinoma and peritumor cirrhosis tissues using tissue chip technology.

BACKGROUND/AIMS: The objective of this study was to explore the associations of expression of transporter associated with antigen processing 1 (TAP1) and tumor necrosis factor alpha (TNF-α with the occurrence and development of HBV-related hepatocellular carcinoma (HCC). METHODOLOGY: The expression of TAP1 and TNF-α in 38 HCC, 32 peritumor liver cirrhosis and 28 normal liver tissues, were assessed by immunohistochemical assay using tissue microarray technology. RESULTS: TAP1 and TNF-α were negative in normal liver tissue hut positive in HCC and peritumor cirrhosis tissue. There were no significant differences in the rates of positivity for TAP1 and TNF-α between HCC and peritumor cirrhosis tissue (p>0.05), but there was a significant difference when rates in HCC and peritumor cirrhosis tissue were compared with those in normal liver tissue (p<0.0001, p<0.01, respectively). The degree of differentiation of HCC was correlated with TNF-α expression (p<0.05), but not TAP1 expression (p>0.05), CONCLUSIONS: Major histocompatibility complex class I molecules are involved in HBV-related HCC. TNF-α plays an important role in liver cirrhosis and in formation and development of HCC following HBV infection. TNF-α can be used as an indicator of the degree of differentiation of HCC.

Effects of EMG-based robot for upper extremity rehabilitation on post-stroke patients: a systematic review and meta-analysis.

Objective: A growing body of research shows the promise and efficacy of EMG-based robot interventions in improving the motor function in stroke survivors. However, it is still controversial whether the effect of EMG-based robot is more effective than conventional therapies. This study focused on the effects of EMG-based robot on upper limb motor control, spasticity and activity limitation in stroke survivors compared with conventional rehabilitation techniques. Methods: We searched electronic databases for relevant randomized controlled trials. Outcomes included Fugl-Meyer assessment scale (FMA), Modified Ashworth Scale (MAS), and activity level. Result: Thirteen studies with 330 subjects were included. The results showed that the outcomes post intervention was significantly improved in the EMG-based robot group. Results from subgroup analyses further revealed that the efficacy of the treatment was better in patients in the subacute stage, those who received a total treatment time of less than 1000 min, and those who received EMG-based robotic therapy combined with electrical stimulation (ES). Conclusion: The effect of EMG-based robot is superior to conventional therapies in terms of improving upper extremity motor control, spasticity and activity limitation. Further research should explore optimal parameters of EMG-based robot therapy and its long-term effects on upper limb function in post-stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier: 387070.

Ultrasonic neuromodulation mediated by mechanosensitive ion channels: current and future.

Ultrasound neuromodulation technology is a promising neuromodulation approach, with the advantages of noninvasiveness, high-resolution, deep penetration and good targeting, which aid in circumventing the side effects of drugs and invasive therapeutic interventions. Ultrasound can cause mechanical effects, activate mechanosensitive ion channels and alter neuronal excitability, producing biological effects. The structural determination of mechanosensitive ion channels will greatly contribute to our understanding of the molecular mechanisms underlying mechanosensory transduction. However, the underlying biological mechanism of ultrasonic neuromodulation remains poorly understood. Hence, this review aims to provide an outline of the properties of ultrasound, the structures of specific mechanosensitive ion channels, and their role in ultrasound neuromodulation.

Electromyography-Force Relation and Muscle Fiber Conduction Velocity Affected by Spinal Cord Injury.

A surface electromyography (EMG) analysis was performed in this study to examine central neural and peripheral muscle changes after a spinal cord injury (SCI). A linear electrode array was used to record surface EMG signals from the biceps brachii (BB) in 15 SCI subjects and 14 matched healthy control subjects as they performed elbow flexor isometric contractions from 10% to 80% maximum voluntary contraction. Muscle fiber conduction velocity (MFCV) and BB EMG-force relation were examined. MFCV was found to be significantly slower in the SCI group than the control group, evident at all force levels. The BB EMG-force relation was well fit by quadratic functions in both groups. All healthy control EMG-force relations were best fit with positive quadratic coefficients. In contrast, the EMG-force relation in eight SCI subjects was best fit with negative quadratic coefficients, suggesting impaired EMG modulation at high forces. The alterations in MFCV and EMG-force relation after SCI suggest complex neuromuscular changes after SCI, including alterations in central neural drive and muscle properties.

The interaction between changes of muscle activation and cortical network dynamics during isometric elbow contraction: a sEMG and fNIRS study.

Objective: The relationship between muscle activation during motor tasks and cerebral cortical activity remains poorly understood. The aim of this study was to investigate the correlation between brain network connectivity and the non-linear characteristics of muscle activation changes during different levels of isometric contractions. Methods: Twenty-one healthy subjects were recruited and were asked to perform isometric elbow contractions in both dominant and non-dominant sides. Blood oxygen concentrations in brain from functional Near-infrared Spectroscopy (fNIRS) and surface electromyography (sEMG) signals in the biceps brachii (BIC) and triceps brachii (TRI) muscles were recorded simultaneously and compared during 80% and 20% of maximum voluntary contraction (MVC). Functional connectivity, effective connectivity, and graph theory indicators were used to measure information interaction in brain activity during motor tasks. The non-linear characteristics of sEMG signals, fuzzy approximate entropy (fApEn), were used to evaluate the signal complexity changes in motor tasks. Pearson correlation analysis was used to examine the correlation between brain network characteristic values and sEMG parameters under different task conditions. Results: The effective connectivity between brain regions in motor tasks in dominant side was significantly higher than that in non-dominant side under different contractions (p < 0.05). The results of graph theory analysis showed that the clustering coefficient and node-local efficiency of the contralateral motor cortex were significantly varied under different contractions (p < 0.01). fApEn and co-contraction index (CCI) of sEMG under 80% MVC condition were significantly higher than that under 20% MVC condition (p < 0.05). There was a significant positive correlation between the fApEn and the blood oxygen value in the contralateral brain regions in both dominant or non-dominant sides (p < 0.001). The node-local efficiency of the contralateral motor cortex in the dominant side was positively correlated with the fApEn of the EMG signals (p < 0.05). Conclusion: In this study, the mapping relationship between brain network related indicators and non-linear characteristic of sEMG in different motor tasks was verified. These findings provide evidence for further exploration of the interaction between the brain activity and the execution of motor tasks, and the parameters might be useful in evaluation of rehabilitation intervention.

Brainmask: an ultrasoft and moist micro-electrocorticography electrode for accurate positioning and long-lasting recordings.

Bacterial cellulose (BC), a natural biomaterial synthesized by bacteria, has a unique structure of a cellulose nanofiber-weaved three-dimensional reticulated network. BC films can be ultrasoft with sufficient mechanical strength, strong water absorption and moisture retention and have been widely used in facial masks. These films have the potential to be applied to implantable neural interfaces due to their conformality and moisture, which are two critical issues for traditional polymer or silicone electrodes. In this work, we propose a micro-electrocorticography (micro-ECoG) electrode named "Brainmask", which comprises a BC film as the substrate and separated multichannel parylene-C microelectrodes bonded on the top surface. Brainmask can not only guarantee the precise position of microelectrode sites attached to any nonplanar epidural surface but also improve the long-lasting signal quality during acute implantation with an exposed cranial window for at least one hour, as well as the in vivo recording validated for one week. This novel ultrasoft and moist device stands as a next-generation neural interface regardless of complex surface or time of duration.

Effects of Non-Invasive Brain Stimulation on Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

In recent years, the potential of non-invasive brain stimulation (NIBS) for the therapeutic effect of post-stroke spasticity has been explored. There are various NIBS methods depending on the stimulation modality, site and parameters. The purpose of this study is to evaluate the efficacy of NIBS on spasticity in patients after stroke. This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. PUBMED (MEDLINE), Web of Science, Cochrane Library and Excerpta Medica Database (EMBASE) were searched for all randomized controlled trials (RCTs) published before December 2021. Two independent researchers screened relevant articles and extracted data. This meta-analysis included 14 articles, and all included articles included 18 RCT datasets. The results showed that repetitive transcranial magnetic stimulation (rTMS) (MD = −0.40, [95% CI]: −0.56 to −0.25, p < 0.01) had a significant effect on improving spasticity, in which low-frequency rTMS (LF-rTMS) (MD = −0.51, [95% CI]: −0.78 to −0.24, p < 0.01) and stimulation of the unaffected hemisphere (MD = −0.58, [95% CI]: −0.80 to −0.36, p < 0.01) were beneficial on Modified Ashworth Scale (MAS) in patients with post-stroke spasticity. Transcranial direct current stimulation (tDCS) (MD = −0.65, [95% CI]: −1.07 to −0.22, p < 0.01) also had a significant impact on post-stroke rehabilitation, with anodal stimulation (MD = −0.74, [95% CI]: −1.35 to −0.13, p < 0.05) being more effective in improving spasticity in patients. This meta-analysis revealed moderate evidence that NIBS reduces spasticity after stroke and may promote recovery in stroke survivors. Future studies investigating the mechanisms of NIBS in addressing spasticity are warranted to further support the clinical application of NIBS in post-stroke spasticity.

The development path of the medical profession in China's engineering universities from the perspective of the 'four new' disciplines.

In recent years, China has actively promoted the construction of first-class universities and disciplines of the world ('Double First-Class'), and built a new model of university development to solve Chinese problems and support high-quality economic and social development. In the context of China's efforts to promote the construction of new engineering, new medicine, new agriculture, and new liberal arts (referred to as the 'four new' disciplines), these disciplines are developing rapidly. As a specialty dealing with major life issues, medical education has become increasingly prominent. To enhance the comprehensive strength of universities, corresponding to the 'four new' disciplines strategy, engineering universities are building and developing medical specialties one after another. At present, the greatest problem in the medical specialty of engineering universities is the tendency to blindly follow trends and integrate new concepts with traditional methods. However, to date, the integration of medical and nonmedical specialties has been superficial and thus has not been successful. To address this problem, this paper, guided by the policies aimed at developing the 'four new' disciplines, analyses the current situation of traditional medicine education and professional development in engineering universities and proposes measures to enhance the competitiveness of new medicine in engineering universities, thereby promoting the development of universities.KEY MESSAGESThe implementation of the 'four new' disciplines is a strategic choice for higher education.Engineering technology is an efficient path and hands-on approach to solving medical problems.Interdisciplinary and comprehensive educational approaches play an important role in the development of medical science.

Case Management Improves Satisfaction, Anxiety, and Depression of Patients with Pregnancy Loss after In Vitro Fertilization and Embryo Transfer.

Objective: Pregnancy loss has negative impacts on both the physical and the mental health of expectant mothers, which calls for an in-depth investigation. In this study, we examined the effects of case management on patients with pregnancy loss after in vitro fertilization and embryo transfer (IVF-ET). Methods: 100 participants that had suffered pregnancy loss after IVF-ET-assisted pregnancy from January 2019 to March 2020 were divided into routine care and case management groups, each with 50 cases. For the routine care group, a doctor led the diagnostic and treatment processes and a nurse assisted with the treatment. For the case management group, a nurse led the patient diagnostic and treatment processes and a doctor controlled the diagnosis and treatment plan formulation. Case management models were established according to the comprehensive peripregnancy loss care of patients with pregnancy loss after IVF-ET-assisted pregnancy. The participants' outcomes (satisfaction, anxiety, and depression) were assessed at the time of pregnancy loss and 1 and 3 months after pregnancy loss during follow-up of the routine care and case management groups. Results: There was no statistical difference between the patients in the two groups with regard to their general information statistics (P > 0.05) or their satisfaction, anxiety, and depression at the time of pregnancy loss (P > 0.05). One month after pregnancy loss, there was no statistical difference in anxiety between the two groups (P > 0.05), but satisfaction was greater and depression was significantly reduced in the case management group compared with the routine care group (P < 0.05). Conclusion: Case management care can have a positive effect on improving the satisfaction, anxiety, and depression of patients that have had pregnancy loss after IVF-ET.

Transcranial ultrasound stimulation applied in ischemic stroke rehabilitation: A review.

Ischemic stroke is a serious medical condition that is caused by cerebral vascular occlusion and leads to neurological dysfunction. After stroke, patients suffer from long-term sensory, motor and cognitive impairment. Non-invasive neuromodulation technology has been widely studied in the field of stroke rehabilitation. Transcranial ultrasound stimulation (TUS), as a safe and non-invasive technique with deep penetration ability and a tiny focus, is an emerging technology. It can produce mechanical and thermal effects by delivering sound waves to brain tissue that can induce the production of neurotrophic factors (NFs) in the brain, and reduce cell apoptosis and the inflammatory response. TUS, which involves application of an acoustic wave, can also dissolve blood clots and be used to deliver therapeutic drugs to the ischemic region. TUS has great potential in the treatment of ischemic stroke. Future advancements in imaging and parameter optimization will improve the safety and efficacy of this technology in the treatment of ischemic stroke.

Synthesis and in vivo bioactivity of lipophilic alendronate derivatives against osteoporosis.

New lipophilic alendronate amidated derivatives anchored alkyl chains (C(n)H(2n+1), n = 12, 14, 16, 18) had been obtained through the reaction of alendronate with carboxylic acid under anhydrous condition. The physicochemical parameters, such as the solubility and partition coefficient P(o/w) in n-octanol/water, were determined through calculation by performing reversion phase high-performance liquid chromatography (RP-HPLC). The results showed that the derivatives had improved lipophilicity compared with alendronate. The in vivo bioactivities of the derivatives were investigated using the hindlimb unloading growing rats' model. The results showed that the derivatives had in vivo bioactivity against hindlimb unloading growing rats' bone loss, which indicated that the lipophilic derivative would be a promising new potent bisphosphates for treatment of the osteoporosis.

Interrater and Intrarater Reliability of Electrical Impedance Myography: A Comparison between Large and Small Handheld Electrode Arrays.

The objective of this study was to evaluate the interrater and intrarater reliability of electrical impedance myography (EIM) using handheld sensors of different sizes. Electrical impedance myography of the biceps brachii muscle of twenty healthy individuals was performed by two raters using both large and small sensors. The procedures were also repeated 5 to 8 days after the first recording session. The repeatability of the resistance, reactance, and phase angle at two different current frequencies (50 and 100 kHz) was assessed by the intraclass correlation coefficient (ICC). The ICCs of the large sensor were higher than those of the small sensor for both the intrarater and interrater reliabilities. High-frequency current tended to improve the ICC for the small sensor. These results indicate reasonable repeatability of the handheld electrode arrays for EIM measurements. The findings suggest that electrode array should be selected appropriately according to the size of the tested muscle.

Quantifying the Changes of Mechanical and Electrical Properties of Paralyzed Muscle in Survivors With Cervical Spinal Cord Injury.

Background: Survivors with spinal cord injury (SCI) have neuromuscular deficits such as muscle atrophy that lead to functional impairments. This study utilized myotonometry and electrical impedance myography (EIM) to quantitatively evaluate the changes in muscle mechanical properties and compositions after SCI. Methods: This study adopted a cross-sectional design. Eighteen SCI patients and 18 healthy individuals were recruited. The outcome measures were: (1) The myotonometer measured muscle mechanical parameters of oscillation frequency (freq), dynamic stiffness, logarithmic decrement (decr), mechanical stress relaxation time, and indication of creep. (2) The electrical impedance myography measured parameters of resistance (R), reactance (X), and phase angle (θ). (3) muscle strength (maxForce); (4) clinical scales of Manual Muscle Testing (MMT) and modified Ashworth scale (MAS). All outcome measures were compared between the bicep brachii muscle of the weaker side of the SCI group and the non-dominate side of the healthy group. Correlation analysis was performed at quantitative data and clinical scales. Results: Freq, stiffness, and maxForce of the SCI group were significantly lower (p < 0.01) than those of the healthy control. The relaxation time and creep were significantly higher in the SCI group than in the control group. Significant differences of R and Xc were observed between the two groups. Significant correlation was observed between freq, stiffness, and months past injury, and between Xc, creep, and relaxation time. Conclusions: Reduced muscle tone and stiffness might relate to muscle atrophy, and higher relax time and creep may be caused by poor contractile ability. The changes in EIM parameters could indirectly reflect the muscle cell size, and fatty and connective tissue alterations. These findings support the feasibility of myotonometer and EIM to quantify muscle mechanical and intrinsic properties in patients with SCI. The results could facilitate the understanding of neuromuscular changes that are related to functional impairments.

Identify the Alteration of Balance Control and Risk of Falling in Stroke Survivors During Obstacle Crossing Based on Kinematic Analysis.

This study aims to compare the differences in the kinematic characteristics of crossing obstacles of different heights between stroke survivors and age-matched healthy controls and to identify the changes of balance control strategy and risk of falling. Twelve stroke survivors and twelve aged-matched healthy controls were recruited. A three-dimensional motion analysis system and two force plates were used to measure the kinematic and kinetic data during crossing obstacles with heights of 10, 20, and 30% leg length. The results showed that during leading and trailing limb clearance, (AP) center of mass (COM) velocities of the stroke group were smaller than those of the healthy controls for all heights. The decreased distances between COM and center of pressure (COP) in the AP direction during the both trailing and leading limb support period were also found between stroke survivors and healthy controls for all heights. The COM velocity and COM-COP distance significantly correlated with the lower limb muscle strength. In addition, stroke survivors showed greater lateral pelvic tilt, greater hip abduction, and larger peak velocity in the medio-lateral (ML) direction. There was a positive correlation between the COM-COP distance in the AP direction and the clinical scales. These results might identify that the stroke survivors used a conservative strategy to negotiate the obstacles and control balance due to a lack of muscle strength. However, the abnormal patterns during obstacle crossing might increase the risk of falling. The findings could be used to design specific rehabilitation training programs to enhance body stability, reduce energy cost, and improve motion efficiency.

Correlation Between Muscle Structures and Electrical Properties of the Tibialis Anterior in Subacute Stroke Survivors: A Pilot Study.

Electrical impedance myography (EIM) is a non-invasive diagnostic tool that assesses the muscle inherent properties, whereas ultrasonography can assess the alteration in muscle architecture. This study aimed to combine EIM with ultrasonography to assess the changes of the tibialis anterior (TA) muscle properties during passive plantar/dorsiflexion in stroke survivors. Fifteen patients with subacute stroke were recruited. The muscle structures were simultaneously assessed by EIM and ultrasonography at five different extension angles (-10°, 0°, 10°, 20°, and 30°) of the ankle joint. The EIM parameters measured were resistance (R), reactance (X), and phase angle (θ). The parameters recorded by ultrasonography were pennation angle (PA), muscle thickness (MT), and fascicle length (FL). Two-way repeated ANOVA was performed to compare the differences between the affected and unaffected sides as well as the parameters that changed with joint angle. Linear correlation analysis was conducted to assess the association between muscle parameters and clinical scores. The results showed that as the ankle was passively plantarflexed, the θ (P = 0.003) and PA (P < 0.001) values decreased, and the X (P < 0.001), R (P < 0.001), and FL (P < 0.001) values increased. Significant correlations were found between the FL and R values (r = 0.615, P = 0.015), MT and R values (r = 0.522, P = 0.046), and FL and θ values (r = 0.561, P = 0.03), as well as between the PA and the Fugl-Meyer Assessment of Lower Extremity score (r = 0.615, P = 0.015), the R and the Modified Ashworth Scale (MAS) score (r = 0.58, P = 0.023), and the PA and the manual muscle testing (MMT) score (r = -0.575, P = 0.025). This study demonstrated a correlation between the EIM and the ultrasonography parameters at different joint angles. Therefore, both methods could jointly be applied in patients with stroke to detect changes in the muscle inherent properties and muscle architecture. This could assist clinicians to quantitatively evaluate the muscle condition in people with subacute stroke. The study was registered on the Chinese Clinical Trial Registry (trial registration number: ChiCTR-IOR-17012299, http://www.chictr.org.cn/showprojen.aspx?proj=19818). Clinical Trial Registration Number: ChiCTR-IOR-17012299.