电针傍刺经筋结点治疗缺血性脑卒中急性期上肢偏瘫的临床研究

目的通过观察电针傍次上肢经筋结点治疗缺血性脑卒中急性期上肢偏瘫的临床疗效,探讨电针傍次经筋结点治疗缺血性卒中急性期肢体瘫痪的作用机制。方法60例缺血性卒中急性期偏瘫的患者采用SPSS软件随机数字生成器分为治疗组与对照组各30例。治疗组采用电针傍刺上肢经筋结点治疗,对照组采用电针上肢常规经穴治疗。分别于治疗前后观察评价两组上肢的肌力(MMT徒手肌力评定法)、关节活动度(ROM关节活动度评定法)、运动功能(Fugl-Meyer运动功能评分量表、ARAT上肢动作研究量表)、临床神经功能缺损程度(NIHSS量表)确定疗效。结果两组患者治疗后ROM评分下降,Barthel指数、Fugl-Meyer评分、ARAT评分均上升。治疗组较对照组ROM评分、Barthel指数、Fugl-Meyer评分、ARAT评分改善更优(P<0.05);疗程结束后治疗组肌力经MMT评定后有效率为90%,高于对照组的76.67%(P<0.05);治疗组疗效经神经功能缺损程度评价有效率为93.33%,高于对照组76.67%(P<0.05)。结论电针傍刺经筋结点与常规针刺治疗都可以改善缺血性卒中急性期上肢瘫痪,但电针傍刺经筋结点治疗效果更佳。     

Successful treatment of a recurrent post-dural puncture headache with an epidural blood patch 18 months after the initial dural puncture

Inadvertent dural puncture is a recognised complication of epidural insertion. Parturients are at increased risk of developing a post-dural puncture headache, which can be debilitating for a mother caring for a newborn infant. Epidural blood patch is an effective treatment in patients presenting acutely with post-dural puncture headaches but its efficacy in those with delayed presentation or with late recurrent post-dural puncture headache is less clear. We present the case of a woman with a recurrent post-dural puncture headache who was successfully treated with an epidural blood patch 18 months after the initial dural puncture. Patients who develop post-dural puncture headaches may remain symptomatic for some time and an epidural blood patch may be beneficial, following appropriate investigation.     

微创穿刺抽吸术与开颅手术治疗脑出血的疗效

目的探讨微创穿刺抽吸术与开颅手术治疗脑出血的疗效。方法选择2017年1月-2018年1月治疗的脑出血患者80例作为对象,根据住院时间先后顺序随机数字表分为对照组(n=40)和观察组(n=40)。观察组给予患者微创穿刺抽吸术治疗,对照组给予患者开颅手术治疗,比较两组患者术后总治愈效率和手术开展时间、住院天数。结果观察组手术开展时间、住院天数短于对照组(P<0.05);观察组的总治愈效率为90%高于对照组75%(P<0.05);观察组患者术后意识恢复时间短于对照组(P<0.05)观察组患者术后肢体障碍及肺部感染、伤口感染发生率均略低于对照组,但差异不具有统计学意义(P>0.05)。结论微创穿刺抽吸术在脑出血临床治疗中比开颅手术总治愈率高、安全性高、恢复快。     

前房穿刺时限对原发性急性闭角型青光眼大发作的预后影响

目的评价前房穿刺时限对药物不可控制、持续高眼压状态下的原发性急性闭角型青光眼大发作的预后影响。方法回顾性分析2014年1～12月收治于华中科技大学同济医学院附属同济医院眼科的原发性急性闭角型青光眼大发作患者27例(28眼),发作眼急诊行前房穿刺放液术,术后按眼压情况即房水外流通道是否有效恢复分为A、B两组,对两组前房穿刺时限及视力转归情况进行比较。结果 A组前房穿刺时限明显低于B组,差异有统计学意义(t=-7.30,P0.01);A组视力恢复情况明显优于B组,差异有统计学意义(t=6.15,P0.01)。结论原发性急性闭角型青光眼大发作行前房穿刺后,对房水外流通路能有效恢复、眼内压短期下降的患者,穿刺放液时限较短,视力恢复较好。     

经皮肺穿刺肺癌兔应用化疗药物对肿瘤细胞沿针道转移率影响的研究

目的探究化疗药物对已进行经皮肺穿刺肺癌兔术后肿瘤细胞沿针道转移率的影响。方法将成功建立的肺癌兔模型分为治疗组24只,对照组20只,所有患兔在计算机断层扫描(CT)引导下成功进行细针吸取细胞学检查(FNAC)5次,治疗组在进行穿刺后保留套管拔出针芯,边给予化疗药物边撤出套管。沿针道搜集组织并进行病理细胞学检测。结果治疗组中,3个不同部位5次穿刺均未发现阳性转移的发生率比较,差异无统计学意义(P﹥0.05);对照组中,脏层胸膜5次穿刺均未发现阳性转移的发生率分别低于壁层胸膜和胸壁组织,差异均有统计学意义(P﹤0.05);治疗组脏层胸膜5次穿刺均未发现阳性转移的发生率高于对照组,差异有统计学意义(P﹤0.05)。穿刺后,治疗组脏层胸膜肿瘤细胞转移阳性率明显低于对照组,差异有统计学意义(P﹤0.01);两组壁层胸膜及胸壁组织的肿瘤细胞转移阳性率比较,差异均无统计学意义(P﹥0.05)。结论经皮肺穿刺肺癌兔使用化疗药物可降低肿瘤细胞沿针道的阳性转移率。     

槽型鞘脑穿刺针的设计及动物实验初步结果

目的测试槽型鞘脑穿刺针用于实验动物脑组织穿刺的可操作性和安全性。 方法新西兰兔6只，麻醉后骨窗开颅显露双侧大脑半球，左侧大脑半球以传统脑穿刺针进行穿刺，右侧以槽型鞘脑穿刺针穿刺，完成穿刺、拔出穿刺针留置槽形鞘、置管后拔出槽形鞘等步骤。拔出穿刺针后穿刺道以苏木素染色，观察30 min后处死实验动物，提取脑组织，沿脑组织穿刺道制3 μm厚切片，常规HE染色，显微镜下观察脑组织穿刺道病理解剖学变化（脑组织破损及出血情况），评估损伤程度。 结果2种穿刺针穿刺操作后均会造成穿刺道局灶性脑挫裂伤，表现为穿刺道组织缺损、脑组织淤血、水肿。光镜下可见穿刺道脑组织破碎、细胞排列不规则、水肿的细胞体增大和细胞核固缩，穿刺道外围细胞结构正常。2种穿刺针针道脑组织病理特征差别不明显。 结论槽型鞘脑穿刺针穿刺操作简便，通过槽型鞘置入引流管方便，脑组织损伤程度与传统脑穿刺针无明显差别。     

颈动脉穿刺溶栓桥接血管内技术治疗急性脑梗死的效果

目的 分析颈动脉穿刺溶栓桥接血管内技术治疗急性前循环供血区梗死的临床疗效。方法 选取2017年1月-2018年12月于本院诊治的急性前循环供血区梗死患者138例,观察组(69例)行颈动脉穿刺溶栓结合血管内技术治疗,对照组(69例)行静脉溶栓结合血管内技术治疗,比较患者的基线资料、诊治、并发症以及死亡情况; 采用改良脑梗死溶栓(Modified thrombolysis incerebral infarction,mTICI)量表评估血管再通情况,美国国立卫生研究院卒中量表(National institutes of health stroke scale,NIHSS)评估神经功能恢复情况,改良Rankin量表(Modifled Rankin scale,mRS)评估患者预后; 分析影响患者预后的危险因素。结果 与对照组比较,观察组发病至血管开通时间缩短,取栓次数减少(P<0.05),观察组血管成功再通率和mTICI分级高,术后30 d内NIHSS评分降低,术后90 d预后良好率高(P<0.05); 入院NIHSS评分≥15分、侧支代偿不良、取栓次数>3次、发病至血管再通时间>250 min均是导致患者预后不良的独立危险因素(P<0.05)。结论 颈动脉穿刺溶栓桥接血管内技术治疗急性脑梗死安全有效,可减少取栓次数,缩短发病至血管开通时间,进而提高血管成功再通率和血管再通程度,促进神经功能恢复,同时患者预后良好,未出现并发症和病死率的明显增加。     

Melatonin alleviates brain injury in mice subjected to cecal ligation and puncture via attenuating inflammation,apoptosis, and oxidative stress: the role of SIRT1 signaling

Sepsis is a systemic inflammatory response to infection that causes severe neurological complications. Previous studies have suggested that melatonin is protective during sepsis. Additionally, silent information regulator 1 (SIRT1) was reported to be beneficial in sepsis. However, the role of SIRT1 signaling in the protective effect of melatonin against septic encephalopathy remains unclear. This study aimed to investigate the role of SIRT1 in the protective effect of melatonin. EX527, a SIRT1 inhibitor, was used to reveal the role of SIRT1 in melatonin's action. Cecal ligation and puncture or sham operation was performed in male C57BL/6J mice. Melatonin was administrated intraperitoneally (30 mg/kg). The survival rate of mice was recorded for the 7‐day period following the sham or CLP operation. The blood–brain barrier (BBB) integrity, brain water content, levels of inflammatory cytokines (TNF‐α, IL‐1β, and HMGB1), and the level of oxidative stress (superoxide dismutase (SOD), catalase (CAT), and malondialdehyde (MDA)) and apoptosis were assessed. The expression of SIRT1, Ac‐FoxO1, Ac‐p53, Ac‐NF‐κB, Bcl‐2, and Bax was detected by Western blot. The results suggested that melatonin improved survival rate, attenuated brain edema and neuronal apoptosis, and preserved BBB integrity. Melatonin decreased the production of TNF‐α, IL‐1β, and HMGB1. Melatonin increased the activity of SOD and CAT and decreased the MDA production. Additionally, melatonin upregulated the expression of SIRT1 and Bcl‐2 and downregulated the expression of Ac‐FoxO1, Ac‐p53, Ac‐NF‐κB, and Bax. However, the protective effects of melatonin were abolished by EX527. In conclusion, our results demonstrate that melatonin attenuates sepsis‐induced brain injury via SIRT1 signaling activation.     

Intrathecal catheterisation after observed accidental dural puncture in labouring women: update of a meta-analysis and a trial-sequential analysis

BackgroundOur meta-analysis from 2013 showed that inserting a catheter intrathecally after an observed accidental dural puncture can reduce the need for epidural blood patch in labouring women requesting epidural analgesia. We updated our conventional meta-analysis and added a trial-sequential analysis (TSA).MethodsA systematic literature search was conducted to identify studies that compared inserting the catheter intrathecally with an epidural catheter re-site or with no intervention. The extracted data were pooled and the risk ratio (RR) and 95% confidence interval (95%CI) for the incidence of post-dural puncture headache (PDPH) was calculated, using the random effects model. A contour-enhanced funnel plot was constructed. A TSA was performed and the cumulative Z score, monitoring and futility boundaries were constructed.ResultsOur search identified 13 studies, reporting on 1653 patients, with a low risk of bias. The RR for the incidence of PDPH was 0.82 (95%CI 0.71 to 0.95) and the RR for the need for epidural blood patch was 0.62 (95%CI 0.49 to 0.79); heterogeneity of both analyses was high. The TSA showed that the monitoring or futility boundaries were not crossed, indicating insufficient data to exclude a type I error of statistical analysis. Contour-enhanced funnel plots were symmetric, suggesting no publication bias.ConclusionsConventional meta-analyses showed for the first time that intrathecal catheterisation can reduce the incidence of PDPH. However, TSA did not corroborate this finding. Despite increasing use in clinical practice there is no firm evidence on which to base a definite conclusion.