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1.
下肢运动功能障碍是脑卒中患者最常见和最迫切需要解决的问题之一,即使早期、规范介入康复治疗,仍有许多患者在发病6个月后还不能恢复行走功能或遗留严重异常步态,对患者的日常活动和自理能力造成巨大影响,给社会和家庭带来沉重经济负担。下肢运动功能障碍的康复治疗技术包括神经调控、头针等以大脑为靶点的中枢干预技术,以及协同功能性电刺激(FES)、机器人辅助步态训练(RAGT)等以肢体为靶点的外周干预技术。虽然中枢干预与外周干预刺激靶点不同,但是治疗目的一致。为了提高治疗效果,有研究发现将有效的中枢干预技术与外周干预技术联合应用比单一中枢或外周治疗的效果更好。国内学者将这种模式称为"脑-肢协同调控治疗技术",该技术根据协同部位不同可分为脑-上肢协同治疗模式和脑-下肢协同治疗模式;根据协同顺序的不同,又可分为脑-肢体同步治疗模式和脑-肢体非同步治疗模式,其中非同步治疗模式又可分为先大脑刺激后肢体刺激模式和先肢体刺激后大脑刺激模式。目前,脑-肢协同调控治疗技术在临床中被普遍应用和研究。由于经颅直流电刺激(tDCS)治疗安全性高、设备携带方便、后延效应时间长等优势,被广泛与下肢康复治疗技术协同应用。但由于参与协同的下肢康复技术种类不同以及协同治疗顺序的不一致,tDCS协同下肢康复治疗的效果存在较大差异。本文就国内外近年来不同治疗参数的经颅直流电刺激协同不同的下肢康复治疗技术及不同脑-肢体协同治疗顺序,在脑卒中偏瘫下肢康复中的应用模式作一综述,并探讨影响协同治疗效果的因素及可能有效的协同治疗模式,旨在为脑卒中后下肢功能障碍的研究和治疗提供新思路。  相似文献   
2.
[摘要] 目的 评估直接抗病毒药物(direct antivirus agent, DAA)治疗肝移植术后HCV感染复发的有效性和安全性。方法?回顾性分析首都医科大学附属北京佑安医院2011年2月—2018年12月收治的14例肝移植术后HCV感染复发患者的DAA治疗临床数据,比较患者基线与治疗结束后肝肾功能、血常规、凝血功能、病毒学水平以及无创纤维化评分天冬氨酸转氨酶血小板比率指数(aspartate aminotransferase-platelet ratio index, APRI)的差异。利用电子病历系统和电话随访收集患者治疗期间不良反应发生情况。结果?所有患者均在治疗结束时达到病毒学清除,12周、24周持续病毒学应答率均为100%,DAA治疗后随访17~44个月,期间均未见病毒学复发。与基线水平相比,治疗终点时ALT、AST、TBIL、γ-谷氨酰转移酶以及无创纤维化评分APRI显著下降,WBC、HGB、PLT、CRE、肾小球滤过率和血糖等指标均未见显著变化。DAA治疗期间共3例患者发生不良反应,均为轻度,可自然缓解。结论?肝移植术后HCV感染复发的DAA治疗是安全有效的。  相似文献   
3.
目的分析煤矿作业人员工作家庭冲突对其职业紧张发生的影响,为降低其职业紧张的发生提供参考依据。方法通过分层整群抽样的方法纳入1500名煤矿工人作为研究对象,采用ERI量表和工作家庭冲突量表调查研究对象的工作家庭冲突和职业紧张现状,采用二分类logistic回归对职业紧张的影响因素进行分析。结果研究共调查了1346名煤矿作业工人,工作家庭冲突分数结果显示,不同轮班、婚姻和工种的煤矿作业人员其分数差异较大(P<0.05);煤矿工人职业紧张阳性率为47.77%,煤矿工作人员在不同年龄、工龄和婚姻状况之间职业紧张阳性率差异较大(分别为χ^(2)=20.938、χ^(2)=19.873、χ^(2)=6.273,P<0.05);工作家庭冲突三维度的方面(时间、压力、行为)的得分都与付出、超负荷和ERI比值呈现出正相关关系(P<0.05);多因素回归分析发现:年龄>45岁(OR=1.370,95%CI:1.052~1.785)、工龄>10年(OR=1.788,95%CI:1.223~2.614)和家庭-工作冲突(OR=1.070,95%CI:1.049~1.091)均是煤矿作业人员发生职业紧张的危险因素(P<0.05)。结论研究表明煤矿作业工人目前发生职业紧张状况不容乐观,家庭-工作冲突可以增加职业紧张发生的风险。  相似文献   
4.
Rifamycins (rifampin, rifabutin, and rifapentine) play an essential role in the treatment of mycobacterial and some nonmycobacterial infections. They also induce the activity of various drug transporting and metabolizing enzymes, which can impact the concentrations and efficacy of substrates. Many anticoagulant and antiplatelet (AC/AP) agents are substrates of these enzymes and have narrow therapeutic indices, leading to risks of thrombosis or bleeding when coadministered with rifamycins. The objective of this systematic review was to evaluate the effects on AC/AP pharmacokinetics, laboratory markers, and clinical safety and efficacy of combined use with rifamycins. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidance was performed. The PubMed, Embase, and Web of Science databases were queried for English-language reports on combination use of rifamycins and AC/AP agents from database inception through August 2021. The 29 studies identified examined warfarin (n = 17), direct oral anticoagulants (DOACs) (n = 8), and antiplatelet agents (n = 4) combined with rifampin (n = 28) or rifabutin (n = 1). Eleven studies were case reports or small case series; 14 reported on pharmacokinetic or laboratory markers in healthy volunteers. Rifampin-warfarin combinations led to reductions in warfarin area under the curve (AUC) of 15%–74%, with variability by warfarin isomer and study. Warfarin dose increases of up to 3–5 times prerifampin doses were required to maintain coagulation parameters in the therapeutic range. DOAC AUCs were decreased by 20%–67%, with variability by individual agent and with rifampin versus rifabutin. The active metabolite of clopidogrel increased substantially with rifampin coadministration, whereas prasugrel was largely unaffected and ticagrelor saw decreases. Our review suggests most combinations of AC/AP agents and rifampin are problematic. Further studies are required to determine whether rifabutin or rifapentine could be safe alternatives for coadministration with AC/AP drugs.  相似文献   
5.
ObjectiveEmerging evidence shows the effectiveness of speech and language therapy (SLT); however, precise therapeutic parameters remain unclear. Evidence for the use of adjunctive transcranial direct current stimulation (tDCS) to treat post-stroke aphasia (PSA) is promising; however, the utility of combining tDCS and electroacupuncture (EA) has not yet been analyzed. This study assessed the therapeutic consequences of EA and tDCS coupled with SLT in subacute PSA patients who were also undergoing hyperbaric oxygen therapy (HBOT).MethodsA retrospective analysis was conducted on subacute (< 6 months) PSA patients who were divided into three groups: patients who received EA plus tDCS (acupuncture group), patients who underwent tDCS (tDCS group), and patients who experienced conventional therapy (HBOT + SLT). All subjects underwent 21 days of treatment and also received conventional treatment. The aphasia battery of Chinese (ABC) was used to score pre- and post-intervention status.ResultsThe analysis comprised 238 patients. Cerebral infarction was the most frequent stroke type (137 [57.6%]), while motor (66 [27.7%]) and global aphasia (60 [25.2%]) were the most common types of aphasia. After 21 days of intervention, the ABC scores of all patients were improved. The acupuncture group had the highest ABC scores, but only repetition, naming, and spontaneous speech were statistically improved (P < 0.01). Post-hoc tests revealed significant improvement in word retrieval in the acupuncture and tDCS groups (P < 0.01, P = 0.037), while the acupuncture group had additional significant improvement in spontaneous conversation (P < 0.01).ConclusionCombining acupuncture and tDCS as an adjuvant therapy for subacute PSA led to significant spontaneous speech and word retrieval improvements. Future prospective, multi-ethnic, multi-center trials are warranted.  相似文献   
6.
《Human immunology》2022,83(2):130-133
The stimulation of AT1R (Angiotensin II Receptor Type 1) by Angiotensin II has, in addition to the effects on the renin-angiotensin system, also pro-inflammatory effects through stimulation of ADAM17 and subsequent production of INF-gamma and Interleukin-6. This pro-inflammatory action stimulate the cytokine storm that characterizes the most severe forms of SARS-CoV-2 infection. We studied the effect of AT1Rab on the AT1R on 74 subjects with SARS-CoV-2 infection with respiratory symptoms requiring hospitalization. We divided the patients into 2 groups: 34 with moderate and 40 with severe symptoms that required ICU admission. Hospitalized subjects showed a 50% reduction in the frequency of AT1Rab compared to healthy reference population. Of the ICU patients, 33/40 (82.5%) were AT1Rab negative and 16/33 of them (48.5%) died. All 7 patients positive for AT1Rab survived. These preliminary data seem to indicate a protective role played by AT1R autoantibodies on inflammatory activation in SARS-CoV-2 infection pathology.  相似文献   
7.
利用脑网络研究经颅直流电刺激(tDCS)对脑功能机制和脑皮层状态的影响具有重要意义。本研究基于偏定向相干因果分析方法,构建被试在不同tDCS刺激实验范式下进行运动想象的因效性脑网络。以因效性脑网络的功能脑区通道信息流入、流出率为局部特征,平均聚类系数、全局效率为全局特征,分析研究tDCS对运动想象脑网络特征的影响。16名健康被试均为右利手。结果显示,被试执行左手运动想象下,伪刺激和阳极刺激C4后的C4通道信息流出率、流入率、平均聚类系数和全局效率分别为0.142±0.014、0.193±0.013、0.585±0.046、0.347±0.031和0.223±0.025、0.258±0.023、0.817±0.021、0.491±0.091,均存在显著性差异(P<0.05);tDCS阴极刺激C4后的C4通道信息流出率、平均聚类系数和全局效率分别为0.109±0.009、0.356±0.037和0.252±0.024,与伪刺激相比差异显著(P<0.05),C4通道信息流入率为0.184±0.008,与伪刺激相比无显著差异(P>0.05)。研究表明,阳极tDCS有效激活该脑区皮层的活跃性,使脑区信息交流更加频繁,增加脑网络的聚集程度,提高脑网络的连通性;阴极tDCS刺激则会抑制脑区皮层的活跃性,降低了脑区信息的流出,减少脑网络的聚集程度,降低脑网络的连通性。  相似文献   
8.
Background and aimsWhile low-density lipoprotein cholesterol (LDL-C) is a good predictor of atherosclerotic cardiovascular disease, apolipoprotein B (ApoB) is superior when the two markers are discordant. We aimed to determine the impact of adiposity, diet and inflammation upon ApoB and LDL-C discordance.Methods and resultsMachine learning (ML) and structural equation models (SEMs) were applied to the National Health and Nutrition Examination Survey to investigate cardiometabolic and dietary factors when LDL-C and ApoB are concordant/discordant. Mendelian randomisation (MR) determined whether adiposity and inflammation exposures were causal of elevated/decreased LDL-C and/or ApoB. ML showed body mass index (BMI), dietary saturated fatty acids (SFA), dietary fibre, serum C-reactive protein (CRP) and uric acid were the most strongly associated variables (R2 = 0.70) in those with low LDL-C and high ApoB. SEMs revealed that fibre (b = ?0.42, p = 0.001) and SFA (b = 0.28, p = 0.014) had a significant association with our outcome (joined effect of ApoB and LDL-C). BMI (b = 0.65, p = 0.001), fibre (b = ?0.24, p = 0.014) and SFA (b = 0.26, p = 0.032) had significant associations with CRP. MR analysis showed genetically higher body fat percentage had a significant causal effect on ApoB (Inverse variance weighted (IVW) = Beta: 0.172, p = 0.0001) but not LDL-C (IVW = Beta: 0.006, p = 0.845).ConclusionOur data show increased discordance between ApoB and LDL-C is associated with cardiometabolic, clinical and dietary abnormalities and that body fat percentage is causal of elevated ApoB.  相似文献   
9.
为评估超声内镜检查术(endoscopic ultrasonography,EUS)对胆总管小结石的诊断价值,纳入2018年1月—2021年7月在东南大学附属中大医院住院并诊断为可疑胆总管结石的患者60例。所有患者于同一次住院期间行EUS及磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)。以经内镜逆行胰胆管造影、开腹探查或腹腔镜胆总管探查结果为金标准,比较EUS及MRCP对胆总管结石的诊断结果,计算2种检查方法的灵敏度、特异度、阳性预测值、阴性预测值。结果显示,60例患者中46例确诊胆总管结石,EUS诊断准确43例,MRCP诊断准确35例;14例患者证实胆总管结石阴性,EUS诊断准确12例,MRCP诊断准确13例。EUS诊断灵敏度明显高于MRCP[93.48%(43/46)比76.09%(35/46),χ2=4.128,P=0.042]。结石直径≤1.0 cm者45例,其中EUS确诊42例,MRCP确诊34例(诊断准确率93.33%比75.56%,χ2=4.145,P=0.042);直径≤0.8 cm者39例,其中EUS确诊36例,MRCP确诊28例(诊断准确率92.31%比71.79%,χ2=4.266,P=0.039);直径≤0.5 cm者26例,其中EUS确诊24例,MRCP确诊16例(诊断准确率92.31%比61.54%,χ2=5.038,P=0.021)。在胆总管结石的诊断方面,EUS有明显的诊断优势,且诊断准确性不受结石大小的影响,因此对于临床高度怀疑胆总管结石但MRCP结果阴性的患者,需进一步行EUS。  相似文献   
10.
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