SUSTAINED EFFICACY OF INCOBOTULINUMTOXINA FOLLOWING REPEATED INJECTIONS FOR UPPER-LIMB POST-STROKE SPASTICITY: A POST HOC ANALYSIS

ObjectiveThis post hoc analysis assessed the impact of repeated incobotulinumtoxinA injections on muscle tone, disability, and caregiver burden in adults with upper-limb post-stroke spasticity.DesignData from the double-blind, placebo-controlled main period and three open-label extension cycles of two Phase 3, randomized, multicentre trials were pooled.MethodsSubjects received incobotulinumtoxinA 400 Units at 12-week intervals (±3 days) (study 3001, {"type":"clinical-trial","attrs":{"text":"NCT01392300","term_id":"NCT01392300"}}NCT01392300) or ≤ 400 Units at ≥12-week intervals based on clinical need (study 0410, {"type":"clinical-trial","attrs":{"text":"NCT00432666","term_id":"NCT00432666"}}NCT00432666). Ashworth Scale (AS) arm sumscore (sum of elbow, wrist, finger and thumb flexor, and forearm pronator AS scores), Disability Assessment Scale (DAS), and Carer Burden Scale (CBS) scores were assessed.ResultsAmong 465 subjects, from study baseline to 4 weeks post-injection, mean (standard deviation) AS arm sumscore improved continuously: main period, –3.23 (2.55) (placebo, –1.49 (2.09)); extension cycles 1, 2, and 3, –4.38 (2.85), –4.87 (3.05), and –5.03 (3.02), respectively. DAS principal target domain responder rate increased from 47.4% in the main period (placebo 27.2%) to 66.6% in extension cycle 3. Significant improvements in CBS scores 4 weeks post-injection accompanied improved functional disability in all cycles.ConclusionIncobotulinumtoxinA conferred sustained improvements in muscle tone, disability, and caregiver burden in subjects with upper-limb poststroke spasticity.LAY ABSTRACTSpasticity (muscle overactivity) often occurs in patients after stroke and may lead to further disability. The results of 2 clinical trials were used to assess the effect of incobotulinumtoxinA injections (maximum dose used per injection session 400 Units) on arm and hand spasticity in patients after stroke. This study looked at the impact of treatment on disability and the burden on carers. The results from 4 treatment cycles were assessed. There was a continuous decrease in spasticity, together with improvements in disability in all treatment cycles. The burden on those who cared for patients also decreased. We showed that repeated incobotulinumtoxinA treatment across 4 cycles led to a decrease in spasticity, patient disability and burden on carers.Key words: botulinum neurotoxin, duration of effect, incobotulinumtoxinA, upper limb, spasticity, caregiver burden, rehabilitation

Stroke is an increasing cause of disability globally (1), and the development of spasticity in stroke survivors may contribute to further disability (2, 3). The prevalence of post-stroke spasticity ranges from 4.0% to 42.6% (2, 4, 5) and may be associated with reduced ability to perform the basic activities of daily living, and detrimental effects on quality of life (4, 6, 7). In addition to the loss of independence experienced by those affected, post-stroke spasticity can also result in a considerable burden on caregivers (6).The safety and efficacy of botulinum neurotoxin type A (BoNT-A) injections have been well established for the treatment of upper-limb post-stroke spasticity (8–13). Notably, the 24-week BEST study evaluated the efficacy and safety of onabotulinumtoxinA in adults with upper-limb or lower-limb post-stroke spasticity (n = 273), and the addition of onabotulinumtoxinA to the existing standard of care demonstrated improvements in passive goal-oriented activities compared with placebo, as well as additional benefits in active functional goals with no new safety signals (14).IncobotulinumtoxinA (Xeomin^®, Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany) is a BoNTA approved for the treatment of upper-limb spasticity at doses up to 400 Units (U) at intervals no sooner than every 12 weeks in the USA (15); while in Europe doses of up to 500 U at intervals of at least 12 weeks are approved, enabling treatment of a greater number of muscles (16). Two Phase 3 studies have confirmed the efficacy and safety of incobotulinumtoxinA in subjects with upper-limb post-stroke spasticity (17, 18); both studies included a placebo-controlled main period (MP) comprising a single injection cycle, followed by an open-label extension (OLEX) period with 3 fixed, 12-week incobotulinumtoxinA injection cycles (study 3001) (17), or a maximum of 5 flexible-duration injection cycles (study 0410) (19), respectively. Compared with placebo, incobotulinumtoxinA resulted in significant improvements in muscle tone (Ashworth Scale; AS) and functional disability (Disability Assessment Scale, DAS, for the principal target domain) 4 weeks post-treatment in the MP of both studies (17, 18). These improvements were sustained during the OLEX period of both studies (19–21) and associated with significant improvement in caregiver burden from the study baseline to the end of the OLEX period in study 3001 (21).We report here the results of a post hoc analysis, using data pooled from the MP and the first 3 OLEX injection cycles of both studies, to assess the efficacy of incobotulinumtoxinA in a large subject population using the AS sumscore; a novel approach that allows for a holistic clinical assessment of arm spasticity. In addition, we assess the impact of repeated incobotulinumtoxinA injections on caregiver burden in this large population.     

A PRACTICAL GUIDE TO OPTIMIZING THE BENEFITS OF POST-STROKE SPASTICITY INTERVENTIONS WITH BOTULINUM TOXIN A: AN INTERNATIONAL GROUP CONSENSUS

This consensus paper is derived from a meeting of an international group of 19 neurological rehabilitation specialists with a combined experience of more than 250 years (range 4–25 years; mean 14.1 years) in treating post-stroke spasticity with botulinum toxin A. The group undertook critical assessments of some recurring practical challenges, not yet addressed in guidelines, through an extensive literature search. They then discussed the results in the light of their individual clinical experience and developed consensus statements to present to the wider community who treat such patients. The analysis provides a comprehensive overview of treatment with botulinum toxin A, including the use of adjunctive therapies, within a multidisciplinary context, and is aimed at practicing clinicians who treat patients with post-stroke spasticity and require further practical guidance on the use of botulinum toxin A. This paper does not replicate information published elsewhere, but instead aims to provide practical advice to help optimize the use of botulinum toxin A and maximize clinical outcomes. The recommendations for each topic are summarized in a series of statements. Where published high-quality evidence exists, the recommendations reflect this. However, where evidence is not yet conclusive, the group members issued statements and, in some cases, made recommendations based on their clinical experience. LAY ABSTRACTA group of doctors from around the world, who are experts in treating muscle stiffness and spasm (also called spasticity), reviewed the current scientific evidence supporting the effectiveness of using botulinum toxin injections in treatment of spasticity that results from a stroke. When evidence is not available, they discussed and agreed on the best way to treat spasticity using botulinum toxin. The recommendations made by these expert doctors can be used by less-experienced doctors as a guide to how best to use botulinum toxin injection in treating spasticity after a stroke. Key words: spasticity, botulinum toxin, consensus guideline

Botulinum toxin A (BoNT-A) has been in clinical use for treating post-stroke spasticity for approximately 30 years and is the accepted standard of care for focal post-stroke spasticity (1). It is currently known that BoNT-A treatment is safe and effective for use in both upper and lower limb spasticity, where it can result in both active and passive functional gains (2). Furthermore, BoNT-A is a first-line pharmacological treatment in the management of post-stoke focal and multi-focal spasticity, which, along with a multidisciplinary team (MDT) approach, should be part of a rehabilitation programme to promote optimal clinical effect (3–5). In addition, the Royal College of Physicians’ (RCP) guidelines for management of adult spasticity using BoNT-A (6) recommend that patient selection and management should be based on individualized criteria, resulting in a patient-centred approach to management.Despite the ever-expanding literature base on this topic, it is clear that further clinical research is necessary to increase understanding and fill gaps in post-stoke spasticity treatment protocols. The group felt that, in the intervening time, there remained a need to provide practical advice on how best to tailor treatment regimens using BoNT-A for individual patients in order to optimize care.Although BoNT-A is an established treatment for focal spasticity, there is little consensus on how to improve efficacy, and there is a need to increase prescribers’ confidence in its use, share current best practice, and identify reasons for sub-optimal responses (e.g. injection technique, dosing, muscle selection).The group agreed 3 key areas in which additional practical guidance and/or personal training and supervision is required: (i) individualized approach to spastic upper limb in stroke; (ii) optimal injection technique and preparation of the toxin; and (iii) adjunctive treatments. They examined the evidence for each topic, obtained from literature searches using the College of College of Physicians and Surgeons of British Columbia review, Medline, CINAHL and PubMed databases. They subsequently met on 2 separate occasions for full-day discussions to agree consensus statements on the topics. The gaps in the literature were filled with the knowledge acquired from the combined clinical experience of the group (6).Table IConsensus statements from the international group of experts

重复伤害性电刺激下大鼠脑功能性磁共振成像的变化

目的:观察重复伤害性电刺激下大鼠脑功能磁共振成像的变化.方法:健康清洁级SD大鼠24只,麻醉后行4个相同时间段的左前爪重复伤害性电刺激(分别为A、B、C、D,刺激间期为10 min);刺激期间予脑功能磁共振成像扫描,用统计参数法行图像分析不同时间段伤害性电刺激下脑功能成像的变化.结果:不同时间段刺激鼠左前爪激活数目情况:D时间段的总的激活数目显著低于A、B、C时间段,差异有统计学意义(P＜0.05);C时间段总的激活数目显著低于A、B时间段,差异有统计学意义(P＜ 0.05).A、B、C、D时间段伤害性电刺激大鼠均存在明显的局部脑区的血氧水平依赖(blood-oxygenation level-dependent,BOLD)信号的强烈变化,主要激活脑区包括:伏膈核(accumbens nucleus,Acb)、右侧初级感觉皮质(primary somatosensory cortex,SI)、右侧腹后外侧丘脑核(ventral posterolateral thalamic nucleus,VPL)及后扣带回皮质(retrosplenial granular cortex,RSG);在重复伤害性电刺激后,中枢对电刺激引起的躯体感觉传导通路及加工网络的BOLD信号响应减弱.结论:重复伤害性电刺激后,大鼠脑功能成像显示激活脑区数目减少,伏膈核、右侧S1、VPL、RSG脑区激活体素减小,可能与中枢对伤害性刺激的调制有关.     

自我管理教育对脑卒中后抑郁病人的治疗效果

目的探讨自我管理教育对脑卒中后抑郁（PSD）病人的治疗效果。方法 120例PSD病人随机分为治疗组和对照组各60例,治疗组在对照组治疗基础上给予自我管理教育,比较组间治疗效果。结果两组病人治疗6月后抑郁改善程度及日常生活活动能力比较差异有显著性（χ2=44.43、4.30,P〈0.05）。结论积极地自我管理教育对PSD有良好的治疗作用,可明显缓解PSD病人的抑郁症状,增强脑卒中病人的康复效果,值得在临床中推广应用。     

PREDICTORS OF RESOURCEFULNESS IN SCHOOL-AGED CHILDREN

Children need to develop appropriate cognitive-behavioral repertoires to maintain mental health and prevent depression. Resourcefulness is learned throughout life in the context of one's environment. However, environmental or situational factors and individual factors in children's development of resourcefulness have not been studied. This study examined the effects of the situational factors of family context (one or two parents, and number of siblings) and maternal characteristics (employment, learned resourcefulness, and adaptive functioning), and individual (child) factors (gender, academic performance, and automatic thoughts) on learned resourcefulness in school-aged children. A convenience sample of 122 fifth and sixth graders was recruited from four public schools. The child's automatic thoughts and maternal resourcefulness were predictors of child's resourcefulness. Further research is needed to examine additional factors that may promote resourcefulness in school-aged children, so that appropriate nursing strategies can be implemented.     

PHYSICAL INACTIVITY AFTER STROKE: INCIDENCE AND EARLY PREDICTORS BASED ON 190 INDIVIDUALS IN A 1-YEAR FOLLOW-UP OF THE FALL STUDY OF GOTHENBURG

ObjectiveTo determine the incidence of physical inactivity and factors prior to stroke and in acute stroke that are associated with physical inactivity 1 year after strokeDesignProspective longitudinal cohortPatientsA total of 190 consecutively included individuals with acute strokeMethodsA follow-up questionnaire, relating to physical activity level using the Saltin-Grimby Physical Activity Scale, was sent to participants in the Fall Study of Gothenburg 1 year after stroke. Predictors of physical inactivity at baseline were identified using univariable and multivariable logistic regression analyses.ResultsPhysical inactivity 1 year after stroke was reported by 70 (37%) of the 190 patients who answered the questionnaire and was associated with physical inactivity before the stroke, odds ratio (OR) 4.07 (95% confidence interval (95% CI) 1.69–9.80, p = 0.002); stroke severity (assessed by National Institutes of Health Stroke Scale (NIHSS), score 1–4), OR 2.65 (95% CI) 1.04–6.80, p = 0.042) and fear of falling in acute stroke, OR 2.37 (95% CI 1.01–5.60, p = 0.048).ConclusionAlmost 4 in 10 participants reported physical inactivity 1 year after stroke. Physical inactivity before the stroke, stroke severity and fear of falling in acute stroke are the 3 main factors that predict physical inactivity 1 year after stroke.LAY ABSTRACTAfter a stroke, there is a risk of becoming physically inactive, which could affect one’s health. In order to create a rehabilitation plan with individualized preventive actions and interventions against physical inactivity, it is important, early after stroke onset, to identify patients who are at risk of becoming physically inactive. Previous studies of the early prediction of physical inactivity are few in number, with small sample sizes. This research on 190 individuals describes which factors prior to and in acute stroke (which is the first week after stroke) are associated with physical inactivity 1 year after stroke. The results showed that physical inactivity before stroke, stroke severity, and a fear of falling in acute stroke are associated with physical inactivity 1 year after stroke.Key words: stroke, physical activity, rehabilitation

Physical activity has been defined by the World Health Organization (WHO) as ”any bodily movement produced by skeletal muscles that requires energy expenditure” (1). In November 2020, the WHO published updated guidelines for physical activity with the key message that we should become more physically active, regardless of age and function. According to these new guidelines, at least 150–300 min of accumulated physical activity of moderate to vigorous intensity every week are recommended for adults. As physical activity affects our bodies and minds, with a beneficial outcome for all ages and variabilities, these guidelines are important (2). However, 25% of adults worldwide have been reported not to be physically active enough (3). As a result, after a stroke, compliance with the guidelines for physical activity can be even more difficult and the risk of becoming physically inactive can be greater compared with those who have not had a stroke (4–10). A review of 26 studies showed that balance (postural control), degree of physical fitness and walking ability are associated with a higher physical activity level after stroke (4). The sample sizes in the review were generally small, with an age range of 65–75 years. In some studies, the inclusion of the participants was not reported or occurred long after stroke onset (4). In a more recent meta-analysis, physical inactivity was associated with higher age, male sex, low physical function, depression, fatigue, low self-efficacy and poor quality of life (11). However, in only 7 of the 21 studies included, the main aim was to study physical activity level (11). In a small study based on 77 individuals, functional dependence, older age and previous low physical activity level were found to be early determinants of physical inactivity 1 year after stroke (12). The primary driver of this study was to target the knowledge gap related to small sample sizes and few studies based on early prediction, to confirm previous analyses, to increase the confidence in estimates, and to reduce the uncertainty. To enable the early identification of individuals at risk of becoming physically inactive post-stroke and to create individualized rehabilitation plans with preventive actions and interventions against physical inactivity, finding the determinants of physical inactivity is of great clinical interest.The aim of this study was to determine the incidence of physical inactivity and factors prior to stroke and in acute stroke that are associated with the occurrence of physical inactivity 1 year after stroke. Based on previous research on the early prediction of physical inactivity 6 months after stroke, established in parts of the current population, we hypothesized that a low physical activity level prior to the stroke, stroke severity, the number of drugs and impaired postural control in acute stroke are associated with physical inactivity 1 year post-stroke (13).     

PREDICTORS OF SUICIDAL BEHAVIOR IN A SAMPLE OF TURKISH SUICIDE ATTEMPTERS

In a Turkish sample, 100 suicide attempters, were compared with 60 healthy controls on measures of hopelessness, depression, and suicidal ideation. Suicide attempters were more depressive, more hopeless, and displayed greater suicidal ideation than healthy controls. Depression severity rather than hopelessness correlated with suicidal intent. Suicide lethality was independent of depression severity, hopelessness, and suicidal ideation and intent, suggesting that lethality is likely due to chance.     

肾嗜酸性细胞瘤的影像学诊断

目的探讨螺旋CT和MR对肾嗜酸性细胞瘤的诊断及鉴别诊断的价值。方法回顾性分析12例肾嗜酸性细胞瘤的CT和（或）MRI表现。结果 CT检查12例,平扫8例病灶呈均匀软组织密度影,3例呈不均匀软组织密度影,1例瘤体周边有环状钙化。增强扫描后病灶呈轻中度强化,6例见星状瘢痕。MRI检查3例,2例T1WI呈等低信号、T2WI呈等高信号;1例T1WI呈等信号、T2WI等低信号。结论多数肾嗜酸性细胞瘤的影像学表现具有一定特征性。CT、MRI检查相结合,特别是动态扫描有助于术前做出正确的诊断。     

RELATIONSHIP BETWEEN GAIT PROFILE SCORE AND CLINICAL ASSESSMENTS OF GAIT IN POST-STROKE PATIENTS

BackgroundGait Profile Score (GPS) was validated as quality measure for the Gait Analysis (GA) in several patholgies, but GPS was never compared with clinical scales in post-stroke patients.ObjectiveThe aim of the study was to quantify functional limitation of post-stroke hemiparetic patients using clinical-functional scales and GPS and to assess the presence of correlation between GPS and the clinical-based outcome scales.MethodsThirty-three patients were assessed with the Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), Functional Ambulation Category (FAC), Functional Independence Measure (FIM) and Ten-Meter Walk Test (10-MWT); GPS was obtained by GA.ResultsGPS showed a fair relationship with FAC (p = 0.017; r = –0.412), TIS (p = 0.011, r = –0.436) and 10-MWT (p = 0.009, r = 0.49) and good correlation with BBS (p = 0.001; r = –0.561). The three regression models were statistically significant: Model 1 showed that FAC, GPS and FIM had a statistically significant effect in the determination of the BBS, in model 2 and 3, FIM presented a statistically significant effect on TIS determination.ConclusionGPS seems to be an independent linear predictor of balance performance in stroke patient, and GVSs on sagittal plane might help clinicians to investigate the acquired compensatory strategies.LAY ABSTRACTThe relationship between Gait Profile Score and clinical assessments in 33 post-stroke patients was investigated in this study. The results exhibited that the Gait Profile Score showed a fair relationship with Functional Ambulation Category, Trunk Impairment Scale and Ten-Meter Walk Test and good correlation with the Berg Balance Scale in the hemiparetic group. This study may have clinical implications for rehabilitation evaluation of poststroke hemiparetic patients. This will enable rehabilitation clinicians to quantify the rehabilitation needs of patients more easily, measure rehabilitation progress, and study the relationship between balance and gait impairment.Key words: stroke, neurorehabilitation, Gait Profile Score, Gait Variable Score, clinical scale

Disability after stroke is a major burden on society, due to its high incidence and prevalence. This is the case not only for developed countries, but also for low- and middle-incomes countries, where stroke is the fourth-largest cause of disability among people over 65 years of age (1). However, disability after stroke is underestimated, because it is difficult to make an immediate and comprehensive assessment. In 2015 the Global Burden of Disease Study estimated 10.3 million new strokes and 113 million disability-adjusted life years per year (2). In low-income countries, there is also a higher incidence of stroke and deaths compared with high-income countries (3). Among the priorities of rehabilitation programmes, dynamic balance and falls prevention are essential features for the clinical management of hemiparetic patients (4, 5), especially in maintaining walking ability.The assessment of gait and posture impairment in hemiparetic post-stroke patients is key to planning rehabilitative intervention. Gait and posture are among the most representative and complex human motor attributes, after speech and hand dexterity, due to their adaptation during the evolutionary process. The close physiological relationship between gait and posture has been well described, but there is little evidence regarding the adaptation of gait and posture to cerebral lesions (6).The gait pattern of hemiparetic post-stroke patients can be variably altered by impairments in motor function, such as weakness and stiffness. These modifications can affect gait control and balance in particular, with homolateral reduction in articular range of motion, stride length and cadence reduction, and occurrence of a classical asymmetrical gait pattern (7).Some disease-specific clinical scales include gait assessment items, but do not investigate the mechanism and reciprocal effect of balance and gait impairments. Among clinical outcome scales, the Berg Balance Scale (BBS) has been widely adopted for use in hemiparetic patients (8–9), although it is not specifically developed for patients with stroke; however, the scale has a good level of reliability and describes several relevant aspects of the patients’ functional status. Trunk impairment during walking and general ambulatory capacity are also related to balance performance, and these parameters are evaluated using the Trunk Impairment Scale (TIS) and the Functional Ambulation Category (FAC), respectively (10–11). The Ten-Meter Walk Test (10MWT) is considered an excellent measure of “speed” of ambulation (expressed in m/s) in stroke patients, and is useful to describe ambulation status, prescribe exercise, and track functional progress (12). Finally, the Functional Independence Measure (FIM) is considered a “gold standard” for the assessment of activities of daily living (ADL) in rehabilitation, and is a widely used and accepted measure of disability (13).On the other hand, gait pattern in post-stroke patients has been described quantitativly, evidencing a reduction in walking speed, asymmetric postural behaviour during walking and standing, altered kinematics, and reduced ankle push-off ability during terminal stance (14). In these studies, gait patterns were commonly analysed using many specific parameters obtained from a gait analysis test (spatio-temporal variables, angle values in specific gait instant, range of motion, peak joint moment and power).There is increasing evidence to support the application of summary parameters computed from gait analysis testing, i.e. the Gait Profile Score (GPS) (15), for the characterization of gait quality in different pathologies. Although the GPS has been studied in patients with celebral palsy and other conditions (16), its application in post-stroke patients has not been extensively studied (17).GPS can be defined as a summary measure, which, together with its Gait Variable Scores (GVSs), can be used to quantify the deviation of a gait pattern from the physiological condition, thus allowing a simple, objective and immediate view that quantifies the degree of gait impairment and its deviation from normality (18–19). GPS has been shown to have excellent reliability in post-stroke patients. Devetak et al. (18), found a high intra- and inter-session reliability of GPS, in both non-paretic and paretic lower limbs in post-stroke subjects. However, in the same patients, the authors also found that GVS related to the hip joint had lower reliability than the other GVSs; which they consider may be related to the difficulty of placement of precise markers on hip landmarks. More recently, Fukuchi et al. also investigated the effect of gait speed on the GPS in post-stroke individuals, demonstrating that the gait speed significantly affects the GPS (17).Although some clinical outcome scales have been compared with gait measures of dynamic balance (10–12), correlation of the GPS with clinical outcomes in post-stroke patients has not been investigated. The aims of the current study were: (i) to quantify the functional limitation of a sample of post-stroke hemiparetic patients using clinical-functional scales and GPS; (ii) to assess the correlation between GPS and the clinical outcome scales, in order to elucidate the relationship between balance and gait impairment.     

LASTING BIOLOGICAL EFFECTS OF EARLY ENVIRONMENTAL INFLUENCES : VIII. EFFECTS OF NEONATAL INFECTION, PERINATAL MALNUTRITION, AND CROWDING ON CATECHOLAMINE METABOLISM OF BRAIN

The effects of neonatal infection, perinatal malnutrition, and crowding on the metabolism of brain catecholamine were studied in specific pathogen-free mice. Metabolic turnover of catecholamine was determined by measuring the incorporation of precursor tyrosine-¹⁴C into brain tissue, catabolic activity of norepinephrine-³H at various times after intracisternal injection, and tissue levels of dopamine and norepinephrine. The rate of tyrosine incorporation was decreased by neonatal infection but was increased by perinatal malnutrition and crowding. There was no difference in catabolic activity of norepinephrine between infected, crowded, and control groups. In the malnourished group, however, the total radioactivity from norepinephrine was significantly higher than in the control group ½ and 2 hr after injection. The brain contents of dopamine and norepinephrine were depressed in the malnourished group. There was no significant difference in catecholamine levels between infected, crowded, and control groups. In the malnourished group, treatment of the mothers with growth hormone prevented almost completely weight loss during lactation, and also resulted in higher fetal weight. Hormone treatment restored to normal the levels of brain catecholamine and the enzymatic activity of brain tyrosine hydroxylase in progeny of malnourished mothers.     

子宫切除手术后急性术后疼痛和疼痛缓解的预测因子

目的:检验人口学变量、临床变量和心理变量对急性术后疼痛强度和术后疼痛缓解的影响。方法:共有99个接受子宫切除手术的被试,在手术前24小时(T1)和术后48~72小时(T2)接受两次测量。人口学变量、临床变量和心理变量在T1测量,急性术后疼痛强度和疼痛缓解在T2测量。结果:研究发现疼痛灾难化和自我效能感都能够显著地预测急性术后疼痛强度。虽然术后疼痛缓解与运动恐惧、疼痛灾难化、手术恐惧和疼痛自我效能感有显著的相关,但在多元线性回归方程中疼痛自我效能感是唯一能够预测术后疼痛缓解的变量。结论:疼痛灾难化和疼痛自我效能感能够显著地预测急性术后疼痛强度,疼痛自我效能感能够显著地预测急性术后疼痛缓解。     

中国医学影像技术

本文应用彩色多普勒冠状动脉血流显像新技术检查了