Do positional changes of the inferior alveolar canal after sagittal split mandibular osteotomy affect neurosensory recovery?

The purpose of this study was to assess the pre- and postoperative position and dimensions of the inferior alveolar canal (IAC) following sagittal split osteotomy (SSO) and identify any association with postoperative neurosensory deficit (NSD) at 1 year. This retrospective cohort study enrolled consecutive patients who had SSO performed to correct skeletal malocclusion. The pre- and postoperative cone beam computed tomography data were superimposed to visualize differences in IAC position and dimensions. Subjective and objective neurosensory tests were used to determine NSD in the inferior alveolar nerve distribution. A total of 20 subjects were included. The preoperative distance from the lateral cortex of the IAC to the inner aspect of the lateral cortex of the mandible was significantly greater in sides with NSD when compared to sides without NSD (P = 0.01). A significantly greater reduction in the postoperative distance measurement was seen in sides with NSD when compared to sides without NSD (P = 0.01). The magnitude of mandibular movement was significantly increased in sides with NSD (P = 0.02). The preoperative location of the IAC, as well as certain changes in the mediolateral and vertical positions as a result of SSO, are risk factors for postoperative NSD.     

The screen for cognitive impairment in psychiatry (SCIP) is associated with disease severity and cognitive complaints in major depression

Objective: To assess the relationship between the Screen for Cognitive Impairment in Psychiatry (SCIP) score and illness severity, subjective cognition and functioning in a cohort of major depressive disorder (MDD) patients.

Methods: Patients (n?=?40) diagnosed with MDD (DSM-IV-TR) completed the SCIP, a brief neuropsychological test, and a battery of self-administered questionnaires evaluating functioning (GAF, SDS, WHODAS 2.0, EDEC, PDQ-D5). Disease severity was evaluated with the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI).

Results: Age and sex were associated with performance in the SCIP. The SCIP-Global index score was associated with disease severity (r?=??0.316, p?<?.05), the SDS, a patient self-assessment of daily functioning (r?=??0.368, p?<?.05), and the EDEC subscales of patient-reported cognitive deficits (r?=??0.388, p?<?.05) and their functional impacts (r?=??0.335, p?<?.05). Multivariate analysis adjusted for age and sex confirmed these tests are independent predictors of performance in the SCIP (CGI-S, F_[3,34]?=?4.478, p?=?.009; SDS, F_[3,34]?=?3.365, p?=?.030; EDEC-perceived cognitive deficits, F_[3,34]?=?5.216, p?=?.005; EDEC-perceived impacts of functional impairment, F_[3,34]?=?5.154, p?=?.005).

Conclusions: This study confirms that the SCIP can be used during routine clinical evaluation of MDD, and that cognitive deficits objectively assessed in the SCIP are associated with disease severity and self-reported cognitive dysfunction and impairment in daily life.     

针刺配合康复训练治疗脑卒中上肢功能障碍的队列研究

目的:探讨针刺配合康复训练对脑卒中上肢功能障碍患者神经功能特异性烯醇化酶(NSE)、硫化氢(H_2S)、神经营养因子(NGF)与脑血管动力学的影响。方法:选取2016年5月至2017年10月空军军医大学唐都医院收治的脑卒中上肢功能障碍患者198例进行回顾性分析。将患者分为针刺配合康复训练治疗观察组100例,单纯依靠康复训练治疗对照组98例。比较与分析2组治疗前后的NSE、H_2S、NGF与脑血管动力学等。结果:观察组治疗后NSE(12. 36±6. 35)μg/L,H_2S(52. 19±3. 77)μmol/L,NGF(152. 94±32. 67) pg/m L。对照组治疗后NSE (16. 28±7. 45)μg/L,H_2S (36. 67±6. 95)μmol/L,NGF(129. 81±33. 02) pg/m L。观察组治疗后颈动脉血流速度平均值(V_(mean))(26. 45±3. 79) cm/s,血流量(Q_(mean))(18. 52±3. 32) cm~3/s,外周阻力(RV)(82. 37±22. 39) k Pa·s/m,舒张压与临界压差值(DP)(0. 45±0. 08) k Pa. s/m,动态阻力(DR)(32. 36±10. 08) k Pa。对照组治疗后V_(mean)(19. 86±3. 73) cm/s,Q_(mean)(14. 79±2. 72) cm3/s,RV(95. 31±30. 45)k Pa·s/m,DP(0. 63±0. 14) k Pa·s/m,DR(42. 37±9. 67) k Pa。观察组治疗前FMA评分为(38. 41±7. 52)分,治疗后FMA评分为(54. 61±5. 34)分,改善值(16. 22±6. 46)分。MBI指数治疗前为(36. 75±6. 87),治疗后为(60. 33±12. 73),改善值为(23. 58±9. 34)。观察组中医证候积分治疗前(16. 52±0. 68)和治疗后(4. 60±0. 22)。对照组中医证候积分治疗前(16. 95±0. 83)分和治疗后(8. 72±0. 27)分。结论:针刺配合康复训练能够有效的帮助脑卒中上肢功能障碍患者的恢复神经功能,加速脑血管血流速度,减少压强阻力,从而达到治疗患者上肢及手功能,恢复日常生活活动能力的效果。     

La gestión de la asistencia neurológica en tiempos de la pandemia de Covid-19

IntroductionThe COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic.DevelopmentWe report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures.ConclusionDespite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.     

Ictus isquémico e infección por SARS-CoV-2, ¿asociación casual o causal?

IntroductionIschaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection.MethodsWe describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients.ResultsThe association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental.ConclusionsSystemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.     

La danse créative,une approche holistique aux bienfaits rééducatifs

The practice of dance, in the context of rehabilitation, is of growing interest as a global, motivating and beneficial approach. Scientific literature shows that dance leads to favorable motor, cognitive and psychosocial effects for people with neurological disorders, notably, for people with Parkinson's disease. Recent studies have also suggested that dance, as a rehabilitation therapy, is an effective approach, which leads to motor and potential cognitive and psychosocial benefits for those with cerebral palsy. Among the numerous existing dance approaches, the creative dance approach is particularly interesting for its specific pedagogical process that not only includes the dancer's physical and psychological experience of dance, but is also guided by the dancer's own capacities of movement. Creative dance uses a participative, inclusive and playful method that facilitates social link and permits the improvement of self-confidence and empowerment. This approach, based on each individual's ability, enables rehabilitation de be adaptable and specific to the needs of each dancer and each group. Oral testimonies of adolescents with neurological disorders who have participated to creative dance classes in a rehabilitation context have shown that this activity is pleasant and leads to observed benefits both during classes and in daily life. Thus, creative dance appears as a promising therapeutic approach, and easy to implement in a rehabilitation context for young people with neurological disorders.     

NIHSS评分分组干预模式在脑梗死患者神经康复中的应用价值

目的:研究美国国立卫生研究院卒中量表(NIH stroke scale,NIHSS)评分分组干预模式在脑梗死患者神经康复中的应用价值。方法:收集脑梗死患者100例,采用NIHSS评估患者的神经功能损伤程度,其中58例患者评分数值≥10分,42例患者评分数值<10分,将100例患者分为实验组和对照组,每组50例患者,其中29例评分数值≥10分,21例评分数值<10分。实验组根据评分结果将评分数值≥10分患者和评分数值<10分患者分别进行不同的护理;对照组采用常规护理;比较护理后两组临床疗效、神经功能、生活质量。结果:实验组患者总有效率为94.00%高于对照组76.00%(P<0.05);护理后实验组神经功能、肢体功能、情绪、思维、活动能力评分均低于对照组(P<0.05)。结论:NIHSS评分分组干预模式能够合理分配和利用护理资源,改善患者的神经功能和生活质量。     

注意缺陷多动障碍患儿血清25（OH）D及微量元素表达水平及临床意义

目的 探究注意缺陷多动障碍(ADHD)患儿血清25羟基维生素D[25(OH)D]、微量元素表达水平及临床意义。方法 选取2019年4月至2020年11月本院诊治的84例ADHD患儿进行研究(ADHD组),依据ADHD分型标准将患儿分为注意缺陷为主型组(28例)、多动为主型组(33例)、混合型组(23例),并选取同期84例体检健康儿童进行对照研究(对照组)。采用高效液相色谱-串联质谱法检测所有受试儿童血清25(OH)D水平；检测血清铁(Fe)、磷(P)、镁(Mg)、钙(Ca)、铜(Cu)、锌(Zn)、铅(Pb)水平；Pearson法分析ADHD患儿血清25(OH)D水平与Cu、Zn、Pb水平的相关性；Logistic回归分析ADHD发生的影响因素；受试者工作特征(ROC)曲线分析血清25(OH)D、Zn、Pb水平对ADHD的诊断价值。结果 ADHD组血清25(OH)D、Cu、Zn水平均显著低于对照组(P<0.05),Pb水平显著高于对照组(P<0.05)；注意缺陷为主型组、多动为主型组、混合型组患儿血清25(OH)D、Fe、P、Mg、Ca、Cu、Zn、Pb水平比较,差异无统计学意义(P>0.05)；ADHD患儿血清25(OH)D水平与Cu、Zn水平均呈正相关(P<0.05),与Pb水平呈负相关(P<0.05)；25(OH)D、Zn是影响ADHD发生的保护因素(P＜0.05),Pb是影响ADHD发生的危险因素(P＜0.05)；血清25(OH)D、Zn、Pb水平诊断ADHD的曲线下面积(AUC)分别为0.773、0.770、0.772,截断值分别为21.01 ng/mL、16.05 μmol/L、50.69 μg/L,相应灵敏度分别为82.1%、77.4%、63.1%,特异度分别为67.9%、71.4%、88.1%；三者联合诊断ADHD的AUC为0.883,其灵敏度、特异度分别为81.0%、81.0%。结论 ADHD患儿血清25(OH)D、Cu、Zn水平降低,Pb水平升高,25(OH)D、微量元素水平与ADHD患儿类型无关,25(OH)D、Zn、Pb联合有助于临床筛查ADHD患儿。