Acupoint electrogymnastics therapy in stroke hemiplegia

BACKGROUND： Electrogymnastics can offer a range of proprioceptive, motor, and cutaneous sensation impulses to the central nerve system. The center receives perception of the paralyzed muscle through the aid of these impulses. During this process, functional reorganization of connecting network between segment and intersegment takes place. OBJECTIVE： To observe the therapeutic efficacy of acupoint electrogymnastics and traditional electroacupuncture on stroke hemiplegia. DESIGN, TIME AND SETTING： A multicenter, randomized, controlled, blinded, clinical study was performed at the College of Acu-moxibustion and Massage in Shanghai University of Traditional Chinese Medicine from May 2004 to September 2006. PARTICIPANTS： A total of 153 patients suffering from stroke hemiplegia, comprising 83 males and 70 females, aged 63-70 years, were admitted to outpatient and inpatient at LongHua Hospital Affiliated Shanghai University of Traditional Chinese medicine, Putuo District Traditional Chinese Medicine Hospital and Changqiao Street Community Health Service Center of Shanghai. METHODS： The patients were randomly divided into treatment （n = 77） and control （n = 76） groups. They were treated with acupoint electrogymnastics and traditional electroacupuncture, respectively. In the treatment group, two pairs of positive and negative JD-2008 type electrodes from a hemiplegia treatment apparatus were directly pasted on the Shousanli （LI 10） and Waiguan （SJ5） acupoints of the upper limb, as well as the Zusanli （S36） and Yanglingquan （GB34） acupoints of the lower limb, respectively. In the control group, needles were consecutively inserted into the above acupoints. Using the method of lifting-inserting and twisting-rotating, the needle was manipulated with small amplitude of 5-7 mm and a fast frequency of 80-120 times/min when the needle was inserted to a suitable depth. When the sensation of needling was attained, the two pairs of positive and negative electrodes of type G6805-Ⅱelectro-acupunctur     

社区2型糖尿病患者自我管理行为现状调查

目的:了解社区2型糖尿病患者自我管理行为的现状并探讨其影响因素。方法:采取分层整群抽样方法,抽取合肥市3个区的3个社区卫生服务中心418例2型糖尿病患者,并对其进行自我管理行为现状调查。结果:自我管理行为总分为(82.30±17.79)分,平均得分指标为63.31%;不同的自我管理活动水平有所不同,其中遵医嘱用药得分最高,平均得分指标为76.47%;血糖监测得分最低,得分指标为54.85%。自我管理水平影响因素众多,其中行为变化阶段、病程、并发症、住院史、居住方式是重要影响因素。结论:患者的自我管理行为现状不够理想,护理人员应对患者进行有针对性的行为干预,延缓和控制并发症的发生,从而提高患者的生活质量。     

控制性肺膨胀改善食管癌术后低氧血症病人氧合的疗效探讨

目的观察控制性肺膨胀在食管癌术后防治低氧血症的疗效。方法随机对照设立应用控制性肺膨胀组26例,对照组26例,观察呼吸频率,心率,血氧饱和度和氧分压等氧合指标变化。结果30min后．SaO2从0．90±0．025升高到0．95±0．028,1h后Pa02从10．0±1．66kPa升高到12．1±2．27kPa。24-72h的持续监测SaO2和PaO2亦保持在0．97～0．98和13．1～13．2kPa。与对照组相比,控制性肺膨胀治疗后SaO2和PaO2提高速度快,且能较长时间维持在稳定水平。结论应用控制性肺膨胀能有效防治食管癌术后早期低氧血症病人急性呼吸衰竭的发生。     

缺血性脑卒中患者疾病感知的影响因素分析

目的调查缺血性脑卒中患者的疾病感知,并分析其影响因素。方法对103例缺血性脑卒中患者应用一般资料调查表、疾病感知量表、美国国立卫生研究院卒中量表和简易应对方式量表进行调查,采用单因素方差分析和多元线性回归等方法进行统计分析。结果缺血性脑卒中患者疾病感知量表疾病同一性因子得分为3.11±2.53分,严重后果因子得分为16.95±4.39分,情绪陈述因子得分为18.45±5.50分。多元逐步线性回归分析显示,患者年龄、性别、家庭住址、职业、NIHSS评分是缺血性脑卒中患者疾病感知的影响因素。结论缺血性脑卒中患者具有负性的疾病感知,医护人员应根据疾病感知的影响因素提供有针对性的健康干预。     

后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形

目的:评价经后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形的安全性和临床初步效果,并探讨其融合固定节段的选择。方法:2007年4月～2010年3月收治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形患者11例,男4例,女7例,年龄14～22岁,平均17.1岁;半椎体均为单个完全分节型,T11 3例,T12 4例,L1 1例,L2 3例;术前侧凸Cobb角82°～125°,平均94.4°,侧凸柔韧性为17.4%～28.9%,平均24.8%;后凸Cobb角72°～145°,平均101.1°;C7铅垂线与骶正中线距离1.5～5.5cm,平均2.9cm。均行经后路松解楔形截骨矫形手术,以触及椎(touched vertebrae,TV)(指站立前后位像上被骶正中线触及的最近端椎体)作为融合固定下端椎;1例合并脊髓拴系和脊髓纵裂者,术中一期行骨嵴切除,解除拴系。结果:均顺利完成手术。平均松解3.0个椎间隙。手术时间5.5～10.0h,平均7.7h;术中出血量1000～7000ml,平均3500ml。无脊髓神经损伤。1例术中切除肋骨小头时引起左侧胸膜撕裂,发生血气胸,行胸腔闭式引流,2周后痊愈;1例术后出现螺钉穿破背部皮肤,1枚螺钉钉尾外露,术后3个月取出该枚螺钉。术后侧凸Cobb角7°～54°,平均28.0°,平均矫正率为70.9%;后凸Cobb角20°～36°,平均27.8°,平均矫正率为71.7%;C7铅垂线与骶正中线距离0.1～2.3cm,平均0.6cm,冠状位平衡平均矫正率为78.1%。随访14～35个月,平均23.4个月,末次随访侧凸Cobb角8°～57°,平均29.7°,丢失率为7.3%;后凸Cobb角22°～38°,平均29.9°,丢失率为7.7%;C7铅垂线与骶正中线距离0.2～2.5cm,平均0.7cm;随访X线片证实植骨均融合,内固定物无松动、断裂。选择TV作为远端融合椎(lowest instrumented vertebrae,LIV)比选择稳定椎(stable vertebrae,SV)平均节省了1.09个椎体,未发现失代偿现象。结论:经后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形安全有效,选择TV作为LIV可以减少融合节段。     

后路全脊椎切除与松解治疗先天性重度脊柱角状后凸

目的探讨后路全脊椎切除与松解治疗先天性重度脊柱角状后凸的临床效果及其安全性。方法2004年2月-2012年2月,采用后路全脊椎切除与松解治疗先天性重度脊柱角状后凸畸形患者14例。其中男5例,女9例;年龄6~42岁,平均20.6岁。先天性分节不全型3例,先天性半椎体型8例和混合型3例。术前脊柱后凸 Cobb 角91°~155°,平均109.4°;术前矢状面偏移-0.1~5.5 cm ,平均0.9 cm。13例合并脊柱侧凸,Cobb角11°~128°,平均67.5°;术前冠状面偏移0~6.5 cm,平均2.6 cm。8例半椎体畸形中有2例合并神经损害,Frankel分级C级和D级各1例。术前Oswestry功能障碍指数（ODI）评分0~45分,平均16.8分。结果手术时间为5.6~10.7 h,平均6.9 h;术中出血1400~5100 ml,平均3160 ml;脊髓短缩为1.9~2.9 cm,平均缩短2.4 cm。融合固定节段为6~14节椎体,平均10.4节。14例患者均得到随访,随访24~96个月,平均44.9个月。末次随访结果：脊柱后凸 Cobb 角9°~44°,平均26.4°,后凸矫正率75.8%;矢状面偏移矫正到-0.8~0.5 cm,平均0.09 cm,矫正率89.8%;脊柱侧凸Cobb角0°~55°,平均17.2°,侧凸矫正率74.6%;冠状位偏移矫正到0~2.7 cm,平均0.5 cm,冠状位不平衡矫正率81.3%。术前2例神经损害者,术后Frankel分级恢复到E级。术后ODI评分0~2分,平均0.2分,改善率为98.8%。所有患者获得良好的骨质愈合,无脊髓损伤。结论后路全脊椎切除与松解治疗先天性重度脊柱角状后凸能有效改善脊柱的柔韧性,可获得极好的畸形矫正,且安全有效。     

Parameters of ocular fundus on spectral-domain optical coherence tomography for glaucoma diagnosis

In this review, we summarize the progression of several parameters assessed by spectral-domain optical coherence tomography (SD-OCT) in recent years for the detection of glaucoma. Monitoring the progression of defects in the retinal nerve fiber layer (RNFL) thickness is essential. Imaging and analysis of retinal ganglion cells (RGCs) and inner plexiform layer (IPL), respectively, have been of great importance. Optic nerve head (ONH) topography obtained from 3D SD-OCT images is another crucial step. Other important assessments involve locating the Bruch’s membrane opening (BMO), estimating the optic disc size and rim area, and measuring the lamina cribrosa displacement. Still other parameters found in the past three years for glaucoma diagnosis comprise central retinal artery resistive index, optic disc perfusion in optical coherence tomography angiography (OCTA) study, peripapillary choroidal thickness, and choroidal area in SD-OCT. Recently, several more ocular fundus parameters have been found, and compared with the earlier parameters to judge the accuracy of diagnosis. While a few of these parameters have been widely used in clinical practice, a fair number are still in the experimental stage.     

Erosion of quantitative host resistance in the apple × Venturia inaequalis pathosystem

Theoretical approaches predict that host quantitative resistance selects for pathogens with a high level of pathogenicity, leading to erosion of the resistance. This process of erosion has, however, rarely been experimentally demonstrated. To investigate the erosion of apple quantitative resistance to scab disease, we surveyed scab incidence over time in a network of three orchards planted with susceptible and quantitatively resistant apple genotypes. We sampled Venturia inaequalis isolates from two of these orchards at the beginning of the experiment and we tested their quantitative components of pathogenicity (i.e., global disease severity, lesion density, lesion size, latent period) under controlled conditions. The disease severity produced by the isolates on the quantitatively resistant apple genotypes differed between the sites. Our study showed that quantitative resistance may be subject to erosion and even complete breakdown, depending on the site. We observed this evolution over time for apple genotypes that combine two broad-spectrum scab resistance QTLs, F11 and F17, showing a significant synergic effect of this combination in favour of resistance (i.e., favourable epistatic effect). We showed that isolates sampled in the orchard where the resistance was inefficient presented a similar level of pathogenicity on both apple genotypes with quantitative resistance and susceptible genotypes. As a consequence, our results revealed a case where the use of quantitative resistance may result in the emergence of a generalist pathogen population that has extended its pathogenicity range by performing similarly on susceptible and resistant genotypes. This emphasizes the need to develop quantitative resistances conducive to trade-offs within the pathogen populations concerned.