芒针针刺配合康复训练治疗脑卒中吞咽障碍疗效观察

目的:评价芒针针刺配合康复训练治疗脑卒中吞咽障碍患者的临床效果。方法:将脑卒中吞咽障碍患者55例随机分为3组:21例接受芒针治疗配合康复训练(联合治疗组),19例仅接受康复训练(对照组1),15例接受常规药物治疗(对照组2)。3组患者疗程均21天。通过观察3组患者治疗前、后及治疗后1年的吞咽功能评分以评价疗效。结果:联合治疗组、对照组1、对照组2的总有效率分别为90.5%、73.7%和46.7%,联合治疗组与2个对照组间总有效率有显著性差异(P<0.001)。治疗后1年的随访结果表明,联合治疗组分别与对照组1、对照组2间吞咽功能评分有显著性差异(均为P<0.001)。结论:芒针针刺配合康复训练治疗脑卒中吞咽障碍疗效优于仅接受康复训练和常规的药物治疗,且有较好的远期疗效。     

马应龙麝香痔疮膏联合光子治疗仪局部照射对混合痔术后患者创面愈合作用的研究

目的探讨马应龙麝香痔疮膏联合光子治疗仪局部照射治疗对混合痔术后患者创面愈合的影响。方法将190例混合痔术后患者随机分为治疗组和对照组各95例。对照组于术后第1日起常规换药后创面涂抹马应龙麝香痔疮膏,治疗组加用光子治疗仪对术后创面进行局部照射,观察2组患者术后疼痛、创缘水肿、创面愈合情况。结果治疗组患者术后7日基本无疼痛或轻度疼痛90例,创缘水肿完全消退82例,与对照组比较差异均有统计学意义（P〈0.05）。治疗组患者术后创面愈合时间明显短于对照组（P〈0.05）。结论马应龙麝香痔疮膏联合光子治疗仪局部照射治疗可明显缓解混合痔术后患者局部疼痛,减轻创缘水肿,明显促进创面愈合。     

Preoperative Gabapentin for Acute Post‐thoracotomy Analgesia: A Randomized,Double‐Blinded,Active Placebo‐Controlled Study

Background: The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods: Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double‐blinded, placebo‐controlled study, and randomly assigned to receive 600 mg gabapentin or active placebo (12.5 mg diphenhydramine) orally within 2 hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient‐controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48 hours. Pain was also assessed at 3 months. Results: One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P = 0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P > 0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, P < 0.001). The frequency of patients experiencing pain at 3 months post‐thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P = 0.72). Conclusions: A single preoperative oral dose of gabapentin (600 mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.     

Dose Related Efficacy of Gabapentin in Acute Herpetic Neuralgia Among Geriatric Patients

Background:

Herpes zoster is an intractable painful condition, more severe in elderly patients. The pain during the first 30 days of onset is known as Acute Herpetic Neuralgia. Multiple treatments using non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and tricyclic anti-depressants are available, but their side effects limit their use in geriatric patients. Gabapentin is also used in chronic neuropathic pain; however, its role in acute herpetic neuralgia is less explored.

Aim:

This study was aimed to determine dose related efficacy and safety of gabapentin in reducing pain of acute herpetic neuralgia in geriatric patients.

Materials and Methods:

In this placebo-controlled, four-week trial including 56 subjects, 42 patients received gabapentin in the dosage of 300 mg (n=15), 600 mg (n=14), and 900 mg(n=13) per day in divided doses and 14 patients received placebo within 72 hours of onset of herpes zoster.

Results:

Subjects receiving gabapentin had a statistically significant reduction (P<0.0001) in visual analog scale (VAS) score as compared to placebo, emphasizing the efficacy of gabapentin in the treatment of acute pain associated with herpes zoster on each assessment (weeks 1, 2, 3, and 4). Gabapentin in doses of 600 mg/day and 900 mg/day was better than 300 mg/day in each visit. However, no difference was observed between gabapentin 600 mg/day and 900 mg/day group at any point of time (P>0.05).

Conclusion:

The results of this study show that gabapentin is effective in acute herpetic neuralgia in different doses with 600 mg/day being the more appropriate dose in terms of safety and efficacy.     

A rare case of primary cutaneous plasmacytoma-like lymphoproliferative disorder following renal transplantation

Post-transplant lymphoproliferative disorder (PTLD) is a lymphoid proliferation that develops as a complication of solid organ or bone marrow transplants. PTLD limited to the skin is very rare. Plasmacytoma-like PTLD is an uncommon variant of monomorphic PTLD. Its presentation in the skin is extraordinary with very few cases reported in the literature. We report a new case of plasmacytoma-like PTLD presenting as multiple skin nodules on the leg of a 74-year-old kidney transplant recipient. Histopathologic and immunohistochemical examination of one nodule revealed atypical plasmacytoid and plasmablastic cells that showed kappa light chain restriction and stained positive for CD138. Staging investigations excluded extracutaneous manifestations of the disease. This case is unusual for several reasons including involvement limited to the skin, plasmacytoid phenotype of the tumor, presentation 18 years following transplantation and Epstein-Barr virus negativity.     

Biological correlates of post-stroke fatigue: a systematic review

Fatigue is a common and disabling consequence of stroke. Its mechanisms are unknown. Neuroanatomical abnormalities (e.g. white matter lesions, brain atrophy), neuroendocrine dysregulation, neurotransmitter changes and inflammation are associated with fatigue in conditions other than stroke. This review sought to identify published studies describing associations between post-stroke fatigue and these biological factors. We searched Medline, EMBASE, CINAHL, PsycINFO and AMED on October 15 and PubMed on 28 December 2010 and included studies in English that recruited at least 10 patients (>18 years old) with stroke, assessed fatigue and reported its relationship with neuroanatomical abnormalities, hypothalamo-pituitary-adrenal axis dysregulation, neurotransmitter changes or inflammation. Of 4916 citations from the searches, 17 studies met our inclusion criteria. There was no association between white matter lesions, brain atrophy or pathological type of stroke and fatigue (seven studies, n = 4746). The data on relationship between lesion location and fatigue were inconclusive: four (n = 675) of 13 studies (n = 1613) showed associations between fatigue and infratentorial lesion location (brainstem in particular) or basal ganglia stroke. One study reported C-reactive protein levels and found an association with fatigue. No studies reported hypothalamo-pituitary-adrenal axis dysregulation or neurotransmitter changes and fatigue. We could not perform meta-analysis because the studies used different methods of fatigue assessment, examined different populations and had different designs. The biological mechanisms of post-stroke fatigue are uncertain. Further studies are required to determine the relationship between post-stroke fatigue and biological factors.     

玻璃纤维桩在青少年前牙冠折直接修复的临床观察

目的评价纤维桩联合复合树脂修复青少年冠折前牙的临床效果。方法选择47颗已行根管治疗的青少年冠折前牙,用纤维桩和复合树脂直接修复。定期随访,观察临床效果。结果 18个月后复查,成功率为87.23%,2颗纤维桩松动脱落,1颗纤维桩折断,另有3颗树脂材料出现折裂或渗漏。结论纤维桩联合复合树脂是一种保护青少年牙体组织较理想的过渡性修复方式。     

The mutual prospective influence of child and parental post-traumatic stress symptoms in pediatric patients

Background: Previous studies found notable rates of post‐traumatic stress symptoms (PTSS) and post‐traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study prospectively examined the presence of PTSS and PTSD and the mutual influence of child and parental PTSS in a large sample of pediatric patients with different medical conditions. Methods: A total of 287 children (aged 6.5–16 years) and their mothers (n = 239) and fathers (n = 221) were assessed at 5–6 weeks and 1 year after an accident or a new diagnosis of cancer or diabetes mellitus type 1 in the child. Results: At the first assessment 11.1% and at the second assessment 10.2% of the children had moderate to severe PTSS. At 5–6 weeks 29.3% of mothers and 18.6% of fathers met criteria for PTSD. At 1 year the rates were 14.6% for mothers and 7.9% for fathers. There were considerable differences of PTSS among different medical diagnostic groups in children and parents. Mothers were more vulnerable than fathers. Structural equation analysis revealed that initially high PTSS in mothers and fathers were longitudinally related to poorer recovery from PTSS in the child. Cross‐lagged effects from the child to the parents and from one parent to the other were not significant. Conclusions: This study highlights the long‐term influence of parental PTSS on the child’s recovery after trauma and calls for a family systems approach and for early interventions in the treatment of traumatized pediatric patients.