Functional Recovery Research Articles

A greedy assist-as-needed controller for end-effect upper limb rehabilitation robot based on 3-DOF potential field constraints.

It has been proven that robot-assisted rehabilitation training can effectively promote the recovery of upper-limb motor function in post-stroke patients. Increasing patients' active participation by providing assist-as-needed (AAN) control strategies is key to the effectiveness of robot-assisted rehabilitation training. In this paper, a greedy assist-as-needed (GAAN) controller based on radial basis function (RBF) network combined with 3 degrees of freedom (3-DOF) potential constraints was proposed to provide AAN interactive forces of an end-effect upper limb rehabilitation robot. The proposed 3-DOF potential fields were adopted to constrain the tangential motions of three kinds of typical target trajectories (one-dimensional (1D) lines, two-dimensional (2D) curves and three-dimensional (3D) spirals) while the GAAN controller was designed to estimate the motor capability of a subject and provide appropriate robot-assisted forces. The co-simulation (Adams-Matlab/Simulink) experiments and behavioral experiments on 10 healthy volunteers were conducted to validate the utility of the GAAN controller. The experimental results demonstrated that the GAAN controller combined with 3-DOF potential field constraints enabled the subjects to actively participate in kinds of tracking tasks while keeping acceptable tracking accuracies. 3D spirals could be better in stimulating subjects' active participation when compared to 1D and 2D target trajectories. The current GAAN controller has the potential to be applied to existing commercial upper limb rehabilitation robots.

Analysis of Limb Loading and Lower Extremity Strength Recovery Across Time After Anterior Cruciate Ligament Reconstruction.

Evidence as to how patient thigh muscle strength and limb loading (LL) during a squatting task recovers throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR) is lacking. Patients will improve LL and strength throughout rehabilitation. Changes in LL and strength over time will be positively correlated. Prospective cohort study. Level 3. A total of 60 participants (28 male/32 female; age, 22.5 ± 9.35 years) participated in 2 visits post-ACLR, assessing LL and strength. Using an instrumented pressure mat, patients completed 3 sets of 3 repetitions of bodyweight squats. Peak force (N), unilateral cumulative load (%), and quadriceps and hamstring isokinetic peak torque (N·m) were calculated and recorded bilaterally. LL and peak torque were compared over time and between limbs. A significant limb-by-time interaction was observed for LL peak force (N), where patients underloaded the ACLR limb at visit 1 compared with the contralateral limb (P < 0.01). Patients increased their ACLR LL across visits (P = 0.04). A limb-by-time interaction for quadriceps peak torque (N·m) was observed where the ACLR limb increased peak torque across visits (P < 0.01); however, strength deficits persisted at visit 2 (P < 0.01) when compared with the nonoperative limb. Weak correlations were observed between all change scores metrics (r, 0.20-0.25). Patients recovering from ACLR exhibited more symmetric loading during a squatting task and improved their lower extremity strength over time. Changes in strength were not related to changes in LL during a squatting task over time. Squatting tasks are safe and easily implemented throughout ACLR recovery. As changes in functional LL and strength recovery are not related, both should be considered in serial postoperative testing for more comprehensive function and strength assessments.

Long Term Physical and Mental Health Outcomes of Older Adults Following a Major Burn Injury: A Burn Model System Investigation.

Older adults are at a higher risk of complications after burn injuries since many physical and mental changes are compounded by increasing age. Few studies have targeted the long-term effects of burns on older adults. Therefore, this study will investigate the long-term physical and mental health outcomes in older adults. 3129 participants from the Burn Model System Database were divided into 3 cohorts based on their age at injury (18-54, 55-64, and 65+). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were derived from the 12-item Short Form (SF-12) and the Veterans RAND 12-item (VR-12) health surveys and analyzed to measure recovery at preinjury, discharge, 2-year follow-up, and 5-year follow-up. ANOVA, T-score analysis, and linear mixed-effects models were utilized to assess for significant differences in outcome scores. PCS scores were significantly different between the 18-54 cohort and 65+ cohorts at the preinjury and 2-year time intervals (p<0.001 and p<0.001, respectively), but not at the 5-year follow up (P=0.28). MCS scores were significantly different between the 18-54 cohort and 65+ cohorts at all time intervals measured (p=0.001, p<0.001, P<0.001, and p=0.005 respectively), though the change in MCS scores over time were not significantly different between age cohorts across time (p=0.088). This supports that patients 65 years and older have a different physical function recovery trajectory when compared to patients under 64 years. These findings underscore the belief that for physical recovery after a burn injury, individualized physical rehabilitation plans will provide the most benefit for patients across all ages.

The Use of Diagnostic Transcranial Magnetic Stimulation as a Predictor of the Functional Outcome in Ischemic Stroke

ABSTRACT. Determination of rehabilitation potential (RP) is necessary for optimal rehabilitation strategy and the best rehabilitation measures. Navigational transcranial magnetic stimulation (nTMS) has been proposed as a method for PR determination in after-stroke patients.THE AIM. was to study the importance of navigational diagnostic transcranial magnetic stimulation as a neurofunctional predictor of motor function recovery after ischemic stroke.MATERIAL AND METHODS. The study included 28 after-stroke patients, 19 men and 9 women, the mean age was 60.07±5.67 years, who underwent a course of inpatient medical rehabilitation at the Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky in 2022–2023. Clinical examination and assessment were conducted before and after the rehabilitation course using validated scales and questionnaires — the Medical Research Committee (MRCs) scale, the Box and Block Test (BBT), the modified Rankin scale (mRS); the rehabilitation routing scale (RRS). The patients were also examined using nTMS at the N.V. Sklifosovsky Research Institute for Emergency Medicine with the determination of motor evoked potential (MEP) parameters from the muscles of the upper and lower extremities.RESULTS. In patients with preserved MEP, there was a significant increase in the strength of the paretic limb on the MRCs scale from 4.00 (2.94–4.06) to 4.22 (3.83–4.89) points (p &lt;0.001) for the upper limb and from 4.00 (3.67–4.00) to 4.44 (3.83–4.61) (p&lt;0.001) for the lower limb. Improvements were revealed according to the mRS scale — the number of patients with an mRS score of 2 points in the group of patients with defined MEP increased by 26.1%, reached values of 1 point — 13.0% of patients, and the number of patients with an assessment of disability and self-care ability of 4 points decreased by 8.7%.CONCLUSION. Navigational transcranial magnetic stimulation is one of the methods for assessing the rehabilitation potential in patients with ischemic stroke. But TMS should not be used as the only method of evaluating rehabilitation potential. The assessment of RP should be comprehensive and based on the complex data obtained.

The Significance of an Initial Controlling Nutritional Status Score in Predicting the Functional Outcome, Complications, and Mortality in a First-Ever Ischemic Stroke

Background and Purpose: Nutritional status can influence the outcomes and mortality of various diseases. The association between initial nutritional status and ischemic stroke outcomes, however, remains poorly understood. This study investigated whether the Controlling Nutritional Status (CONUT) score at admission could predict functional recovery, complications, and survival following an ischemic stroke. Methods: We enrolled a total of 938 patients experiencing their first acute ischemic stroke and categorized them into three groups based on their CONUT score at admission: CONUT 0–1, CONUT 2–4, and CONUT 5–12. The CONUT score was assessed using the serum albumin, total cholesterol, and lymphocyte count. We evaluated the incidence of complications during their hospital stay. Outcomes, including the Modified Rankin Scale (mRS), Functional Independence Measurement (FIM), Functional Ambulatory Classification (FAC), and mortality, were assessed at baseline, as well as at three and six months post-stroke. Results: CONUT scores were significantly associated with functional outcomes (mRS, FIM, and FAC) and mortality during the six-month follow-up period post-stroke (all p &lt; 0.05). The CONUT 5–12 group exhibited significantly poorer improvements in mRS, FIM, and FAC scores (all p &lt; 0.05) and a lower survival rate (p &lt; 0.01) during the six-month follow-up compared to the CONUT 0–1 and CONUT 2–4 groups. Additionally, the incidence of pneumonia, urinary tract infections, pressure sores, falling injuries, and fractures was significantly higher in the CONUT 5–12 group than in the other groups (all p &lt; 0.01). Conclusions: CONUT scores at admission are associated with functional recovery, mortality, and the incidence of complications following a first-ever ischemic stroke. Consequently, the early identification of patients at risk of malnutrition via CONUT scores can be crucial in enhancing patient assessment after an acute stroke.

Exploration of acupuncture for myasthenia gravis based on the theory of yiqi zhouliu

Based on HUANG Yuanyu's theory of yiqi zhouliu (constant circulatory flowing of qi) it is explored that the pathogenesis of myasthenia gravis refers to qi deficiency in the middle jiao and the disarrangement of zhouliu. It is summarized that the approach to acupuncture diagnosis and treatment should focus on replenishing qi of the middle jiao based on yangming and tonifying the functions of zang organs to eliminate pathogens, assisted with regulating shen (spirit) and opening the orifices so as to promote the recovery of motor and non-motor functions of the four limbs, eyelids, speech articulation, swallowing, vision, respiration and mental state in patients.

Optimizing the Preoperative Preparation of Sarcopenic Older People: The Role of Prehabilitation and Nutritional Supplementation before Knee Arthroplasty.

Age-related loss of skeletal muscle strength and mass is linked to adverse postoperative outcomes in older individuals with sarcopenia. Half of patients suffer from severe associated osteoarthritis requiring orthopedic interventions. Mitigating the onset and progression of sarcopenia before surgery is essential to improve the prognosis and reduce surgical complications. The aim of this research was to innovatively explore whether the preoperative period could be the appropriate timeframe to empower surgical resilience, through prehabilitation and dietary supplementation, in older sarcopenic patients undergoing knee arthroplasty. The current literature concerning the effectiveness of prehabilitation and dietary supplementation before knee arthroplasty in sarcopenic older individuals was reviewed, following the SANRA criteria, between December 2023 and February 2024. The study inclusion criteria were as follows: (1) prehabilitation and/or dietary supplementation interventions; (2) human participants aged 65 years and older; (3) relevant outcome reporting (functional status, postoperative complications, and patient-reported outcomes); and (4) articles written in English The extracted information included study characteristics, demographics, intervention details, outcomes, and the main findings. Merged prehabilitation and dietary supplementation strategies extrapolated from the current literature and involving strength, resistance, balance, and flexibility training, as well as essential amino acids, iron, vitamin D, adenosine triphosphate, and glucosamine sulphate supplementation, could improve the functional capacity, ability to withstand the upcoming surgical stressors, and postoperative outcomes in older people undergoing knee arthroplasty. Addressing complex links between knee osteoarthritis and sarcopenia in older individuals undergoing knee arthroplasty requires a multidimensional approach. Prehabilitation emerges as a crucial preliminary step, allowing the optimization of surgical outcomes. Nutraceutical integration, included in a comprehensive care plan, could have a synergic effect in achieving prehabilitation goals. Those interventions are essential for surgical resilience, in terms of muscle function preservation, recovery acceleration, and overall quality of life enhancement. Intensive collaboration among specialists could advance knowledge and the sharable consensus concerning the critical and evolutive field of perioperative care.

Results of innervated digital artery perforator flap and direct-flow homodigital flap application in fingertip soft tissue amputations

ObjectiveThe purpose of this study is to compare the results of the innervated digital artery perforator (IDAP) flap and the direct-flow homodigital flap as reconstruction methods for fingertip soft tissue amputations. This issue is important in hand surgery, and we aim to identify the method that provides the best functional and cosmetic outcomes.MethodsBetween 2020 and 2022, 32 patients with fingertip amputations were reconstructed by the same surgeon using two different methods. The patients were retrospectively divided into two groups: those who underwent IDAP (n = 14) and those who had a direct-flow homodigital flap (n = 18). We compared the groups in terms of defect size, cold intolerance, venous congestion, Sollerman hand function test scores, Seddon sensory test scores, and follow-up periods, as well as flap viability, flexion contracture, and static two-point discrimination (s2PD).ResultsOf the 32 patients (26 men, 6 females; age: mean 28.72 ± 11.5 years), the injuries were caused by different mechanisms, including sharp (57.1% IDAP), crush (75% IDAP) and entanglement (66.7% homodigital). The average area of tissue loss was approximately 2.70 ± 1.37 cm², while the average s2PD measurement was approximately 4.94 ± 1.04 mm. Postoperatively, the Seddon sensory test results for the homodigital flap group were S4 (61.5%), S3 (23.1%), S3+ (7.7%), and S2 (7.7%), compared to the IDAP group, which showed S4 (57.9%), S3+ (21.1%), and S3 (21.1%). Complications occurred in five patients, though no flap loss or revision was required. The postoperative mean Sollerman hand function scores were higher for the homodigital group than for the IDAP group, with values of 75 ± 2.64 and 73 ± 3.34, respectively. Although not statistically significant, the results numerically suggest that the IDAP flap is better in terms of sensory recovery and hand function compared to the homodigital flap (p > 0.05).ConclusionsThis is the first investigation to compare direct-flow flaps with IDAP. The average follow-up period for patients who underwent homodigital surgery was also shorter than that of the IDAP group. Furthermore, the mean postoperative two-point discrimination and postoperative Sollerman function score were higher in patients who had homodigital surgery.

Application of blood flow restriction training in lower limb rehabilitation

With the popularity of national fitness campaigns, sports injuries, especially lower limb injuries such as anterior cruciate ligament tears and ankle sprains, are increasing year by year. There are limitations in traditional treatment such as muscle atrophy. In recent years, the blood flow restriction training method (BFRT) which simulates high-intensity exercise with low intensity and limits arterial and venous blood flow to promote muscle growth and strength enhancement, has drawn attention as a novel approach to rehabilitation. This article reviews the application of BFRT in the rehabilitation of lower limb injuries, discusses its effects on muscle function, pain management and quality of life, and evaluates its safety and prospects for clinical application. BFRT reduces mechanical stress, relieves pain, improves endurance and aerobic capacity, and improves cardiovascular function. However, there are discomfort and potential risks, such as muscle injury and thrombosis, which require individualised adjustments and standardised training. BFRT has shown positive result(reducing pain &amp;oedema and improving function)s in rehabilitation of ACL reconstruction (ACLR) and chronic ankle instability (CAI). In addition, BFRT has been shown to aid in the functional recovery of the lower extremity in patients with Achilles tendon injuries and strokes. Despite the positive effects of BFRT, relevant studies have problems such as small sample sizes and non-uniform parameters. BFRT is considered a safe training modality, but contraindications should be examined before clinical application. Future research endeavours should investigate the impact of BFRT in many rehabilitation contexts and enhance tailored rehabilitation strategies. In order to maximize the therapeutic benefit, a rehabilitation training program should be developed and refined with a minimum effective dose based on the quantification of the in vivo physiological response to BFRT. The identification of the optimal prognostic approach will help to advance the standardisation of BFR treatment methods.

Effect of nursing care based on goal-oriented mind mapping model on the prognosis of patients with severe brain injury.

The objective of this study was to observe the effect of nursing care based on goal-oriented mind-mapping on the prognosis of patients with severe brain injury. Clinical data of 116 patients with severe brain injury admitted to Qinghe County Central Hospital between March 2021 and August 2023 were retrospectively analyzed. Based on the nursing mode the patients received, they were divided into an Observation group (n = 58, patients received nursing based on the goal-oriented mind mapping mode) and a Control group (n = 58, patients received routine care). Data on length of hospital stay, complications, functional recovery, cerebral oxygen metabolism, and quality of life scores of the 2 groups were collected and analyzed. The length of hospital stay of the Observation group was shorter than that of the Control group (P < .05). The total incidence of complications in the Observation group was lower than that in the Control group (P < .05). After intervention, neurological function, cerebral oxygen metabolism indicators, and quality of life of the 2 groups improved significantly compared with those before the intervention; furthermore, the neurological function and cerebral oxygen metabolism indexes of the Observation group were better than those of the Control group (P < .05). The nursing care based on goal-oriented mind-mapping model for patients with severe brain injury can effectively shorten the length of hospital stay, reduce the occurrence of prognostic complications, and improve the recovery of neurological and limb motor functions, and ultimately achieve the goal of improving the quality of life.

Deletion of Slc1a4 Suppresses Single Mauthner Cell Axon Regeneration In Vivo through Growth-Associated Protein 43.

Spinal cord injury (SCI) is a debilitating central nervous system (CNS) disorder that leads to significant motor and sensory impairments. Given the limited regenerative capacity of adult mammalian neurons, this study presents an innovative strategy to enhance axonal regeneration and functional recovery by identifying a novel factor that markedly promotes axonal regeneration. Employing a zebrafish model with targeted single axon injury in Mauthner cells (M-cells) and utilizing the Tg (Tol056: EGFP) transgenic line for in vivo monitoring, we investigate the intrinsic mechanisms underlying axonal regeneration. This research specifically examines the role of amino acid transport, emphasizing the role of the solute carrier 1A4 amino acid transporter in axonal regeneration. Our findings demonstrate that Slc1a4 overexpression significantly enhances axonal regeneration in M-cells, whereas Slc1a4 deficiency impedes this process, which is concomitant with the downregulation of the P53/Gap43 signaling pathway. By elucidating the fundamental role of Slc1a4 in axonal regeneration and uncovering its underlying mechanisms, this study thus provides novel insights into therapeutic strategies for SCI.

Photobiomodulation improves functional recovery after mild traumatic brain injury

AbstractMild traumatic brain injury (mTBI) is a common consequence of head injury but there are no recognized interventions to promote recovery of the brain. We previously showed that photobiomodulation (PBM) significantly reduced the number of apoptotic cells in adult rat hippocampal organotypic slice cultures. In this study, we first optimized PBM delivery parameters for use in mTBI, conducting cadaveric studies to calibrate 660 and 810 nm lasers for transcutaneous delivery of PBM to the cortical surface. We then used an in vivo weight drop mTBI model in adult rats and delivered daily optimized doses of 660, 810 nm, or combined 660/810 nm PBM. Functional recovery was assessed using novel object recognition (NOR) and beam balance tests, whilst histology and immunohistochemistry were used to assess the mTBI neuropathology. We found that PBM at 810, 660 nm, or 810/660 nm all significantly improved both NOR and beam balance performance, with 810 nm PBM having the greatest effects. Histology demonstrated no overt structural damage in the brain after mTBI, however, immunohistochemistry using brain sections showed significantly reduced activation of both CD11b+ microglia and glial fibrillary acidic protein (GFAP)+ astrocytes at 3 days post‐injury. Significantly reduced cortical localization of the apoptosis marker, cleaved caspase‐3, and modest reductions in extracellular matrix deposition after PBM treatment, limited to choroid plexus and periventricular areas were also observed. Our results demonstrate that 810 nm PBM optimally improved functional outcomes after mTBI, reduced markers associated with apoptosis and astrocyte/microglial activation, and thus may be useful as a potential regenerative therapy.

Kidney function in newly diagnosed myeloma patients: factors associated with kidney impairment and recovery

Kidney disease is a common complication of multiple myeloma (MM) and a risk factor for increased morbimortality. In this retrospective cohort study based on medical records, we analyzed the kidney function of patients with renal disease related to MM during the first year of treatment. All patients included were consecutively admitted to the outpatient services of two hospitals between January 2009 and January 2019 and met the diagnostic criteria for MM regardless of the reason for seeking medical help. We excluded patients who had kidney disease or who were on dialysis before MM diagnosis. We investigated the factors associated with renal function recovery using multivariate analysis. We evaluated 167 patients (median age of 66 ± 11.49 years). Almost half of the patients had arterial hypertension (76; 45.5%). The majority had International Staging System (ISS) grades 3 (73; 43.7%) or 2 (60; 35.9%). Seventy-four (44%) patients had an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m² at the time of MM diagnosis. Fifty-two patients (31%) underwent hematopoietic stem cell transplantation (HSCT). After 12 months, 4 (2.3%) patients needed dialysis, and 18 (10.7%) died. The factors associated with an eGFR < 60 ml/min/1.73 m² were anemia, hyperuricemia, 24-hour proteinuria > 1.0 g, and extramedullary plasmacytoma. However, only baseline renal function (eGFR > 60 ml/min/1.73 m2) and HSCT were associated with greater recovery of renal function at 12 months of follow-up.

Efficacy of radial incision combined with tunnel floating line drainage in the treatment of high posterior horseshoe anal fistula and perianal flora: Randomized control trial.

Due to the high prevalence of posterior horseshoe anal fistula and causing numerous complications, this study aimed to investigate the clinical effect of radial incision combined with tunnel floating line drainage (RCTD) and arc incision internal drainage in the treatment of the disease and the influence on perianal flora. Ninety-six subjects treated with high posterior horseshoe anal fistula were stochastically assigned to a joint group (RCTD), and control group (arc incision internal drainage). The operation-related conditions, complication rate, anal function, and recurrence rate of 6 months after operation were compared, and perianal secretions were collected before operation and 1 day after operation to detect the changes of microbial flora. After operation, it was corroborated notable difference between joint group and control group in operation time, intraoperative blood loss, wound healing time, visual analogue scale score 6 hours after operation and phase I cure rate. Chi square test analysis showed notable difference between control group (27.08%) and joint group (10.40%) in incidence of complications, in terms of number of pathogens detected around anus, significantly smaller of the incremental change for the joint subgroup versus the control subgroup 1 day after operation. RCTD can be the best choice for patients with high posterior horseshoe anal fistula. This operation method has the advantages of short operation time, less trauma, fewer complications, fast recovery of anal function, and can also reduce perianal pathogenic bacteria infection.

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Natural Phycocyanin/Paclitaxel Micelle Delivery of Therapeutic P53 to Activate Apoptosis for HER2 or ER Positive Breast Cancer Therapy.

The P53 gene is commonly mutated in breast cancer, protein based the gene as anticancer drugs could provide efficient and stable advantages by restoring the function of the wild-type P53 protein. In this study, we describe the creation and utilization of a micelle composed by natural phycocyanin and paclitaxel and grafting anti-HER2 (PPH), which effectively packages and transports recombinant P53 protein with anti-ER (PE), resulting in a new entity designated as PE@PPH, to address localization obstacles and modify cellular tropism to the cell membrane or nucleus. The results indicate that PE@PPH has strong antitumor properties, even at low doses of PTX both in vitro and in vivo. These findings suggest that PE@PPH could be an enhancing micelle for delivering therapeutic proteins and promoting protein functional recovery, particularly in addressing the challenges posed by tumor heterogeneity in breast cancer.

Manual Acupuncture for Postoperative Pain and Recovery after Abdominal Surgeries: A Systematic Review.

Introduction: Acupuncture's role in surgical and postoperative contexts is gaining traction. However, the evidence remains patchy and is often of low-grade quality, particularly in the context of postintestinal surgery. Purpose: To assess acupuncture's efficacy in pain relief and functional recovery after abdominal surgery. Methods: We searched PubMed, Cochrane, Web of Science, and Google Scholar for randomized trials using manual acupuncture as the main intervention. Outcomes included postoperative pain, analgesic use, nausea, gastrointestinal (GI) regeneration, and length of hospital stay. For risk of bias assessment Cochrane risk of bias tool 2 was employed. Registered with PROSPERO: CRD42022311718. Results: Of 700 records till May 2023, 8 trials (551 patients; 16-200/trial) were included. Due to factors such as varying experimental settings and unpublished protocols, there was high risk of bias and heterogeneity, making meta-analysis unfeasible. Safety data were documented sufficiently by two trials. However, acupuncture showed marked benefits in pain relief, less analgesic use, fewer nausea cases, and improved GI recovery. One study reported reduced hospitalization time. Conclusion: Due to the varied methodologies and potential biases in existing studies, the definitive effectiveness of acupuncture remains unclear. To confirm the potential benefits of acupuncture as suggested by the reviewed studies, it's imperative to have more standardized study protocols, well-defined interventions and controls, and objective measures of efficacy.

Effects of pulsed electromagnetic fields on bone fractures: a systematic review update.

Fractures are common bone injuries, which have a great burden on global health. Fracture healing is a long-term process that may be influenced by a number of factors. The 10-15% of all bone fractures may be complicated by an impaired healing (i.e. delayed union or non-union). The application of weak electromagnetic fields has been proposed to have different effects on bones such as enhancing proliferation - orientation - migration of osteoblast-like cells and supporting osteogenic differentiation in bone marrow-derived mesenchymal stem cells. Despite the amount of evidence on cellular and histological effects, to date the application of pulsed electromagnetic fields has not achieved univocal consensus in daily practice. The purpose of this systematic review update is to research, select, analyze and summarize the most recent scientific evidence regarding the effects of pulsed electromagnetic fields in the treatment of acute bone fractures. A systematic review using the following MeSH terms (Magnetic Field Therapy; Electromagnetic Fields; Bone and Bones; Fractures, Bone; Fractures Healing) and strings {("Magnetic Field Therapy [mh]" OR "Electromagnetic Fields [mh]) OR "magnetotherapy" OR "pulsed electromagnetic field") and ("Fractures, bone [mh]" OR "Bone and Bones [mh]") and ("Fractures Healing [mh]")} was conducted on PubMed, Cochrane Library, Epistemonikos and Scopus electronic databases. Only full articles published in English between January 2014 and December 2022 were considered. Eligibility criteria were defined according to the Population, Intervention, Comparison, Outcomes, and Study (PICOS) design framework. Case reports, case series, uncontrolled studies and expert opinions were excluded. All articles were checked for quality and risk of bias. Three randomized controlled trials were included (197 patients in total). None of the studies found significant effects of pulsed electromagnetic fields on the acute bone healing process. Contradictory results about pain relief emerged. Only one study showed a transitory positive effect of pulsed electromagnetic fields on strength and range of motion recovery in patients with acute bone fracture. This systematic review update does not support the use of pulsed electromagnetic fields for improving the bone healing process in patients with acute fractures. Controversial evidence was found about the effects of pulsed electromagnetic fields on pain and functional recovery. Considering the scant and heterogenous literature published to date, which represents a limit for our conclusion, further studies with rigorous and high-quality methodology are needed.

Disrupting stroke-induced GAT-1-syntaxin1A interaction promotes functional recovery after stroke.

Although stroke is a frequent cause of permanent disability, our ability to promote stroke recovery is limited. Here, we design a small-molecule stroke recovery promoting agent that works by dissociating γ-aminobutyric acid (GABA) transporter 1 (GAT-1) from syntaxin1A (Synt1A), a soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) protein. Stroke induces an increase in GAT-1-Synt1A interaction in the subacute phase, a critical period for functional recovery. Uncoupling GAT-1-Synt1A reverses stroke-induced GAT-1 dysfunction and cortical excitability decline and enhances synaptic GABAergic inhibition and consequently cortical oscillations and network plasticity by facilitating the assembly of the SNARE complex at the synapse. Based on the molecular mechanism of GAT-1 binding to Synt1A, we design GAT-1-Synt1A blockers. Among them, ZLQ-3 exhibits the greatest potency. Intranasal use of ZLQ-3-1, a glycosylation product of ZLQ-3, substantially lessens impairments of sensorimotor and cognitive functions in rodent models. This compound, or its analogs, may serve as a promoting agent for stroke recovery.

Impact of enhanced recovery after surgery on postoperative blood management following primary total knee arthroplasty: a propensity score-matched analysis.

To evaluate the efficacy of blood management in patients underwent unilateral Total Knee Arthroplasty (TKA)under an enhanced recovery after surgery (ERAS) program. Patients underwent unilateral TKA from January 2019 to October 2023 in a university hospital were retrospectively studied. A total of 200 cases were selected in the analysis. After matching with propensity scoring, 51 patients in each group were included. The postoperative Haemoglobin (Hb), albumin (Alb), C-reactive protein (CRP), total length of stay (LOS), and estimated blood loss after operation were compared between the two groups. Clinical outcomes including Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF-12, and Oxford Knee Score (OKS) were also compared atsixweek and threemonth follow-up. The results showed that the Hb of the ERAS group was significantly higher than those of the non-ERAS group (P < 0.05) on the third postoperative. The mean CRP level was lower, LOS was shorter, and Alb level was higher in the ERAS group compared to that in the non-ERAS group (P < 0.05). The clinical outcomes such as WOMAC and OKS, SF-12 scores were higher in the ERAS group at both follow-up. ERAS protocol effectively minimizes perioperative blood loss and supports optimal nutrient levels in patients. ERAS management significantly contributes to the postoperative recovery of knee function in patients undergoing primary total knee arthroplasty.