中医康复护理对中风肢体功能障碍患者的疗效

目的分析脑卒中肢体功能障碍患者应用中医康复护理干预后,上下肢功能、生活品质以及神经功能损伤症状变化情况。方法选取本院2017年3月-2019年3月收治的160例脑卒中肢体功能障碍患者为研究对象,将其随机均分为采用传统康复护理的常规组,与采用中医康复护理的研究组。对比两组患者护理干预前后上下肢力指标、神经功能损伤评估分值以及生活品质评估分值。结果干预前,两组患者上、下肢肌力差异无统计学意义(P>0.05),干预后,两组患者上、下肢肌力全部明显增加,并且研究组增加幅度优于常规组,差异均具有统计学意义(P<0.05);干预后,研究组与常规组脑卒中患者神经功能缺损评分标准(CSS)评估分值均显著降低,且常规组降低幅度低于研究组;两组生活自理能力评估分值全部显著增加,且研究组提升幅度明显高于常规组,差异均具有统计学意义(P<0.05)。结论脑卒中肢体功能障碍患者应用中医康复护理干预,能够显著提高患者肢体肌肉能力以及生活品质,促进神经功能的修复。     

药物预防动脉粥样硬化的研究进展

动脉粥样硬化是导致心血管疾病及死亡的主要原因，严重危害人类健康。目前预防动脉粥样硬化
的机制众多，以调脂代谢降低炎症反应为基础较多。本文将近几年他啶类、贝特类、烟酸类以及中药等调脂药物
对预防动脉粥样硬化的药理作用以及临床应用研究现状做一综述。     

Symptomatic nonstenotic carotid disease: Evaluation of a proposed classification scheme in a prospective cohort

IntroductionUnraveling symptomatic nonstenotic carotid disease (SyNC) as a stroke etiology from other cryptogenic stroke may have important implications for defining natural history and for tailoring secondary prevention strategies. We aim to describe the characteristics of the plaques in a prospectively-collected cohort of patients with non-invasive imaging suggesting symptomatic carotid stenosis but whose DSA demonstrated nonstenotic atheromatous disease, and to evaluate the recurrence rate depending on the type of SyNC.MethodsWe reviewed prospectively-collected data for patients presenting with new neurologic events and non-invasive imaging suggestive of moderate or severe (≥50%) carotid stenosis between July 2016 and October 2018. Patients were included in the present study if the degree of stenosis on DSA was < 50%. We assigned these patients into groups based on a previously-proposed working definition of SyNC, and analyzed the rate of recurrent stroke in the following 6 months.Results28 patients had DSA-confirmed < 50% stenosis and constituted the study cohort. The median age was 73 years and 64% were male; median presenting NIHSS was 1 (IQR 0–3). The great majority (86%) of carotid plaques had high-risk features including ulcerated plaque (n = 21, 75%) and plaque > 3 mm thick (n = 18, 64%). 17 of 28 patients (61%) met classification criteria for “definite” or “probable” SyNC. Three of five patients in the “definite SyNC” group experienced recurrent neurologic events.ConclusionThe majority of patients with non-invasive imaging suggesting carotid stenosis harbor symptomatic carotid disease per current classifications despite DSA stenosis < 50%. Current classification schema may allow for risk stratification of SyNC patients and these findings warrant further study.     

Altered supraspinal motor networks in survivors of poliomyelitis: A cortico-muscular coherence study

ObjectivePoliomyelitis results in changes to the anterior horn cell. The full extent of cortical network changes in the motor physiology of polio survivors has not been established. Our aim was to investigate how focal degeneration of the lower motor neurons (LMN) in infancy/childhood affects motor network connectivity in adult survivors of polio.MethodsSurface electroencephalography (EEG) and electromyography (EMG) were recorded during an isometric pincer grip task in 25 patients and 11 healthy controls. Spectral signal analysis of cortico-muscular (EEG-EMG) coherence (CMC) was used to identify the cortical regions that are functionally synchronous and connected to the periphery during the pincer grip task.ResultsA pattern of CMC was noted in polio survivors that was not present in healthy individuals. Significant CMC in low gamma frequency bands (30–47 Hz) was observed in frontal and parietal regions.ConclusionThese findings imply a differential engagement of cortical networks in polio survivors that extends beyond the motor cortex and suggest a disease-related functional reorganisation of the cortical motor network.SignificanceThis research has implications for other similar LMN conditions, including spinal muscular atrophy (SMA). CMC has potential in future clinical trials as a biomarker of altered function in motor networks in post-polio syndrome, SMA, and other related conditions.     

全膝关节置换术前应用双下肢全长摄影对不同体位下肢负重轴线的影响

目的探讨全膝关节置换术前应用双下肢全长摄影对不同体位下肢负重轴线的影响。方法选择在我院接受全膝关节置换术患者138例,均拍摄两组双下肢全长正位片,一组以骨盆正中,下肢呈中立位为标准,另一组以膑骨正中,胫骨覆盖腓骨小头内1/3为标准方案。比较两种体位下的股骨胫骨机械轴夹角等数据,并评估两者图像质量。术后随访,比较术前术后膝关节功能。结果骨盆正中以及髌骨正中下摄影获得的股骨侧弓角(FBA)、机械股骨远端外侧角(mLDFA)以及近端内侧角(mMPTA)比较,差异均有统计学意义(P<0.05),且前者明显高于后者,但机械股胫角(mFTA)比较差异无统计学意义(P>0.05);两种体位下患者摄影图像质量比较差异无统计学意义(P>0.05);患者术后疼痛、功能、活动度、屈曲畸形和稳定性评分较术前均显著上升(P<0.05)。结论骨盆正中体位的双下肢全长摄影在全膝关节置换术的应用可正确展示患者本身该有的下肢力线,减小人为操作不当引起的误差,同时可以优化下肢力线在不同摄影体位的角度测量。     

The association between liver fat and systemic calcified atherosclerosis

BackgroundThe association of nonalcoholic fatty liver disease (NAFLD) with systemic calcified atherosclerosis, other than the coronary arteries, has not been clearly elucidated. We investigated the association between NAFLD and calcification in eight different vascular beds.MethodsIn a community-based cohort with computed tomography scans for carotid artery, coronary artery, thoracic aorta, abdominal aorta, iliac artery, renal artery, celiac trunk, and superior mesenteric artery, the association between NAFLD and arterial calcification was evaluated with adjustment for age, sex, hypertension, dyslipidemia, diabetes, obesity, current smoking status, and family history of heart disease in the first-degree relatives.ResultsIn age- and sex-adjusted models, NAFLD was significantly associated with calcification in the coronary artery, carotid artery, thoracic aorta, celiac trunk, and superior mesenteric artery vascular beds (P < .05). However, adjustment for the traditional chronic venous disease risk factors attenuated the associations, except in the case of the thoracic aorta (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.09-1.78) and celiac trunk (OR, 2.05; 95% CI, 1.16-3.65). In addition, NAFLD was independently associated with multiarterial calcification (four or more [OR, 1.33; 95% CI, 1.01-1.74], five or more [OR, 1.46; 95% CI, 1.09-1.97], and six or more [OR, 1.58; 95% CI, 1.09-2.30] of eight evaluated arterial segments).ConclusionsThe association between NAFLD and arterial calcification is mainly mediated by conventional risk factors. The independent association between NAFLD and calcification in the thoracic aorta and celiac trunk as well as in a larger number of vascular beds needs confirmation in future prospective studies in diverse populations.     

双黄连对动脉粥样硬化大鼠TLR4/MyD88/NF-κB信号通路表达的影响实验研究

目的探究双黄连对动脉粥样硬化大鼠体内TLR4/MyD88/NF-κB信号通路表达的影响。方法建立动脉粥样硬化大鼠模型,进行双黄连不同剂量的处理后,对大鼠进行相关检测。结果双黄连处理组大鼠血清中的总胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白均明显低于模型组,高剂量组效果更明显;将胸主动脉进行HE染色后发现,相比模型组,双黄连处理组均有管腔狭窄的减轻,脂质斑块的减少,泡沫细胞沉积的减少,蓝色颗粒钙化病灶的缩小;免疫组化实验和Western Blot实验检测发现,双黄连处理组大鼠的动脉组织中TLR4、MyD88、NF-κB表达相比模型组发生了明显降低,且高剂量组降低更明显。结论双黄连有利于减轻大鼠动脉粥样硬化的病症,其机理在于降低TLR4、MyD88、NF-κB蛋白的表达水平,且疗效显著。