神经源性声带运动障碍与喉神经电生理

声带运动障碍的病因和临床表现复杂多变，涉及多学科，从病因上分为神经源性和非神经源性。对于神经源性声带运动障碍的诊治，首先通过喉镜等检查明确有无声带运动障碍及严重程度，值得注意的是声带纵向张力变化障碍也属于运动障碍的范畴；然后采用喉肌电图（LEMG）检查进行定性分析，在确诊神经源性损伤后，进一步对神经损伤部位进行定位诊断并查找导致神经损伤的病因；同时根据喉部神经电生理评估结果，判断预后。最后综合上述的评估结果制定相应的治疗策略。     

针灸联合川芎茶调散治疗周围性面神经麻痹(风寒证)

目的:观察川芎茶调散加减方联合针灸治疗周围性面神经麻痹(风寒证)的临床效果。方法:选取2018年2月至2019年2月威海市中医院收治的急性周围性面瘫患者108例作为研究对象,按照随机数字表法分为对照组与观察组,每组54例。对照组给予常规西药治疗,观察组给予川芎茶调散加减方口服联合针灸治疗。比较2组患者主要症状的改善时间、肌电图检查相关指标、面部神经功能分级的变化,测定血清中相关因子水平,比较临床效果。结果:观察组、对照组的有效率92.59%、75.93%,以观察组临床效果更好(P0.05);观察组患者治疗后的闭目、抬眉、鼓颊的改善时间明显短于对照组(P0.05);观察组患者的肌电图结果RI潜伏期低于对照组,CMAP波幅高于对照组,面部神经功能分级改善更明显(P0.05);观察组患者血清中TNF-α、IL-17含量明显低于对照组,GDNF含量显著高于对照组(P0.05)。结论:川芎茶调散加减方联合针灸利于促进患者临床症状的缓解,改善肌电图指标,促进面部神经功能的恢复,推断其起效可能与通过调控血清中TNF-α、GDNF、IL-17等水平以减轻患者神经病变的炎性反应损伤程度有关。     

医源性面瘫的手术治疗

报道医源性面瘫的手术治疗经验，探讨其发生原因、处理措施及治疗效果。     

Case Study of Phrenic Nerve Paralysis: “I Can't Breathe!”

BackgroundThe anatomic course of the phrenic nerve runs in the fascia covering the anterior scalene muscle. Interscalene blocks are commonly performed by an anesthesiologist for shoulder surgery, such as a rotator cuff repair, total shoulder replacement, humeral fracture, or other arm surgery. Phrenic nerve palsy or paralysis is a known complication from interscalene block and is covered in multiple case reports and series in both Anesthesia and Neurosurgical literature, but only one case report in the Emergency Medicine literature.Case ReportThis case involves a 57-year-old man who had an uncomplicated arthroscopic rotator cuff repair with placement of interscalene block under care of anesthesia. He was discharged with a pain pump in place and then subsequently presented to the Emergency Department (ED) later that same day for evaluation of dyspnea. Using point-of-care ultrasound, his right diaphragm did not appear to be moving. Chest x-ray study revealed an elevated right hemidiaphragm. He was diagnosed with iatrogenic right phrenic nerve paralysis from interscalene block.Why Should an Emergency Physician Be Aware of This?Emergent diagnosis of phrenic nerve paralysis in the ED is complicated by a distressed patient and need for quick intervention. Most formal tests for this diagnosis are not immediately available to emergency physicians. Ultrasound is a rapid and reproducible, noninvasive resource with high sensitivity and specificity, making it an ideal imaging modality for the emergent evaluation of possible phrenic nerve palsy or paralysis.     

中西医结合治疗动眼神经麻痹疗效观察

目的了解中西医结合法治疗动眼神经麻痹的临床疗效。方法对我院2012-03—2014-03收治的动眼神经麻痹患者进行抽样,择取74例患者随机分成2组,对照组予以基础性西医疗法,实验组在对照组治疗基础上予以中医疗法(包括针刺及服用中药正容汤等),观察2组患者的临床治疗效果。结果实验组总有效率(94.60%)明显高于对照组(64.86%),差异具有统计学意义(P0.05)。结论中西医结合法治疗动眼神经麻痹临床疗效确切,安全系数高,值得临床大力推广使用。     

针刺联合优质护理干预对周围性面神经麻痹急性期患者的影响

目的分析针刺联合优质护理干预对周围性面神经麻痹急性期患者的影响。方法以2016年1月—2019年2月60例周围性面神经麻痹急性期患者为研究对象,患者按照护理方法不同,将其分为对照组、观察组各30例患者,对照组进行神经内科的常规护理,观察组进行针刺联合优质护理干预,对2组患者临床疗效和护理满意度等进行观察。结果对照组总有效率为70%,观察组总有效率为96.6%(P<0.05)。对照组护理满意度为63.3%,观察组护理满意度为96.6%(P<0.05)。结论周围性面神经麻痹急性期患者临床治疗中,针刺联合优质护理干预的应用,可以提升患者临床疗效,降低患者住院时间,实现其护理满意度的提升。     

Inactivated influenza vaccine formulated with single-stranded RNA-based adjuvant confers mucosal immunity and cross-protection against influenza virus infection

Influenza vaccination is considered the most valuable means to prevent and control seasonal influenza infections, which causes various clinical symptoms, ranging from mild cough and fever to even death. Among various influenza vaccine types, the inactivated subunit type is known to provide improved safety with reduced reactogenicity. However, there are some drawbacks associated with inactivated subunit type vaccines, with the main ones being its low immunogenicity and the induction of Th2-biased immune responses. In this study, we investigated the role of a single-stranded RNA (ssRNA) derived from the intergenic region in the internal ribosome entry site of the Cricket paralysis virus as an adjuvant rather than the universal vaccine for a seasonal inactivated subunit influenza vaccine. The ssRNA adjuvant stimulated not only well-balanced cellular (indicated by IgG2a, IFN-γ, IL-2, and TNF-α) and humoral (indicated by IgG1 and IL-4) immune responses but also a mucosal immune response (indicated by IgA), a key protector against respiratory virus infections. It also increases the HI titer, the surrogate marker of influenza vaccine efficacy. Furthermore, ssRNA adjuvant confers cross-protective immune responses against heterologous influenza virus infection while promoting enhanced viral clearance. Moreover, ssRNA adjuvant increases the number of memory CD4⁺ and CD8⁺ T cells, which can be expected to induce long-term immune responses. Therefore, this ssRNA-adjuvanted seasonal inactivated subunit influenza vaccine might be the best influenza vaccine generating robust humoral and cellular immune responses and conferring cross-protective and long-term immunity.     

Cibenzoline-induced respiratory muscular paralysis in a hemodialysis patient

A 69-year-old man was admitted to our kidney center with endstage renal failure. We started intermittent peritoneal dialysis immediately because of severe azotemia, hyperkalemia, and metabolic acidosis. Two weeks after admission, he developed uremic pericarditis with frequent ventricular premature contractions and supraventricular premature contractions. The intermittent peritoneal dialysis was then replaced by intensive hemodialysis, and oral administration of 300 mg/d of cibenzoline was started. Four days later, he developed thirst, weakness, and dyspnea due to respiratory muscular paralysis. We initiated respiratory support with a respirator because analysis of his blood gases revealed marked hypercapnia and hypoxia. He also developed hypoglycemia and prolonged PQ and QRS intervals on the electrocardiogram, which we believed were due to cibenzoline intoxication; we discontinued the cibenzoline immediately. All symptoms improved, and he was extubated 5 days later. After 2 months, his pericardial effusion disappeared. He now continues maintenance hemodialysis as an outpatient. We suspect that the cibenzoline induced the respiratory muscular paralysis for 2 reasons: 1) the patient experienced the respiratory muscular paralysis, at the same time he also experienced thirst, weakness, hypoglycemia, and prolonged PQ and QRS intervals on electrocardiogram, and all of these symptoms improved after the discontinuation of cibenzoline, and 2) his plasma concentration of cibenzoline became remarkably elevated, to 20 times above the standard therapeutic level. This patient's clinical course indicates that hemodialysis might be superior to intermittent peritoneal dialysis for treatment of cibenzoline intoxication.     

Late results of laterofixation in the treatment of bilateral abductor paralysis of the vocal cords: a clinical study with long-term follow-up

Thirty-four patients with bilateral vocal cord abductor paralysis were treated surgically during the period from 1960 to 1979. The main cause of paralysis was thyroid surgery (85%). Woodman's external laterofixation was performed in 31 patients, 1 had laterofixation by laryngofissure and 2 had endoscopic arytenoidectomy. In Woodman's procedure the body of the arytenoid cartilage was removed in 10 cases and mobilized from the cricoarytenoid joint in 21 cases. Thirteen of the 34 patients needed further surgery. Including previously performed procedures in 6 patients, altogether 68 operations were performed and 17 patients (50%) were operated on more than once. The immediate failure rate of laterofixation was 22% but the need for reoperation increased with time and the total failure rate of the method was 44%. Endoscopic arytenoidectomy was successful in 1 of 2 cases as a primary operation and in 3 of 3 cases as secondary operation. Follow-up time ranged from 2 months to 29 years 8 months (mean 15 years 10 months).