Is computer-assisted training effective in improving rehabilitative outcomes after brain injury? A case-control hospital-based study

BackgroundRehabilitation of impaired cognitive functions begins to be considered a standard component of medical care after acquired brain injury. Indeed, many evidences support the effectiveness of the two major categories of techniques, i.e. the traditional and computer-assisted ones, which are widely used in cognitive rehabilitative treatment.ObjectiveAim of this study is to evaluate the effects of pc – cognitive training in brain injury patients.MethodsWe studied 35 subjects (randomly divided into two groups), affected by traumatic or vascular brain injury, having attended from January 2010 to December 2012 the Laboratory of Robotic and Cognitive Rehabilitation of IRCCS Neurolesi of Messina. Cognitive impairment was investigated through psychometric battery, administered before (T0) and two months (T1) after the cognitive pc-training, which was performed only by the experimental group, in addition to conventional treatment. Statistical analysis was performed using Wilcoxon test with a p < 0.01.ResultsAt time T0, all patients showed language deficits and cognitive alterations in visual attention and memory abilities. After the rehabilitation program we noted a global improvement in both the groups. However, at T1, the experimental group showed a greater cognitive improvement than the control group, with significant differences in nearly all the neuropsychological tests performed.ConclusionsOur data suggest that cognitive pc-training may be a promising methodology to optimize the rehabilitation outcomes following brain injury.     

高尿酸血症认知功能障碍模型大鼠皮层和海马的代谢组学研究

目的基于核磁共振氢谱(1H-NMR)代谢组学方法研究高尿酸血症诱发大鼠认知功能障碍模型的皮层和海马的内源性差异代谢物变化。方法采用含2%尿酸和2%氧嗪酸钾的高尿酸复合饲料饲喂大鼠12周,Morris水迷宫测定大鼠认知功能,并利用1H-NMR分析大鼠皮层和海马中的差异代谢物。结果高尿酸血症大鼠显示较长的逃逸潜伏期,表现出认知功能障碍;且大鼠的皮层和海马中分别筛选出27和18种差异代谢物,其中共有6种差异代谢物。γ-氨基丁酸、谷氨酸、谷氨酰胺、乳酸、甘露醇、牛磺酸和谷胱甘肽均有显著变化,可能作为高尿酸血症认知功能障碍的特征生物标志物,与学习、记忆功能损伤的发生和发展密切相关。结论高尿酸饮食可干扰机体的正常代谢,其诱发认知功能障碍机制可能与能量代谢的糖酵解和三羧酸循环、氨基酸代谢、氧化应激、神经递质转化以及细胞膜功能的紊乱等有关。     

骨髓增殖性肿瘤与缺血性卒中

【摘要】 骨髓增殖性肿瘤常出现血管并发症，最常累及脑血管，以缺血性卒中最为常见。骨髓增殖性肿瘤作为缺血性卒中的病因之一，其诊断与治疗不同于其他病因所致卒中。白细胞增多、JAK2V617F基因突变等相继被发现与缺血性卒中相关。本文对骨髓增殖性肿瘤伴缺血性卒中的发生、机制及防治的新进展进行综述。     

Impairments,Disabilities and Handicap in Children with Epilepsy

Motor and sensory function were evaluated in 269 children with epilepsy. The EB test, the Bruininks Oseretsky Test of Motor Proficiency, the Cailler Asuza Scale and the International Classification of Impairments, Disabilities and Handicap (WHO) were used.

An evaluative measure of motor and sensory function, the EB test, was developed for children aged 6–16 years with epilepsy. The new physiotherapy protocol included gross motor function, balance, coordination, strength, range of motion, velocity, fine motor function, sensation, perception and performance in neurological tests. The quality and level of sensorimotor function were scored and classification of handicap was performed. The reliability of the test was found to be good, r₈ = 0.9, as well as validity and responsiveness to change.

In 72 children with intractable epilepsy, sensorimotor impairments were found in 88% and also present in the absence of major disorders such as mental retardation and cerebral palsy.

The motor and sensory function of 50 children were investigated before and 6 months, after epilepsy surgery, in 34 children also 2 years after surgery. Significant motor and sensory improvements were found in 72% of the children, including those with multiple disabilities. Improvements were seen in 95% in the seizure-free group (n = 20) and in 64% in those with reduced seizure frequency (n = 22). The younger children (n = 13) benefited more (85%) from surgery as regards sensorimotor function than did older children and adolescents (n = 37) (68%).

In 88 mentally retarded children with epilepsy, motor and sensory impairments, resulting in disabilities and handicap, were found in 97%. The severity of the mental retardation and of the epilepsy correlated with the severity of the motor and sensory dysfunction. In another 84 children and adolescents with epilepsy but without additional neurodisorders, deficits in gross motor function—balance, coordination and speed—were found in about 30%. Boys performed better than girls. Motor function scores improved with age but motor problems persisted in the teenage years. The children on monotherapy performed significantly better than those on polytherapy.

The pattern of handicap was assessed in 217 children and adolescents with epilepsy. Handicap was most severe in the dimensions of physical independence and orientation. It was more severe with a long duration of epilepsy and when the onset of seizures was early in life. Handicap was significantly reduced after epilepsy surgery.     

益气活血法在缺血性中风后神经修复中的生物学基础研究进展

中风是全球死亡和残疾的主要原因，开发增强中风后恢复和增强神经修复的方法至关重要。中风后的恢复涉及复杂的相互关联的神经修复系统。神经修复整个过程需要神经元胞体对伤害性刺激作出应答，通过神经干细胞增殖与迁移、轴浆运输信号分子、细胞骨架结构构建以及轴突末端生长锥形成等一系列协调的相互作用，才能实现再生生长。神经功能重塑作为神经功能缺损治疗潜在的新靶点，无论是神经功能重塑的具体机制，还是神经功能缺损临床治疗方案，均具有重要研究意义。脑损伤后，由于其内在修复机制十分复杂，单一的治疗措施时常难以奏效，综合治疗将是提高脑内再修复功能的发展方向。益气活血法具有神经保护、血管再生、神经发生及环路重建等多方面生物效应，可共同促进损伤后的神经功能重塑；其作用机制与细胞自噬、免疫调节及微小RNA调控密切相关，充分体现了益气活血法的多途径、多靶点、整体调节的治疗特点以及对中风后的神经修复发挥重要的治疗作用。因此，进行益气活血法对中风后脑功能康复的研究具有十分重要的理论和指导意义。