Kinematic analysis of kicking movements in preterm infants with very low birth weight and full-term infants

BACKGROUND AND PURPOSE: Study of kicking development provides important information to understand how early spontaneous movements change in infants as they acquire voluntary control. Researchers have investigated the kicking movements of preterm infants; however, the movement patterns that they have described were inconsistent. The purpose of this study, therefore, was to examine the development of kicking movements with kinematic analysis in preterm infants with very low birth weight (VLBW) and full-term infants. SUBJECTS AND METHODS: Twenty-two infants with VLBW who were divided into low gestational age (gestational age of <30 weeks, n=9) and high gestational age (gestational age of >or=30 weeks, n=13) classes and 22 full-term infants were evaluated during kicking movements using 4 synchronized cameras and 3-dimensional kinematic analysis when the infants were 2 and 4 months of corrected age. RESULTS: The infants with VLBW and a high gestational age showed similar kicking movements compared with the full-term infants. In contrast, the infants with VLBW and a low gestational age exhibited a higher kick frequency and a shorter flexion phase at 4 months of corrected age. They also exhibited a higher hip-knee correlation and lower variability in the interlimb coordination pattern at 2 and 4 months of corrected age. DISCUSSION AND CONCLUSION: The findings indicate that infants with VLBW, particularly those with a low gestational age, have age-related differences in movement organization and coordination of kicking compared with full-term infants.     

Compensatory stepping responses in individuals with stroke: a pilot study

Impaired postural control and a high incidence of falls are commonly observed following stroke. Compensatory stepping responses are critical to reactive balance control. We hypothesize that, following a stroke, individuals with unilateral limb dyscontrol will be faced with the unique challenge of controlling such rapid stepping reactions that may eventually be linked to the high rate of falling. The objectives of this exploratory pilot study were to investigate compensatory stepping in individuals poststroke with regard to: (1) choice of initial stepping limb (paretic or non-paretic); (2) step characteristics; and (3) differences in step characteristics when the initial step is taken with the paretic vs. the non-paretic limb. Four subjects following stroke (38-165 days post) and 11 healthy young adults were recruited. Anterior and posterior perturbations were delivered by using a weight drop system. Force plates recorded centre-of-pressure excursion prior to the onset of stepping and step timing. Of the four subjects, three only attempted to step with their non-paretic limb and one stepped with either limb. Time to foot-off was generally slow, whereas step onset time and swing time were comparable to healthy controls. Two of the four subjects executed multistep responses in every trial, and attempts to force stepping with the paretic limb were unsuccessful in three of the four subjects. Despite high clinical balance scores, these individuals with stroke demonstrated impaired compensatory stepping responses, suggesting that current clinical evaluations might not accurately reflect reactive balance control in this population.     

晚期早产儿早发型败血症与早产儿脑损伤的相关性研究

目的 观察晚期早产儿(LPI)早发型败血症合并脑损伤的临床表现.方法 选取新生儿科住院LPI患儿423例,发生败血症患儿为观察组(n = 104),未发生患儿为对照组(n= 319).比较2组患儿一般情况、临床表现、磁共振成像(MRI)变化、治疗及转归、28 d新生儿神经行为测定(NBNA)评分.结果 观察组呼吸暂停及...     

Relationship between spontaneous kicking and age of walking attainment in preterm infants with very low birth weight and full-term infants

BACKGROUND AND PURPOSES: Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. SUBJECTS AND METHODS: Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. RESULTS: Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. DISCUSSION AND CONCLUSION: The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants.     

运动疗法促进坐骨神经损伤小鼠的运动功能恢复

目的:评估运动疗法对坐骨神经损伤小鼠运动功能恢复的促进作用。方法:将60只雄性C57BL/6小鼠随机分为假手术组、坐骨神经损伤组和运动治疗组,每组20只。通过挤压坐骨神经建立坐骨神经损伤小鼠模型。对各组小鼠脚趾形态和坐骨神经功能指数(Sciatic Functional Index,SFI)进行评估。通过免疫荧光染色观察各组小鼠神经纤维的形态及数量。使用透射电子显微镜检查小鼠坐骨神经损伤部位远端的有髓神经纤维数量。使用real-time PCR检测与神经损伤修复相关的基因。结果:与假手术组比较,坐骨神经损伤组小鼠脚趾不能张开,SFI高且下降速度慢,差异有统计学意义(P<0.001)。与坐骨神经损伤组比较,运动治疗组小鼠脚趾张开功能轻度恢复,SFI下降速度快,差异有统计学意义(P<0.001)。免疫荧光染色结果显示:坐骨神经损伤组受损部位远端神经纤维数量少,密度低;而运动治疗组受损部位远端神经纤维数量和密度均升高。电镜结果显示:与假手术组比较,坐骨神经损伤组小鼠受损部位远端有髓神经纤维比例降低,差异有统计学意义(P<0.001);与坐骨神经损伤组比较,运动治疗组小鼠受损部位远端有髓神经纤维比例升高,差异有统计学意义(P<0.01)。Real-time PCR结果显示:与假手术组比较,坐骨神经损伤组BDNF,Mpz和Cdh1基因表达均降低(P<0.01或P<0.001),Artn基因表达升高(P<0.001);与坐骨神经损伤组比较,运动治疗组BDNF,Mpz,Cdh1,Gap-43,cJun基因表达水平升高(P<0.01或P<0.001),Artn基因表达降低(P<0.01)。结论:运动疗法对坐骨神经损伤小鼠的运动功能恢复有促进作用。     

Effect of a developmental program on motor performance in infants born preterm

A randomised controlled trial was conducted to evaluate the effect of a motor developmental program in improving motor performance in Thai infants born preterm. Eighty-four preterm born infants were randomly assigned to either a control or intervention group. Additionally, 27 low-risk preterm infants were included forming a comparative group for this study. From term equivalent age to four months adjusted age, all infants had their motor performance assessed monthly with the Test of Infant Motor Performance by one of the physiotherapist research assistants blind to group assignment and infants' adjusted age. In addition, the intervention infants received a developmental program at each monthly visit. Motor performance for each group plotted against age revealed linear trends of progression. The intervention group showed the greatest improvement. Two-way repeated measures ANOVA revealed significant differences across age and among groups. Scheffé comparisons indicated that the mean differences between each pair of the three groups were significant and supported the finding of greater improvement of the intervention infants over the control group. Thus the results suggest that the intervention program is likely to have beneficial effects when offered to a similar population of preterm born infants.     

Effects of high-intensity endurance and resistance exercise on HIV metabolic abnormalities: a pilot study

The purposes of this pilot study were to examine the effects of a 16-week supervised high-intensity combined endurance and resistance exercise training program on HIV-associated metabolic abnormalities (abdominal adiposity, dyslipidemia, and insulin resistance) and to explore methodological issues related to the design and implementation of the research protocol in preparation for a randomized controlled trial. A one-group pretest-posttest design was used, with outcomes measured at baseline and within 1 week after the conclusion of the training program. The exercise program consisted of 16 weeks (preceded by a 2-week phase-in period) of three endurance sessions (20 min at 70%-80% of VO (2max)) and two resistance sessions per week (one set of 8-10 repetitions at 80% of one-repetition maximum on seven exercises). Outcome measures included lipid levels (total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides), visceral and subcutaneous adipose area measured by electron beam tomography, fat and lean mass of trunk and limbs measured by dual-energy X-ray absorptiometry, and insulin sensitivity measured by the homeostatic model assessment. Nine participants were recruited, 5 of whom completed the intervention and had pretest and posttest data available for analyses. Aerobic capacity and strength improved over the course of the intervention. Statistically significant decreases were found for total and trunk fat mass (1,324.9 g [+/-733.6] and 992.8 g [+/-733.6], respectively). Triglycerides decreased by 59 mg/dL (+/-69.88), and insulin sensitivity decreased by 15.7% (+/-41.7%), neither of which was a statistically significant change. Results suggest that further testing of the combined exercise intervention in a randomized controlled design is warranted.     

Effects of topical essential oil on exercise volume after a 12-week exercise program for women with fibromyalgia: a pilot study

OBJECTIVES: We determined--in women with fibromyalgia (FM)--effects of essential oils used with a 12-week exercise program on exercise volume, pain, physical performance, and physical function. DESIGN: This was a randomized clinical trial comparing 024 essential oil with sham oil combined with exercise. Settings: Settings included community sites in southern California. SUBJECTS: The study included 20 women randomized to 024 oil, 23 to sham oil. INTERVENTIONS: Women were trained in oil application before exercise, at bedtime on exercise days; the 12-week program included weekly group sessions with trained leaders guided by a prerecorded regimen (allowing choice of program level) plus 2 days of home exercise with the recorded regimen. OUTCOME MEASURES: Primary: Exercise volume (number of days exercised multiplied by exercise level--intensity and duration). Secondary: Pain (Brief Pain Inventory), measures of physical performance (30-second chair stands, 6-minute walk, multidimensional balance), and self-reported physical function (Composite Physical Function scale). RESULTS: The average participant was 54 years old, had some college education, was married, Caucasian, and minimally/mildly depressed. There was no significant difference in exercise volume between women using 024 as compared with those using sham oil after 12 weeks (depression as covariate). There were no significant group nor pre- to postexercise changes in pain intensity or interference. There were greater positive changes in 30-second chair stands, 6-minute walk distance, and multidimensional balance scores in the 024 group than in the sham group, but these were not significant. The counterirritant 024 oil was not different from the sham oil in its effect on exercise volume (frequency, exercise level--intensity and duration) for women with FM. It is unknown whether 024 actually decreases local pain when used with exercise. CONCLUSIONS: Increases in physical function found, while not significant, may be attributable to the exercise regimen or to the interaction of the oils and exercise regimen.     

Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study

We prospectively investigated non-invasive selective brain cooling (SBC) in patients with severe traumatic brain injury. Sixty-six in-patients were randomized into three groups. In one group, brain temperature was maintained at 33 - 35 degrees C by cooling the head and neck (SBC); in a second group, mild systemic hypothermia (MSH; rectal temperature 33 - 35 degrees C) was produced with a cooling blanket; and a control group was not exposed to hypothermia. Natural rewarming began after 3 days. Mean intracranial pressure 24, 48 or 72 h after injury was significantly lower in the SBC group than in the control group. Mean serum superoxide dismutase levels on Days 3 and 7 after injury in the SBC and MSH groups were significantly higher than in the control group. The percentage of patients with a good neurological outcome 2 years after injury was 72.7%, 57.1% and 34.8% in the SBC, MSH and control groups, respectively. Complications were managed without severe sequelae. Non-invasive SBC was safe and effective.     

Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a pilot study

Kangaroo care (KC), skin-to-skin contact between mother and infant, is a promising method for blunting pain responses. This crossover pilot tested KC effects on biobehavioral responses to heel stick in preterm infants (30-32 weeks' gestational age, 2-9 days old) measured by Premature Infant Pain Profile (PIPP) and salivary and serum cortisol. Mother-infant dyads were randomly assigned to KC heel stick (KCH) first or incubator heel stick (IH) first. Study 1 (80-min study, N = 18) tested the effect of 80 min of KC before and throughout the heel stick procedure versus incubator care. Study 2 (30-min study, N = 10) tested 30 min of KC before and throughout the heel stick versus incubator care. KCH and IH began during a premeasurement phase and continued through four data collection phases: baseline, heel warming, heel stick, and recovery. PIPP responses were measured every 30 s during data collection; salivary cortisol was measured at the end of baseline and recovery; and serum cortisol was measured during heel stick. Study 1 showed no differences between KCH and IH. Study 2 showed lower PIPP scores at four time points during recovery (p < .05 to p < .001), lower salivary cortisol at the end of recovery (p < .05), and lower serum cortisol during heel stick for the KCH condition (p < .05) as well as clinically lower PIPP scores in the KCH condition during heel stick. Thirty minutes of KC before and throughout the heel stick reduced biobehavioral responses to pain in preterm infants.     

胶质细胞源性神经营养因子与早产儿脑室周围白质软化的研究进展

胶质细胞源性神经营养因子(GDNF)是由胶质细胞分泌的一种具有神经营养作用的同源二聚体蛋白质,在神经系统等部位分布,其对中枢和周围神经细胞的发育、生长、损伤及修复过程均具有其他神经因子不可替代的重要作用。近年来,随着新生儿重症监护医学的迅猛发展,早产儿生存率得以提高,早产儿脑损伤发生率也随之上升;而脑室周围白质软化(PVL)是早产儿脑白质损伤的主要神经病理形式,成为当今关注和研究的热点。本文就GDNF来源、结构、功能及其在PVL发生、发展中的表达及其可能的保护作用机制进行综述。     

Accelerated cerebral white matter development in preterm infants: a voxel-based morphometry study with diffusion tensor MR imaging

Twenty-seven preterm infants were compared to 10 full-term infants at term equivalent age using a voxel-based analysis of diffusion tensor imaging of the brain. Preterm infants exhibited higher fractional anisotropy values, which may suggest accelerated maturation, in the location of the sagittal stratum. While some earlier findings in preterm infants have suggested developmental delays, the results of this study are more consistent with accelerated white matter development, possibly as a result of increased sensorimotor stimulation in the extrauterine environment. These results are the first to suggest that the increased intensity of stimulation associated with preterm birth may advance the process of white matter maturation in the human brain. Questions remain about whether these findings reflect acceleration of the process of white matter maturation generally, or localized alterations induced specifically by activity in affected pathways.     

Challenges of breastfeeding preterm infants: a case study

Promoting breastfeeding of preterm infants offers clinical challenges for maternal-child nurses, and requires understanding the experience of the mother. Maternal-child nurses, in collaboration with hospital- and community-based lactation specialists, can meet the unique needs of preterm infants and their mothers. There are several opportunities for nurses to educate other health care professionals in the care of preterm infants and their mothers. The case study in this article presents one mother's experience of delivering a preterm infant and the many obstacles to breastfeeding that she encountered, and it also offers suggestions for what nurses and other health care professionals can do to make sure other mothers have a more positive experience.     

Association of lipid peroxidation with hepatocellular injury in preterm infants

Introduction  

We wished to determine whether cholestasis induced by total parenteral nutrition (TPN) in preterm newborn infants is associated with increased oxidative stress secondary to increased reactive oxygen intermediates. We hypothesized that elevated urinary thiobarbituric-acid-reacting substances (TBARS), a marker of oxidative stress, would be associated with hepatocellular injury as measured by serum alanine transaminase (ALT) and aspartate transaminase (AST) levels.     

Effects of exercise on fatigue and physical capacity in men with chronic widespread pain - a pilot study

Background

There is very limited knowledge about the effects of exercise on men with Chronic Widespread Pain (CWP), especially regarding fatigue. We wanted to investigate the effects of resistance exercise compared with pool exercise on multidimensional fatigue, psychological distress and physical capacity in men with CWP.

Methods

Thirty-four men with CWP, with a mean age of 49 (SD 8, range 26–59) years, were randomised to 12 weeks of standardised pool exercise (PE) or resistance exercise (RE). The primary outcome was the Multidimensional Fatigue Inventory (MFI-20). Depression, anxiety, isometric force, pain and health-related quality of life were also assessed.

Results

No significant differences were found for changes in MFI-20 between the exercise groups. The RE group improved the isometric forces of right shoulder abduction (RE: ?2.2 SD 1.5 N, PE: ?0.6 SD 1.2 N, p?=?0.009), right knee flexion (RE: ?50, SD 50 N, PE: ?-17, SD 71 N, p?=?0.003) and left knee flexion (RE: ?33 SD 39, PE: ?-9 SD 52 N, p?=?0.017) compared with the PE group. The drop-out rate was 29 % in the RE group and 18 % in the PE group.

Conclusions

Both a resistance exercise programme and a pool exercise programme improved different dimensions of fatigue in men with CWP. There were no differences in the change in fatigue over time between the exercise groups. Resistance exercise improved isometric strength compared with pool exercise. Because different types of exercise appear to improve different aspects of health, the goals could guide the choice of treatment. Further exercise studies with larger groups are needed to gain more knowledge about the effect of exercise on fatigue in men with CWP.

Trial registration

ClinicalTrials.gov Identifier NCT01278641. Registration date April 2008.

     

天麻素对脑外伤大鼠认知功能的影响及机制研究

摘要 目的：观察天麻素对脑外伤大鼠认知功能的影响,并探索其作用机制。 方法：70只SD大鼠随机分为正常对照组（n=10）、假手术组（n=20）、自然恢复组（n=20）和天麻治疗组（n=20）。采用控制性皮质撞击的方法制作大鼠脑外伤模型。手术大鼠在术后第1、2、3、4周进行行为学评价并利用RT-PCR技术对海马区的脑源性营养因子（BDNF）和突触素（SynⅠ）的mRNA表达情况进行检测。使用SPSS 16.0对实验数据进行统计分析。 结果：天麻治疗组第3、4周逃避潜伏期同自然恢复组相比差异有显著性（P＜0.05）。两组游泳时间百分比在第4周时差异有显著性（P＜0.05）。BDNF mRNA：造模后第2、3、4周自然恢复组同天麻治疗组相比差异有显著性（P＜0.05）。SynⅠ mRNA：自然恢复组第1、2周时同天麻治疗组相比差异无显著性（P＞0.05）,第3、4周时两者差异存在显著性（P＜0.05）。 结论：天麻素能够影响脑外伤大鼠海马区的神经重塑,从而改善脑外伤大鼠的认知功能。