多功能套针浮刺疗法治疗神经根型颈椎病——一项随机对照观察研究＊

目的 评价多功能套针浮刺疗法对神经根型颈椎病的临床疗效。方法 选取256例神经根型颈椎病患者，按随机数字表法分为观察组与对照组各128例。观察组应用多功能套针浮刺疗法进行干预，对照组为常规针刺治疗。两组患者均治疗7天。分别于治疗前后观察两组患者的简化McGill疼痛问卷（SF-MPQ）、国际标准颈椎功能障碍指数（NDI）和田中靖久颈椎病症状20分法量表评分，并于治疗结束后3个月观察复发率。结果 两组患者治疗后的SF-MPQ量表评分、NDI量表评分及田中靖久颈椎病症状20分法评分与治疗前相比均有改善（P<0.05），且观察组优于对照组（P<0.05）；两组患者于治疗后3个月随访，SF-MPQ量表评分与治疗后相比均有改善，且观察组优于对照组（P<0.05）；观察组临床疗效总有效率为96.88%，愈显率为81.25%；对照组总有效率为78.13%，愈显率为46.88%，观察组优于对照组（P<0.05）。结论 应用多功能套针浮刺疗法治疗神经根型颈椎病临床疗效显著，见效较快，可有效降低其复发率，且作用稳定，效果持久，值得临床推广应用。     

Lateral Corticospinal Tract and Dorsal Column Damage: Predictive Relationships With Motor and Sensory Scores at Discharge From Acute Rehabilitation After Spinal Cord Injury

ObjectiveTo determine if lateral corticospinal tract (LCST) integrity demonstrates a significant predictive relationship with future ipsilateral lower extremity motor function (LEMS) and if dorsal column (DC) integrity demonstrates a significant predictive relationship with future light touch (LT) sensory function post spinal cord injury (SCI) at time of discharge from inpatient rehabilitation.DesignRetrospective analyses of imaging and clinical outcomes.SettingUniversity and academic hospital.ParticipantsA total of 151 participants (N=151) with SCI.InterventionsInpatient rehabilitation.Main Outcome MeasuresLEMS and LT scores at discharge from inpatient rehabilitation.ResultsIn 151 participants, right LCST spared tissue demonstrated a significant predictive relationship with right LEMS percentage recovered (β=0.56; 95% confidence interval [CI], 0.37-0.73; R=0.43; P<.001). Left LCST spared tissue demonstrated a significant predictive relationship with left LEMS percentage recovered (β=0.66; 95% CI, 0.50-0.82; R=0.51; P<.001). DC spared tissue demonstrated a significant predictive relationship with LT percentage recovered (β=0.69; 95% CI, 0.52-0.87; R=0.55; P<.001). When subgrouping the participants into motor complete vs incomplete SCI, motor relationships were no longer significant, but the sensory relationship remained significant. Those who had no voluntary motor function but recovered some also had significantly greater LCST spared tissue than those who did not recover motor function.ConclusionsLCST demonstrated significant moderate predictive relationships with lower extremity motor function at the time of discharge from inpatient rehabilitation, in an ipsilesional manner. DC integrity demonstrated a significant moderate predictive relationship with recovered function of LT. With further development, these neuroimaging methods might be used to predict potential deficits after SCI and to provide corresponding targeted interventions.     

Matrine,oxymatrine, and compound Kushen injection from the roots of Sophora flavescens: an overview of their anticancer activities

In the present review, we updated current information on the chemistry, contents, and anticancer properties of matrine (MT), oxymatrine (OMT), and compound Kushen injection (CKI). The anticancer properties were focused on lung, breast, and liver cancer cells because they are most susceptible. Sources of information were from Google, Google Scholar, PubMed, PubMed Central, Science Direct, PubChem, J-Stage, Directory of Open Access Journals (DOAJ), and China National Knowledge Infrastructure (CNKI). Reference was also made on botanical websites, such as Flora of China and World Flora Online. MT and OMT are dominant quinolizidine alkaloids from the roots of Sophora flavescens (Kushen) of the family Fabaceae. Against lung, breast, and liver cancer cells, MT and OMT inhibit cell proliferation; induce cell cycle arrest, apoptosis, and autophagy; restrict angiogenesis; and inhibit cell metastasis, invasion, and migration. The processes involve various molecular targets and signaling pathways. CKI is a traditional Chinese medicine (TCM) composed of root extracts of S. flavescens and Smilax glabra (Baituling) of the family Smilacaceae. With MT and OMT as major components, CKI has been approved for the treatment of cancer in China more than 20 years ago. In recent years, systematic reviews and meta-analysis have been undertaken to evaluate the anticancer effects of CKI. When CKI is used alone and in combination with chemotherapy of western medicine, there is much to be learned concerning their interactions besides their individual and integrated efficacy. Some perspectives of MT, OMT, and CKI are discussed, and their suggestions for future research are provided.     

The retrospective study for effectiveness of cervical cerclage in preventing recurrent preterm birth

ObjectiveThis study aimed to clarify the effectiveness of cervical cerclage in preventing recurrent preterm births.Materials and methodsA retrospective study was conducted using the perinatal registration database of the Japan Society of Obstetrics and Gynecology for the Perinatal Center from 2014 to 2016. The efficacies of history-indicated, ultrasound-indicated, and physical examination-indicated cerclage as preventive treatments for women with a history of preterm birth were evaluated by comparing cerclage and non-cerclage cases. Fisher's exact test was performed to evaluate any significant differences in patient backgrounds. Prior to the evaluation, propensity score matching was performed for history-indicated and ultrasound-indicated cerclage patients.ResultsFor this study, 6060 multiparous women with a history of preterm birth were reviewed. After excluding 17 patients with unknown indications for cervical cerclage, 6043 patients were included in the study. History-indicated and ultrasound-indicated cerclage did not reduce the risk of preterm birth in subsequent pregnancies for any of the pregnancy periods (p = 0.413, p = 1.000). In contrast, physical examination-indicated cerclage significantly reduced the risk of subsequent preterm births for all pregnancy periods (p < 0.001).ConclusionSubsequent preterm births were effectively prevented only in physical examination-indicated cerclage cases. For history- or ultrasound-indicated cerclage, statistically significant differences in subsequent preterm births were not evident.     

Clinical and radiological characteristics of spinal epidural lipomatosis: A retrospective review of 90 consecutive patients

BackgroundThe epidemiology and clinical characteristics of spinal epidural lipomatosis (SEL) have been well-reported in the literature. However, few studies investigated the concomitant spinal pathologies that were present in patients with SEL. Therefore, we aimed to summarize the clinical and radiological characteristics of patients with SEL diagnosed on spinal imaging.MethodsPatients who were diagnosed with SEL on magnetic resonance imaging from January 2018 to October 2020 at our institution were included in the study. Clinical data was collected using a standardized data collection form. SEL was graded using a modified version of the Borré grading system. Factors associated with moderate or severe SEL were determined using multiple logistic regression.ResultsA total of 90 patients were included in the analysis. The mean (±SD) age was 59.3 (±17.1) years, and 62 patients (68.9%) were male. 61 patients (67.8%) had moderate or severe SEL. Most patients were overweight or obese (57 patients, 63.3%). The most common presenting symptoms was back pain (57 patients, 63.3%). SEL was diagnosed incidentally in 42 patients (46.7%). The lumbar spine was the most common site of SEL (35 patients, 38.9%). The most common concomitant spinal pathologies were disc bulge (83 patients, 92.2%) and flavum hypertrophy (60 patients, 66.7%). Moderate or severe SEL was associated with WHO Obesity Class, back pain or radicular leg pain at first presentation, and SEL that was worst at the lumbar or lumbosacral spinal level.ConclusionsModerate or severe SEL were independently associated with WHO Obesity Class, back pain, radicular leg pain, and SEL that was worst at the lumbar or lumbosacral spinal level. Future studies should prospectively evaluate whether weight loss therapy is warranted in patients with SEL.     

Patients' expectations,experience and acceptability of postoperative analgesia: a nested qualitative study within a randomised controlled trial comparing rectus sheath catheter and thoracic epidural analgesia

Adequate postoperative analgesia is a key element of enhanced recovery programmes. Thoracic epidural analgesia is associated with superior postoperative analgesia but can lead to complications. Rectus sheath catheter analgesia may provide an alternative. In a nested qualitative study (within a two-year randomised controlled trial) focussing on the acceptability, expectations and experiences of receiving the interventions, participants (n = 20) were interviewed 4 weeks post-intervention using a grounded theory approach. Constant comparative analysis, with patient and public involvement, enabled emerging findings to be pursued through subsequent data collection. We found no notable differences regarding postoperative acceptability or the experience of pain management. Pre-operatively, however, thoracic epidural analgesia was a source of anticipatory fear and anxiety. Both interventions resulted in some experienced adverse events (proportionately more with thoracic epidural analgesia). Participants had negative experiences of the insertion of thoracic epidural analgesia; others receiving the rectus sheath catheter lacked confidence in staff members' ability to manage the local anaesthetic infusion pump. The anticipation of the technique of thoracic epidural analgesia, and concerns about its impact on mobility, represented an additional, unpleasant experience for patients already managing an illness experience, anticipating a life-changing operation and dealing with concerns about the future. The anticipation of rectus sheath catheter analgesia was not associated with such anxieties. Patients' experiences start far earlier than the experience of the intervention itself through anticipatory anxieties and fears about receiving a technique and its potential implications. Complex pain packages can take on greater meaning than their actual efficacy in relieving postoperative pain. Future research into patient acceptability and experience should not focus solely on efficacy of pain relief but should include anticipatory fears, anxieties and experiences.