吞咽训练配合针刺对慢性神经源性吞咽障碍的影响

目的研究吞咽训练配合针刺对病程超过1个月的慢性期不同病程脑卒中和脑外伤患者吞咽障碍的影响。 方法将符合入选标准的吞咽障碍患者61例分成治疗组（n＝30）和对照组（n＝31）。再根据病程的不同将2组患者分别分成2个亚组：病程1～2个月组（治疗组n＝14,对照组n＝17）和病程&rt;2个月组（治疗组n＝16,对照组n＝14）。治疗组患者在吞咽训练的基础上配合舌咽和颈项部腧穴针刺,每周针刺治疗5 d,4周为1个疗程,共治疗2个疗程,疗程间休息1周;对照组患者只接受吞咽训练,每周5 d,每日1次,每次30 min,连续训练9周。在治疗前后进行疗效评价。 结果治疗结束后,各组的吞咽评分较治疗前均有显著提高(P<0.01),且治疗组的吞咽评分提高更为明显,与对照组比较差异有统计学意义(P<0.01)。分别比较2组患者不同病程亚组间吞咽评分增加值,治疗组2个亚组之间差异无统计学意义（P＞0.05）,对照组之间差异亦无统计学意义（P＞0.05）。2组患者疗效比较,治疗组的治愈率（40.0%）显著高于对照组（16.1%）,差异有统计学意义（P＜0.05）,而总有效率比较,差异无统计学意义（P＞0.05)。 结论吞咽训练配合针刺能够改善脑卒中和脑外伤吞咽障碍患者的吞咽功能,且病程的长短对疗效无影响。     

Strategies for treating and managing testicular cancer

Testicular cancer is a malignant neoplasm of the testis that carries an extremely favourable survival rate with current treatment strategies. This article discusses its aetiology, presentation, risk factors and diagnosis. Management strategies fall into two categories depending on subtype. Both are discussed for early and for late stage disease.     

急性脑卒中重症吞咽障碍患者的康复护理

对150例脑卒中吞咽障碍患者进行针对性康复护理,包括吞咽功能评定、鼻饲、心理护理、吞咽器官训练、直接摄水训练、直接摄食训练。经过治疗和康复护理,患者基本痊愈65.3%,明显好转23.3%, 好转7.3%,无效4.0%。对脑卒中重症吞咽障碍患者尽早进行针对性康复护理有利于患者吞咽功能恢复、降低并发症的发生,缩短了病情,提高了患者的生命质量。     

Racotumomab for treating lung cancer and pediatric refractory malignancies

ABSTRACT

Introduction: Racotumomab (originally known as 1E10 mAb) is an anti-idiotype murine IgG1 directed to membrane glycoconjugates expressed in aggressive solid tumors. It was developed as a mirror image of the idiotype of another antibody against N-glycolyl-containing molecules, such as the NeuGcGM3 ganglioside. After a successful phase II/III study, racotumomab formulated in alum was conditionally approved in Latin American countries as maintenance therapy for advanced non-small cell lung cancer.

Areas covered: This review analyzes the biology of the target antigen, summarizes preclinical studies and discusses clinical trials in adults and the pediatric experience with racotumomab.

Expert opinion: Proper patient selection and combination with chemotherapy, radiotherapy or checkpoint inhibitors appear to be critical issues to maximize the effects of racotumomab vaccination in lung cancer. In a recent phase I clinical trial in children with relapsed or resistant neuroectodermal malignancies, racotumomab was well tolerated and immunogenic, and its evaluation as immunotherapy for high-risk neuroblastoma is warranted.     

Isoflurane therapy for severe refractory status asthmaticus in children

Objective To describe the use of inhaled isoflurane in a series of children with life-threatening asthma.Design Retrospective case series.Setting Pediatric intensive care unit of a tertiary-care children's hospital.Ten children ranging in age from 1 to 16 years with 11 episodes of severe asthma requiring invasive mechanical ventilation in the pediatric intensive care unit over a 5-year period.Results Isoflurane resulted in an improvement in arterial pH and a reduction in partial pressure of arterial carbon dioxide (PaCO₂) in all the 11 instances. This effect was sustained in 10 cases and led to clinical improvement and rapid weaning from mechanical ventilation. One child failed to show sustained response and was placed on veno-venous extracorporeal membrane oxygenation. One child died secondary to anoxic brain injury sustained prior to hospitalization. Hypotension was the major side effect, and occurred in 8 children necessitating vasopressor support.Conclusions Isoflurane improves arterial pH and reduces partial pressure of arterial carbon dioxide in mechanically ventilated children with life-threatening status asthmaticus who are not responsive to conventional management.     

重症脑卒中吞咽障碍26例疗效分析

INTRODUCTION Patients with severe cerebral hemorrhage and cerebral thrombus andserious dysphagia lived on nasal feeding and venous transfu-sion. These patients' quality of life, rehabilitation of paralysis,aphasia is unfavorable due to various complications. Therefore,many patients gave up treatment wearing nasal feeding tube. In thisstudy, we investigated treatment and affecting factors of dysphagia.     

Phase I study of intraperitoneal bevacizumab for treating refractory malignant ascites

ObjectiveThis prospective, dose-escalation phase I study evaluated the safety and efficacy of intraperitoneal bevacizumab in managing refractory malignant ascites and explored the recommended dose of bevacizumab for further study.MethodsPatients with refractory malignant ascites were enrolled. Bevacizumab was intraperitoneal administered weekly at an initial dose of 2.5 mg/kg, with dose escalation to 5 and 7.5 mg/kg performed following the standard “3 + 3” rule. The total duration of treatment was 2 or 3 weeks.ResultsBetween December 2013 and September 2014, 13 patients (2.5 mg/kg, n = 4; 5 mg/kg, n = 3; 7.5 mg/kg, n = 6) with refractory malignant ascites were enrolled. Bevacizumab was well tolerated, and the most common treatment-related adverse events were abdominal pain (5/13), abdominal distension (2/13), and fatigue (2/13). The dose-limiting toxicity at 7.5 mg/kg was grade 3 bowel obstruction (1/13). The maximum tolerated dose (MTD) was not reached. The overall response and disease control rates were 7.7 and 61.5%, respectively.ConclusionsIntraperitoneal bevacizumab safe and well tolerated for treating malignant ascites, and the MTD was not reached at doses of 2.5 to 7.5 mg/kg. Intraperitoneal bevacizumab at 7.5 mg/kg weekly is recommended for further study to verify its anti-tumor activity.Trial registration: Clinical Trials {"type":"clinical-trial","attrs":{"text":"NCT01852409","term_id":"NCT01852409"}}NCT01852409.     

磁源性影像结合伽玛刀治疗难治性癫痫

目的:探讨脑磁源性影像定位癫痫灶后结合伽玛刀放射治疗难治性癫痫的应用价值。方法:8例经磁源性影像定位癫痫灶后,指导伽玛刀放射治疗癫痫灶。结果:采用南京军区总医院的评估标准,随访疗效显示满意3例(37.5%),显著改善3例(37.5%),良好1例(12.5%),疗效差1例(12.5%)。无一例出现伽玛刀放射治疗术后功能障碍。结论:磁源性影像可以无创伤性精确定位癫痫灶,可以用于指导伽玛刀放射治疗癫痫灶。     

Bronchial thermoplasty: a new treatment for severe refractory asthma

Bronchial thermoplasty was recently approved for treating severe refractory asthma that is not well controlled by high-dose inhaled corticosteroids and long-acting bronchodilator therapy. This article reviews its indications, evidence of efficacy, and protocols.     

Barbiturate coma for severe, refractory vasospasm following subarachnoid haemorrhage

Objective: To document the outcome of patients treated with barbiturate coma for severe symptomatic angioplasty-resistant vasospasm. To compare mortality with that predicted by admission APACHE II score, and neurological outcome with that of historical controls treated with barbiturate coma for vasospasm, and with historical controls with delayed ischaemic deficits from vasospasm treated with nimodipine. Design: Cohort study. Setting: Neurosurgical Intensive Care Unit of tertiary referral university teaching hospital. Patients: Eleven (6.7 %) of 164 consecutive patients with aneurysmal SAH managed according to our protocol who were treated with thiopentone-induced burst suppression coma for severe symptomatic, angioplasty-resistant vasospasm. Interventions: Chart, database and literature review. Measurements and results: All 11 patients survived to hospital discharge (mortality 0 %) compared with first-day APACHE II predicted mortality of 30.6 % (p = 0.15). Outcome at 6 months was: good recovery 8/11 (72.7 %), moderate disability 2/11 (18.2 %), vegetative survival 1/11 (9.1 %). Ten of 11 (90.9 %) had a good neurological outcome compared with 50.6 % of historical controls with delayed ischaemic deficit from vasospasm (odds ratio 9.78, 95 % confidence interval 1.24–77.0, p = 0.02), and 0 % of previously reported patients treated with barbiturate coma for vasospasm (p < 0.01). Conclusion: Our results are better than previously published outcomes and suggest formal evaluation of barbiturate coma in the treatment of severe resistant symptomatic vasospasm following SAH is warranted. Received: 9 September 1998 Accepted: 3 February 1999     

低频脉冲电刺激结合冰刺激治疗脑卒中后吞咽障碍

目的:探讨低频脉冲电刺激结合冰刺激对脑卒中患者吞咽障碍的治疗效果。方法:脑卒中后吞咽障碍患者60例,随机分为观察组和对照组各30例,2组均给予常规吞咽训练,观察组加用咽部冰刺激及低频电疗。评定临床疗效及平均治疗时间。结果:治疗4周后,观察组有效率明显高于对照组,且平均治疗时间明显短于对照组(均P<0.05)。结论:低频电刺激及咽部冰刺激联合治疗对改善脑卒中后吞咽功能障碍具有显著疗效。     

A videofluoroscopy chair for the evaluation of dysphagia in patients with severe neuromotor disease

Due to the difficulties encountered in positioning severely neurologically impaired individuals for videofluoroscopic studies, the Rehab Tech Video FluoroChair was developed. The purpose of the chair is to provide the severely disabled patient with safe, stable postural support in an upright position for videofluoroscopic studies, with anterior-posterior, lateral, and rotational views easily performed. The chair features a removable headrest, a full back support, armrests, lateral truncal supports, and a patented base which is clamped to the footboard of the radiology table and allows for 200 degrees rotation of the patient. Two case studies illustrate the practical use and versatility of the Rehab Tech Video FluoroChair.     

鼠神经生长因子治疗鼻咽癌放疗后吞咽困难的疗效观察

目的探讨鼠神经生长因子治疗鼻咽癌放疗后吞咽困难的疗效及安全性。 方法采用随机数字表法将58例鼻咽癌放疗后出现吞咽困难患者分成对照组及观察组,对照组给予常规治疗,观察组则在常规治疗基础上辅以鼠神经生长因子肌肉注射,每天注射1次,持续治疗4周。于治疗前、治疗4周时采用洼田饮水试验、电视透视吞咽功能检查（VFSS）及简版世界卫生组织生存质量测定量表（WHOQOL-BREF）对2组患者吞咽功能、生活质量进行评定。 结果经4周治疗后,发现观察组患者饮水试验分级改善值［（1.0±0.8）级］明显优于对照组（P<0.05）;观察组患者在吞咽流质食物时其Rosenbek评分改善值［（1.8±3.1）分］亦显著优于对照组（P<0.05）;观察组患者在吞咽流质、半流质、固体食物时其VDS评分改善值分别为（7.8±7.1）分、（6.2±6.6）分、（9.0±8.7）分,以上指标与对照组间差异均具有统计学意义（P<0.05）;另外观察组患者在吞咽流质、半流质、固体食物时其口腔通过时间(OTT)、咽部通过时间(PTT)及咽部延迟时间(PDT)均较对照组有不同程度改善,并且观察组患者生活质量评分亦显著优于对照组(P<0.05)。 结论鼠神经生长因子治疗放射性后组颅神经损伤具有较好疗效,且治疗过程中未发现与药物相关的明显不良反应。     

Long-term opioid analgesic therapy for severe refractory lumbar spine pain.

OBJECTIVES: To determine the effect of opioid analgesics on pain and function in patients with severe, refractory low back pain and to see if any benefits were sustained long term. DESIGN: Longitudinal evaluation was conducted in two stages. Stage I was an opioid trial, and stage II was long-term treatment. Treated patients were compared with dropouts and trial failures. OUTCOME MEASURES: Pain was measured by the Numerical Rating Scale (NRS) and function was measured by the Oswestry Low Back Disability Score (OSW). Outcomes were evaluated by patient questionnaire and therefore not subject to investigator bias. SETTING: Private office practice. METHODS: Patients were treated for 6-12 weeks with a long-acting or sustained-release opioid. Those who improved significantly were treated long term. The treatment group was compared with dropouts and failures. RESULTS: Thirty-three patients underwent opioid trial. Treatment was discontinued because of intolerable side effects in 5 patients. In the remaining 28, mean NRS improved from 8.6 to 5.9 (p < 0.001), and mean OSW improved from 64 to 54 (p < 0.001). There were 21 patients treated long term (mean, 32 months). NRS improved from 8.45 to 4.90 (p < 0.001), and OSW improved from 64 to 50 (p < 0.001). Two patients returned to work. The changes in pain and function in the treatment group were significantly better than the comparison group. There was no drug diversion, addictive behavior, or organ toxicity. Doses remained stable. CONCLUSION: Long-term opioid analgesic therapy is reasonable treatment for some well-selected patients with refractory low back pain who have failed all other forms of care.     

湿润烧伤膏治疗葡萄球菌烫伤样皮肤综合征的应用

目的：探讨湿润烧伤膏治疗葡萄球菌烫伤样皮肤综合征的效果。方法：选择我科96例葡萄球菌烫伤样皮肤综合征患儿,随机分为对照组41例和观察组55例。两组基础治疗相同,运用相同抗菌药物静脉输入,对照组采用百多邦软膏外涂破损皮肤,观察组采用湿润烧伤膏外涂破损皮肤。观察两组治疗效果。结果：观察组治疗总有效率98.2%,对照组治疗总有效率63.4%。两组比较差异有显著性意义（P〈0.01）。结论：湿润烧伤膏治疗葡萄球菌烫伤样皮肤综合征的效果明显,能减轻患儿症状,有利于促进疾病早日康复。     

Surgical lung volume reduction--an option for treating severe pulmonary emphysema

Lung volume reduction surgery is a novel operative concept, which may be applied in certain patients, who are severely handicapped by advanced pulmonary emphysema and suffer from dyspnea at minimal exercise despite optimal medical therapy. The most destroyed lung parts are resected by video-assisted thoracoscopy. This type of surgery has a surprisingly low morbidity and mortality at specialized centers. It improves symptoms by ameliorating lung function and exercise tolerance. Maximal functional improvement is observed and lung function starts to decline slowly within one to two years thereafter.