This paper proposes virtual impedance adaptation of the lower-limb exoskeleton for human performance augmentation(LEHPA) based on deep reinforcement learning(VIADRL) to mitigate reliance on model accuracy and address ...This paper proposes virtual impedance adaptation of the lower-limb exoskeleton for human performance augmentation(LEHPA) based on deep reinforcement learning(VIADRL) to mitigate reliance on model accuracy and address the ever-changing human-exoskeleton interaction(HEI) dynamics. The classical sensitivity amplification control strategy is expanded to the virtual impedance control strategy with more learnable virtual impedance parameters. The adjustment of these virtual impedance parameters is formalized as finding the optimal policy for a Markov Decision Process and can then be effectively resolved using deep reinforcement learning algorithms. To ensure safe and efficient policy training, a multibody simulation environment is established to facilitate the training process, supplemented by the innovative hybrid inverse-forward dynamics simulation approach for executing the simulation. For comparison purposes, the SADRL strategy is introduced as a benchmark. A novel control performance evaluation method based on the HEI forces at the back, thighs, and shanks is proposed to quantitatively evaluate the performance of our proposed VIADRL strategy. The VIADRL controller is systematically compared with the SADRL controller at five selected walking speeds. The lumped ratio of HEI forces under the SADRL strategy relative to those under the SADRL strategy is as low as 0.81 in simulation and approximately 0.89 on the LEHPA prototype. The overall reduction of HEI forces demonstrates the superiority of the VIADRL strategy in comparison to the SADRL strategy.展开更多
Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), C...Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), Cochrane Library (from 1991), Elsevier sciences database (from 1990), OVID full text database (from 1997), Springer-link database (from 1997), The National Research Register database, ISI Web of knowledge (from 1963), Chinese Medical Citation Index/Chinese Medical Current Contents (CMCI/CMCC, from 1989), China Knowledge Resource Integrated Database (CNKI, from 1915),VIP database (from 1989), and Wanfang database (from 1977) have been searched only for the English and Chinese literatures updated to 10-30-2010. Two researchers independently assessed the methodological quality of studies, extracted and checked the data one another according to the include/exclude standards. Disagreement was resolved by discussions or with the third person. The Review Manage Software 5.0 was used for Meta-analysis. Results: Eventually, 2 randomized controled studies and 2 non-randomized controled studies met the inclusion criteria, with 163 subjects involved in the present meta-analysis. The meta-analysis demonstrated that Tai Chi exercise could improve the ankle flexor/extensor muscle strength and the knee extensor/flexor muscle strength, tested with an isokinetic dynamometer. The limb muscle strength increased significantly after Tai Chi exercise (P<0.01). Conclusion: The meta-analysis favours Tai Chi exercise for improving the lower-limb muscle strength in the older people.展开更多
Unilateral motor impairment can disrupt the coordination between the joints,impeding the patient’s normal gait.To assist such patients to walk normally and naturally,an adaptive control algorithm based on inter-joint...Unilateral motor impairment can disrupt the coordination between the joints,impeding the patient’s normal gait.To assist such patients to walk normally and naturally,an adaptive control algorithm based on inter-joint coordination was proposed in this work for lower-limb exoskeletons.The control strategy can generate the reference trajectory of the affected leg in real time based on a motion coordination model between the joints,and adopt an adaptive controller with virtual windows to track the reference trajectory.Long Short-Term Memory(LSTM)network was also adopted to establish the coordination model between the joints of both lower limbs,which was optimized by preprocessing angle information and adding gait phase information.In the adaptive controller,the virtual windows were symmetrically distributed around the reference trajectory,and its width was adjusted according to the gait phase of the auxiliary leg.In addition,the impedance parameters of the controller were updated online to match the motion capacity of the affected leg based on the spatiotemporal symmetry factors between the bilateral gaits.The LSTM coordination model demonstrated good accuracy and generality in the gait database of seven individuals,with an average root mean square error of 3.5 and 4.1 for the hip and knee joint angle estimation,respectively.To further evaluate the control algorithm,four healthy subjects walked wearing the exoskeleton while additional weights were added around the ankle joint to simulate an asymmetric gait.From the experimental results,it was shown that the algorithm improved the gait symmetry of the subjects to a normal level while exhibiting great adaptability to different subjects.展开更多
Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic fl...Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.展开更多
AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle oxygenation.METHODS Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1....AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle oxygenation.METHODS Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals(nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen(rS O_2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C(Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rS O_2 and clinical parameters.RESULTS The r SO_2 values were significantly lower in patients undergoing HD than in healthy individuals(50.0%± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle r SO_2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle r SO_2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lowerlimb muscle r SO_2 was independently associated with serum inorganic phosphate(standardized coefficient: 0.27) and serum albumin concentrations(standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle r SO_2 between diabetic and nondiabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lowerlimb muscle r SO_2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing nutritional status, and the severity of protein-energy wasting. Finally, we did not routinely examine the arterial vascular status of HD patients without symptoms of peripheral artery disease. As such, it is possible that some HD patients with subclinical peripheral artery disease may have been included in this study.CONCLUSION In HD patients, the oxygenation of lower-limb muscle tissue was associated with serum inorganic phosphate and albumin concentrations, both of which represent nutritional status.展开更多
Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide ...Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide support to the whole body and play an important role in walking,it is proposed that the ratio of the lower limb to the whole body for modern human could be beneficial to bipedal walking.This study tried to estimate the muscle parameters of the lower limb in walking for the subjects with various body proportions.Using a simplified musculoskeletal model,some muscle parameters of the lower limb,e.g.muscle force,stress,work and power,were estimated for modern human adult,child,AL 288-1(the fossil specimens of Australopithecus afarensis,3.18 million years old)and apes.The results show that with the body proportion modern human adult spends less muscle work and power in walking than other subjects.The results imply that using the cost of transport(i.e.the muscle work of the lower limb per unit of displacement)as the criteria,the early hominids,if their body proportions were structurally similar to AL 288-1,could evolve towards what modern human adult looks like,in order to save energy during bipedal walking.展开更多
目的:系统评价水中运动对老年帕金森病患者平衡功能与运动能力的影响。方法:检索中国知网、万方与维普等中文数据库,以及Web of Science、PubMed、EMBASE、ScienceDirect、Cochrane Library等英文数据库,筛选出水中运动干预老年帕金森...目的:系统评价水中运动对老年帕金森病患者平衡功能与运动能力的影响。方法:检索中国知网、万方与维普等中文数据库,以及Web of Science、PubMed、EMBASE、ScienceDirect、Cochrane Library等英文数据库,筛选出水中运动干预老年帕金森病患者的随机对照试验研究文献。检索时限从2000年1月至2025年3月,研究组采用水中运动或水陆联合运动方式,对照组采用常规康复或陆地运动方式。结局指标包括帕金森量表第三部分评分、Berg平衡量表评分、起立-行走计时测验、帕金森病调查问卷39评分及5 min起坐测试结果。由2名研究者独立提取数据,并按照Cochrane手册5.3标准对纳入文献进行偏倚风险评估,采用Rev Man 5.3统计软件进行Meta分析。结果:此次Meta分析共纳入7篇随机对照试验研究,共计241例患者。分析结果显示,与对照组相比,研究组干预后Berg平衡量表评分(MD=5.30,95%CI:2.55-8.06,P=0.0002)、5 min起坐测试次数(MD=3.79,95%CI:1.84-5.75,P=0.0001)明显升高,起立-行走计时明显缩短(MD=-1.93,95%CI:-2.64至-1.22,P<0.00001)。两组干预后帕金森评价量表第三部分评分(MD=-1.31,95%CI:-3.90-1.28,P=0.32)、帕金森病调查问卷39评分(MD=-3.64,95%CI:-9.77-2.49,P=0.24)均无统计学差异。结论:水中运动显著改善了老年帕金森病患者的平衡功能、下肢肌力、步态速度及移动能力,但对上肢协调性、精细动作等运动能力及生活质量的改善效果尚不明确,未来仍需通过方法严谨、长干预周期的研究进行验证。展开更多
目的分析桃红四物汤通过单磷酸腺苷活化蛋白激酶(AMP-activated protein kinase,AMPK)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)信号通路对大鼠动脉粥样硬化形成的影响及作用机制。方法选取60只清洁级雄性SD大鼠,其...目的分析桃红四物汤通过单磷酸腺苷活化蛋白激酶(AMP-activated protein kinase,AMPK)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)信号通路对大鼠动脉粥样硬化形成的影响及作用机制。方法选取60只清洁级雄性SD大鼠,其中10只作为空白组,其余50只采用高脂饮食喂养及动脉内膜损伤方法建立动脉粥样硬化模型,按照随机数表法分为对照组、桃红四物汤低浓度组(L组)、桃红四物汤中浓度组(M组)、桃红四物汤高浓度组(H组)。造模后第9周开始中药干预。空白组与对照组每日予蒸馏水3 mL灌胃,L、M及H组每日分别予相应剂量浓缩至3 mL灌胃。药物干预共8周。观察大鼠下肢动脉粥样硬化斑块程度、AMPK/mTOR信号通路以及血管平滑肌细胞表型转化相关的血管平滑肌激动蛋白(α-smooth muscle actin,α-SMA)、骨桥蛋白(osteopontin,OPN)的差异表达情况。结果与空白组相比,L、M及H组大鼠动脉粥样硬化明显形成,内膜下可见泡沫细胞形成,p-AMPK、OPN在L、M及H组中明显高表达,而mTOR、α-SMA的表达明显下调(P<0.05)。结论桃红四物汤可通过激活AMPK/mTOR信号通路,降低平滑肌细胞收缩表型向合成表型的转化,从而抑制平滑肌细胞的增殖,减缓动脉粥样硬化的进展。展开更多
目的:研究表明,重复经颅磁刺激和经颅直流电刺激对改善脑瘫患儿粗大运动功能具有积极作用。采用网状Meta分析方法评价重复经颅磁刺激和经颅直流电刺激对脑瘫患儿下肢运动功能及步态改善的临床疗效。方法:检索中国知网、万方、维普、Sino...目的:研究表明,重复经颅磁刺激和经颅直流电刺激对改善脑瘫患儿粗大运动功能具有积极作用。采用网状Meta分析方法评价重复经颅磁刺激和经颅直流电刺激对脑瘫患儿下肢运动功能及步态改善的临床疗效。方法:检索中国知网、万方、维普、SinoMed、PubMed、Web of Science、Medline数据库,搜索关于重复经颅磁刺激与经颅直流电刺激改善脑瘫患儿下肢运动功能及步态的随机对照试验,检索时限均为数据库建库至2024-10-05。筛选文献、提取资料并评价纳入研究的偏倚风险,采用Stata 15.0软件进行网状Meta分析,使用GRADE证据分级系统进行质量评价。结果:最终纳入19篇研究,涉及常规治疗、高频重复经颅磁刺激、低频重复经颅磁刺激、阳极经颅直流电刺激4种治疗方案。网状Meta分析结果显示,与常规治疗相比,低频重复经颅磁刺激改善脑瘫患儿粗大运动功能方面的疗效最佳[MD=9.48,95%CI(6.61,12.34),P<0.05],在缓解痉挛方面,高频重复经颅磁刺激的疗效最佳[MD=-0.63,95%CI(-1.72,0.45),P<0.05],经颅直流电刺激改善脑瘫患儿踝关节活动度和步速方面的疗效最佳[MD=2.27,95%CI(1.37,3.17),P<0.05;MD=0.11,95%CI(0.05,0.17),P<0.05]。结论:现有临床证据表明,对于脑瘫患儿,在改善下肢粗大运动功能方面,低频重复经颅磁刺激展现出最佳疗效;对于降低肌痉挛程度,高频重复经颅磁刺激的效果更为显著;在步态改善方面,经颅直流电刺激则表现出明显优势。展开更多
文摘This paper proposes virtual impedance adaptation of the lower-limb exoskeleton for human performance augmentation(LEHPA) based on deep reinforcement learning(VIADRL) to mitigate reliance on model accuracy and address the ever-changing human-exoskeleton interaction(HEI) dynamics. The classical sensitivity amplification control strategy is expanded to the virtual impedance control strategy with more learnable virtual impedance parameters. The adjustment of these virtual impedance parameters is formalized as finding the optimal policy for a Markov Decision Process and can then be effectively resolved using deep reinforcement learning algorithms. To ensure safe and efficient policy training, a multibody simulation environment is established to facilitate the training process, supplemented by the innovative hybrid inverse-forward dynamics simulation approach for executing the simulation. For comparison purposes, the SADRL strategy is introduced as a benchmark. A novel control performance evaluation method based on the HEI forces at the back, thighs, and shanks is proposed to quantitatively evaluate the performance of our proposed VIADRL strategy. The VIADRL controller is systematically compared with the SADRL controller at five selected walking speeds. The lumped ratio of HEI forces under the SADRL strategy relative to those under the SADRL strategy is as low as 0.81 in simulation and approximately 0.89 on the LEHPA prototype. The overall reduction of HEI forces demonstrates the superiority of the VIADRL strategy in comparison to the SADRL strategy.
文摘Objective: To assess the effects of Tai Chi (Chinese shadow boxing exercise) for improving the lower-limb muscle strength in elderly people. Methods: The PUBMED database (from 1950), EMBASE-ASP database (from 1974), Cochrane Library (from 1991), Elsevier sciences database (from 1990), OVID full text database (from 1997), Springer-link database (from 1997), The National Research Register database, ISI Web of knowledge (from 1963), Chinese Medical Citation Index/Chinese Medical Current Contents (CMCI/CMCC, from 1989), China Knowledge Resource Integrated Database (CNKI, from 1915),VIP database (from 1989), and Wanfang database (from 1977) have been searched only for the English and Chinese literatures updated to 10-30-2010. Two researchers independently assessed the methodological quality of studies, extracted and checked the data one another according to the include/exclude standards. Disagreement was resolved by discussions or with the third person. The Review Manage Software 5.0 was used for Meta-analysis. Results: Eventually, 2 randomized controled studies and 2 non-randomized controled studies met the inclusion criteria, with 163 subjects involved in the present meta-analysis. The meta-analysis demonstrated that Tai Chi exercise could improve the ankle flexor/extensor muscle strength and the knee extensor/flexor muscle strength, tested with an isokinetic dynamometer. The limb muscle strength increased significantly after Tai Chi exercise (P<0.01). Conclusion: The meta-analysis favours Tai Chi exercise for improving the lower-limb muscle strength in the older people.
基金supported by the Graduate Scientific Research and Innovation Foundation of Chongqing,China(CYB19062)the China Scholarship Council(CSC202206050121).
文摘Unilateral motor impairment can disrupt the coordination between the joints,impeding the patient’s normal gait.To assist such patients to walk normally and naturally,an adaptive control algorithm based on inter-joint coordination was proposed in this work for lower-limb exoskeletons.The control strategy can generate the reference trajectory of the affected leg in real time based on a motion coordination model between the joints,and adopt an adaptive controller with virtual windows to track the reference trajectory.Long Short-Term Memory(LSTM)network was also adopted to establish the coordination model between the joints of both lower limbs,which was optimized by preprocessing angle information and adding gait phase information.In the adaptive controller,the virtual windows were symmetrically distributed around the reference trajectory,and its width was adjusted according to the gait phase of the auxiliary leg.In addition,the impedance parameters of the controller were updated online to match the motion capacity of the affected leg based on the spatiotemporal symmetry factors between the bilateral gaits.The LSTM coordination model demonstrated good accuracy and generality in the gait database of seven individuals,with an average root mean square error of 3.5 and 4.1 for the hip and knee joint angle estimation,respectively.To further evaluate the control algorithm,four healthy subjects walked wearing the exoskeleton while additional weights were added around the ankle joint to simulate an asymmetric gait.From the experimental results,it was shown that the algorithm improved the gait symmetry of the subjects to a normal level while exhibiting great adaptability to different subjects.
文摘Aim: We devised a self-care supporting program targeting patients with early stages of secondary lower-limb lymphedema. The program incorporates “Simple exercises to replace lymphatic drainage” based on lymphatic flow. The purpose of this study was to consider the feasibility of continuing this program. Methods: The participants were patients in the early stages of secondary lower-limb lymphedema after gynecological cancer surgery and lymphedema therapists with more than five years of experience. Patients continued self-care at home after being briefed on the program, and they were analyzed on their self-care continuity status one month later based on a self-administered questionnaire survey and self-care notes. We interviewed the lymphedema therapists about this program to discuss the feasibility of continuing it and obtain feedback. Results: The patients who participated in the study were six women who underwent surgery with lymph node dissection for gynecological cancer. The therapists were five nurses and one occupational therapist. The patient understood the importance of all items in the self-care. “Observation,” “Touching,” and “Skin care” were relatively easy to continue. “Lymph drainage” and “Exercise” were continued with “Simple exercises to replace lymphatic drainage”. “Other exercises” were able to continue by adding distance and time to daily activities. Furthermore, “Measurement” and “Recording” became a burden and were difficult to continue. Nonetheless, this program was generally approved by the lymphedema therapists. They also pointed out the content and format of the self-care notes as improvements. Conclusions: We found that the self-care supporting program that incorporated “Simple exercises to replace lymphatic drainage” might be feasible to continue self-care for patients with early stages of secondary lower-limb lymphedema. Furthermore, we found that we needed to improve the “Measurement” and “Recording” sections of this program.
文摘AIM To evaluate the lower-limb muscle oxygenation in hemodialysis(HD) patients and identify the factors associating with muscle oxygenation.METHODS Sixty-seven HD patients(53 men and 14 women; mean age, 67.1 ± 1.2 years; mean HD duration, 5.6 ± 0.9 years) were recruited. In addition, 15 healthy individuals(nine men and six women; mean age, 38.2 ± 4.6 years) were recruited as the control group. Lower-limb muscle regional saturation of oxygen(rS O_2) was monitored on the lateral side of the gastrocnemius muscle before HD using an INVOS 5100C(Covidien Japan, Tokyo, Japan), which utilizes near-infrared spectroscopy. Here, we evaluated the association between lower-limb muscle rS O_2 and clinical parameters.RESULTS The r SO_2 values were significantly lower in patients undergoing HD than in healthy individuals(50.0%± 1.7% vs 76.8% ± 2.5%, P < 0.001). Lower-limb muscle r SO_2 showed significant positive correlations with diastolic blood pressure, blood urea nitrogen concentration, serum creatinine concentration, serum potassium concentration, serum inorganic phosphate concentration, and serum albumin concentration as well as negative correlation with HD duration. We conducted a multiple linear regression analysis using parameters that were significantly correlated with the lower-limb muscle r SO_2 in a simple linear regression analysis. Multiple regression analysis demonstrated that lowerlimb muscle r SO_2 was independently associated with serum inorganic phosphate(standardized coefficient: 0.27) and serum albumin concentrations(standardized coefficient: 0.24). In addition, there were no differences in lower-limb muscle r SO_2 between diabetic and nondiabetic HD patients. This study has several limitations. Firstly, its sample size was relatively small. Secondly, we could not evaluate the association between lowerlimb muscle r SO_2 and calculated nutritional markers, including normalized protein catabolic rate and body mass index, anthropometric measurements representing nutritional status, and the severity of protein-energy wasting. Finally, we did not routinely examine the arterial vascular status of HD patients without symptoms of peripheral artery disease. As such, it is possible that some HD patients with subclinical peripheral artery disease may have been included in this study.CONCLUSION In HD patients, the oxygenation of lower-limb muscle tissue was associated with serum inorganic phosphate and albumin concentrations, both of which represent nutritional status.
基金Supported in part by the grants fromthe BiotechnologyBiological Sciences Research Council,the Leverhulme Trustthe Natural Environment Research Council,U.K.
文摘Modern human has different body proportion from early hominids and great apes.Comparing with others,in general,modern human adults have relatively long lower limb and heavier body weight.Since the lower limbs provide support to the whole body and play an important role in walking,it is proposed that the ratio of the lower limb to the whole body for modern human could be beneficial to bipedal walking.This study tried to estimate the muscle parameters of the lower limb in walking for the subjects with various body proportions.Using a simplified musculoskeletal model,some muscle parameters of the lower limb,e.g.muscle force,stress,work and power,were estimated for modern human adult,child,AL 288-1(the fossil specimens of Australopithecus afarensis,3.18 million years old)and apes.The results show that with the body proportion modern human adult spends less muscle work and power in walking than other subjects.The results imply that using the cost of transport(i.e.the muscle work of the lower limb per unit of displacement)as the criteria,the early hominids,if their body proportions were structurally similar to AL 288-1,could evolve towards what modern human adult looks like,in order to save energy during bipedal walking.
文摘目的:系统评价水中运动对老年帕金森病患者平衡功能与运动能力的影响。方法:检索中国知网、万方与维普等中文数据库,以及Web of Science、PubMed、EMBASE、ScienceDirect、Cochrane Library等英文数据库,筛选出水中运动干预老年帕金森病患者的随机对照试验研究文献。检索时限从2000年1月至2025年3月,研究组采用水中运动或水陆联合运动方式,对照组采用常规康复或陆地运动方式。结局指标包括帕金森量表第三部分评分、Berg平衡量表评分、起立-行走计时测验、帕金森病调查问卷39评分及5 min起坐测试结果。由2名研究者独立提取数据,并按照Cochrane手册5.3标准对纳入文献进行偏倚风险评估,采用Rev Man 5.3统计软件进行Meta分析。结果:此次Meta分析共纳入7篇随机对照试验研究,共计241例患者。分析结果显示,与对照组相比,研究组干预后Berg平衡量表评分(MD=5.30,95%CI:2.55-8.06,P=0.0002)、5 min起坐测试次数(MD=3.79,95%CI:1.84-5.75,P=0.0001)明显升高,起立-行走计时明显缩短(MD=-1.93,95%CI:-2.64至-1.22,P<0.00001)。两组干预后帕金森评价量表第三部分评分(MD=-1.31,95%CI:-3.90-1.28,P=0.32)、帕金森病调查问卷39评分(MD=-3.64,95%CI:-9.77-2.49,P=0.24)均无统计学差异。结论:水中运动显著改善了老年帕金森病患者的平衡功能、下肢肌力、步态速度及移动能力,但对上肢协调性、精细动作等运动能力及生活质量的改善效果尚不明确,未来仍需通过方法严谨、长干预周期的研究进行验证。
文摘目的分析桃红四物汤通过单磷酸腺苷活化蛋白激酶(AMP-activated protein kinase,AMPK)/哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin,mTOR)信号通路对大鼠动脉粥样硬化形成的影响及作用机制。方法选取60只清洁级雄性SD大鼠,其中10只作为空白组,其余50只采用高脂饮食喂养及动脉内膜损伤方法建立动脉粥样硬化模型,按照随机数表法分为对照组、桃红四物汤低浓度组(L组)、桃红四物汤中浓度组(M组)、桃红四物汤高浓度组(H组)。造模后第9周开始中药干预。空白组与对照组每日予蒸馏水3 mL灌胃,L、M及H组每日分别予相应剂量浓缩至3 mL灌胃。药物干预共8周。观察大鼠下肢动脉粥样硬化斑块程度、AMPK/mTOR信号通路以及血管平滑肌细胞表型转化相关的血管平滑肌激动蛋白(α-smooth muscle actin,α-SMA)、骨桥蛋白(osteopontin,OPN)的差异表达情况。结果与空白组相比,L、M及H组大鼠动脉粥样硬化明显形成,内膜下可见泡沫细胞形成,p-AMPK、OPN在L、M及H组中明显高表达,而mTOR、α-SMA的表达明显下调(P<0.05)。结论桃红四物汤可通过激活AMPK/mTOR信号通路,降低平滑肌细胞收缩表型向合成表型的转化,从而抑制平滑肌细胞的增殖,减缓动脉粥样硬化的进展。
文摘目的:研究表明,重复经颅磁刺激和经颅直流电刺激对改善脑瘫患儿粗大运动功能具有积极作用。采用网状Meta分析方法评价重复经颅磁刺激和经颅直流电刺激对脑瘫患儿下肢运动功能及步态改善的临床疗效。方法:检索中国知网、万方、维普、SinoMed、PubMed、Web of Science、Medline数据库,搜索关于重复经颅磁刺激与经颅直流电刺激改善脑瘫患儿下肢运动功能及步态的随机对照试验,检索时限均为数据库建库至2024-10-05。筛选文献、提取资料并评价纳入研究的偏倚风险,采用Stata 15.0软件进行网状Meta分析,使用GRADE证据分级系统进行质量评价。结果:最终纳入19篇研究,涉及常规治疗、高频重复经颅磁刺激、低频重复经颅磁刺激、阳极经颅直流电刺激4种治疗方案。网状Meta分析结果显示,与常规治疗相比,低频重复经颅磁刺激改善脑瘫患儿粗大运动功能方面的疗效最佳[MD=9.48,95%CI(6.61,12.34),P<0.05],在缓解痉挛方面,高频重复经颅磁刺激的疗效最佳[MD=-0.63,95%CI(-1.72,0.45),P<0.05],经颅直流电刺激改善脑瘫患儿踝关节活动度和步速方面的疗效最佳[MD=2.27,95%CI(1.37,3.17),P<0.05;MD=0.11,95%CI(0.05,0.17),P<0.05]。结论:现有临床证据表明,对于脑瘫患儿,在改善下肢粗大运动功能方面,低频重复经颅磁刺激展现出最佳疗效;对于降低肌痉挛程度,高频重复经颅磁刺激的效果更为显著;在步态改善方面,经颅直流电刺激则表现出明显优势。
