Walking Practice Combined with Virtual Reality Contributes to Early Acquisition of Symmetry Prosthetic Walking: An Experimental Study Using Simulated Prosthesis

Virtual reality (VR)-based rehabilitation has been used in lower limb amputees; however, the extent to which VR is effective in reacquiring symmetrical gait in lower limb amputees is unclear. The purpose of this study was to confirm whether a VR intervention is effective in obtaining a simulated prosthetic gait. The participants were 24 healthy males who had never worn a simulated prosthesis. They were divided into three groups: VR, tablet, and control groups. The intervention consisted of 5 min of in situ stepping on parallel bars and watching a video of a simulated prosthetic leg walker on a head-mounted display or a tablet. Measurements included Gait Up parameters during a 10-m walk and immersion scores. After the intervention, there was a significant interaction between walking speed and leg swing speed in the VR group. The rate of improvement in walking speed and immersion scores was significantly higher in the VR group than in the other two groups, and there was a significant positive correlation between the rate of improvement and immersion scores. Compared to the tablet and control groups, the VR group showed the highest rate of immersion and improvement in walking speed.

Technological Improvement Rates and Evolution of Energy-Based Therapeutics

This paper examines the field of energy-based medical therapies based on the analysis of patents. We define the field as the use of external stimuli to achieve biomedical modifications to treat disease and to increase health. Based upon distinct sets of patents, the field is subdivided into sub-domains for each energy category used to achieve the stimulation: electrical, magnetic, microwave, ultrasound, and optical. Previously developed techniques are used to retrieve the relevant patents for each of the stimulation modes and to determine main paths along the trajectory followed by each sub-domain. The patent sets are analyzed to determine key assignees, number of patents, and dates of emergence of the sub-domains. The sub-domains are found to be largely independent as to patent assignees. Electrical and magnetic stimulation patents emerged earliest in the 1970s and microwave most recently around 1990. The annual rate of improvement of all sub-domains (12–85%) is found to be significantly higher than one we find for an aggregate pharmaceutical domain (5%). Overall, the results suggest an increasingly important role for energy-based therapies in the future of medicine.

Blood Components Therapy as a Preventive Strategy for Coagulopathy in High-Risk Obstetric Patients in a Tertiary Centre in North India - An Interventional Study

BACKGROUND Obstetric practitioners routinely deal with antenatal patients who have high risk of developing established coagulopathy, which leads to a very high incidence of maternal morbidity and mortality. We wanted to assess the role of blood components in preventing disseminated intravascular coagulation (DIC) in highrisk patients and determine the amount of blood components required along with the rate of improvement in the DIC score, during treatment of high-risk obstetric patients of DIC and in patients with established DIC. METHODS This is an interventional study. 274 obstetric patients who were at high risk for developing DIC and / or with established DIC admitted during the 20 months study duration were included in the study. Patients were categorized in to three groups based on the DIC score according to ISTH scoring system in to non-overt and overt DIC groups. Those with DIC score < 5 were grouped as IA and IB randomly and those with DIC score > / = 5 were grouped as II. Software used was ANOVA using variance ratio F test for testing the significance between groups and chisquare test was used to find out the association between the groups or parameter. RESULTS Prophylactic transfusion of blood components showed faster rate of improvement than control group. Average consumption of blood components was more in patients of established coagulopathy as compared to non-overt group. CONCLUSIONS Transfusion of blood components can prevent overt DIC in high-risk patients. KEYWORDS DIC - Disseminated Intravascular Coagulation, PPH - Post Partum Haemorrhage, Coagulopathy, Component Therapy

663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic

Introduction The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown. Methods At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework. Results There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p &lt; 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102). Conclusion This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample. Support (if any):

The contributions of focused attention and open monitoring in mindfulness-based cognitive therapy for affective disturbances: A 3-armed randomized dismantling trial

Objective Mindfulness-based cognitive therapy (MBCT) includes a combination of focused attention (FA) and open monitoring (OM) meditation practices. The aim of this study was to assess both short- and long-term between- and within-group differences in affective disturbance among FA, OM and their combination (MBCT) in the context of a randomized controlled trial. Method One hundred and four participants with mild to severe depression and anxiety were randomized into one of three 8-week interventions: MBCT (n = 32), FA (n = 36) and OM (n = 36). Outcome measures included the Inventory of Depressive Symptomatology (IDS), and the Depression Anxiety Stress Scales (DASS). Mixed effects regression models were used to assess differential treatment effects during treatment, post-treatment (8 weeks) and long-term (20 weeks). The Reliable Change Index (RCI) was used to translate statistical findings into clinically meaningful improvements or deteriorations. Results All treatments demonstrated medium to large improvements (ds = 0.42–1.65) for almost all outcomes. While all treatments were largely comparable in their effects at post-treatment (week 8), the treatments showed meaningful differences in rapidity of response and pattern of deteriorations. FA showed the fastest rate of improvement and the fewest deteriorations on stress, anxiety and depression during treatment, but a loss of treatment-related gains and lasting deteriorations in depression at week 20. OM showed the slowest rate of improvement and lost treatment-related gains for anxiety, resulting in higher anxiety in OM at week 20 than MBCT (d = 0.40) and FA (d = 0.36), though these differences did not reach statistical significance after correcting for multiple comparisons (p’s = .06). MBCT and OM showed deteriorations in stress, anxiety and depression at multiple timepoints during treatment, with lasting deteriorations in stress and depression. MBCT showed the most favorable pattern for long-term treatment of depression. Conclusions FA, OM and MBCT show different patterns of response for different dimensions of affective disturbance. Trial registration This trial is registered at (v NCT01831362); www.clinicaltrials.gov.

Treatment with Delipid Extracorporeal Lipoprotein Filter from Plasma after Intravenous Thrombolysis for Acute Ischemic Stroke: A Single-Center Experience

<b><i>Introduction:</i></b> The delipid extracorporeal lipoprotein filter from plasma (DELP) has been approved for the treatment of acute ischemic stroke (AIS) by the China Food and Drug Administration, but its effectiveness and mechanism are not yet fully determined. The purpose of this study was to evaluate the effect of DELP treatment on AIS patients after intravenous thrombolysis. <b><i>Methods:</i></b> A retrospective study was performed on AIS patients with no improvement within 24 h after intravenous thrombolysis who were subsequently treated with or without DELP. Primary outcome was the proportion with a modified Rankin scale (mRS) of 0–1 at 90 days. Secondary outcomes were changes in National Institute of Health Stroke Scale (NIHSS) score from 24 h to 14 days after thrombolysis, and the rate of improvement in stroke-associated pneumonia (SAP). The main safety outcomes were the rates of symptomatic intracranial hemorrhage and mortality. To investigate its mechanisms, serum biomarkers were measured before and after DELP. <b><i>Results:</i></b> A total of 252 patients were recruited, 63 in the DELP group and 189 matched patients in the NO DELP group. Compared with the NO DELP group, the DELP group showed an increase in the proportion of mRS 0–1 at 90 days (<i>p</i> = 0.042). More decrease in NIHSS from 24 h to 14 days (<i>p</i> = 0.024), a higher rate of improvement in SAP (<i>p</i> = 0.022), and lower mortality (<i>p</i> = 0.040) were shown in DELP group. Furthermore, DELP decreased levels of interleukin (IL)-1β, E-selectin, malondialdehyde, matrix metalloprotein 9, total cholesterol, low-density lipoprotein, and fibrinogen, and increased superoxide dismutase (<i>p</i>&#x3c; 0.05). <b><i>Conclusions:</i></b> DELP following intravenous thrombolysis should be safe, and is associated with neurological function improvement, possibly through multiple neuroprotective mechanisms. Prospective trials are needed.

Ecosystem Health Assessment of Shennongjia National Park, China

Ecosystem health assessment is an important part of improving the management of national parks. In this paper, Shennongjia National Park is taken as the study region. By using satellite remote sensing data from 2000 to 2018, based on the Vitality Organization Resilience (VOR) model, an ecosystem health assessment is created and its spatiotemporal characteristics are analyzed. In the whole region, the ecosystem’s health level has gradually improved; the rate of improvement of the ecosystem’s health level from 2016 to 2018 has been 2.5-times that of the overall rate and the trend of improvement has been obvious. The rate of improvement of the ecosystem’s health level of non-nature protection areas has improved two-fold; the same is true of nature protection areas, and the stability change trend of the two areas has basically been the same. The establishment of national parks has played a significant role in promoting the health of the regional ecosystem. In future planning, relevant departments should pay attention to the ecological protection and restoration of the area and optimize the traditional area layout of Shennongjia National Park.

Relationship Between Electrode Position and Clinical Efficacy of Subthalamic Nucleus Deep Brain Stimulation and Motor Symptoms of Parkinson's Disease

Objectives To investigate the relationship between the position of bilateral STN-DBS location of active contacts and clinical efficacy of STN-DBS in the motor symptoms of Parkinson’ disease (PD) patients. Methods We retrospectively analyzed the clinical data of 57 patients with PD who underwent bilateral STN-DBS from March 2018 to December 2018. UPDRS III scores, LEDD, PDQ-39 scores before operation and within 6 months after operation were determined. The location of activate contacts and volume of tissue activated (VTA) in the Montreal Neurological Institute (MNI) space, and their correlation with the rate of improvement of motor symptoms（UPDRS-Ⅲ score improvement rate）were examined. Results After 6 months of follow up, the UPDRS-Ⅲ scores of 57 patients（Med-off） were improved by 55.4±18.9% (P＜0.001) compared with that before operation. The improvement rate of PDQ-39 score [(47.4±23.2)%, (P<0.001)] and the reduction rate of LEDD [(40.1±24.3)% , (P<0.01)] at 6 months post surgery were positively correlated with the improvement rate of motor symptoms（Med-off）(PDQ-39:r=0.461, P＜0.001; LEDD:r=0.354, P=0.007)，the rate of improvement of UPDRS Ⅲ (Med-off) and the Z-axis coordinate of the active contact in the MNI space were positively correlated (left side:r=0.349,P=0.008;right eide:r=0.369,P=0.005). In the MNI space,there was no correlation between the UPDRS-Ⅲ score improvement rate (Med-off) at 6 months after operation and bilateral VTA in the STN motor subregion,STN associative subregion and STN limbic subregion of the active electrode contacts of 57 patients(all P>0.05).At 6 months after surgery, the difference between the Z-axis coordinate in the different improvement rate subgroups（＜25%, 25% to 50%, and＞50%） in the MNI space was statistically significant (left side: P=0.030; right side: P=0.024). In the MNI space, there was no statistically significant difference between the 3 groups in the VTA of the active electrode contacts (all P>0.05). Conclusions STN-DBS could improve the motor symptoms of PD patients and improved the quality of life. The closer the active stimulation contacts is to the dorsolateral sensorimotor area of STN, the better effect the DBS has on the motor symptoms of PD patients.