卒中后痉挛状态与运动功能缺损和活动受限的关系

对于急性卒中后形成痉挛状态的患者数量及其与残疾的关系还没有一致的意见。Sommerfeld等对痉挛状态的范围及其与运动功能缺损和活动受限的关系进行了研究。 作者对95例首次卒中患者在发病早期(平均5.4 d)和卒中后3个月时进行了检查,内容包括改良Ash-Worth量表(评价痉挛状态)、自诉的肌强直、腱反射、Birgitta Lindmark运动行为表现、9孔针试验(评价手灵巧度)、Rivermead灵活性指数、起立行走试验和Barthel指数。95例患者在卒中3个月后,64例轻偏瘫,18例存     

透穴针刺联合Bobath技术治疗脑卒中后偏瘫肢体痉挛的临床疗效观察

目的探讨透穴针刺联合Bobath技术治疗脑卒中后偏瘫肢体痉挛的临床疗效。方法选取我院收治的88例卒中后偏瘫肢体痉挛病人,随机分为对照组与治疗组,各44例。两组均予内科基础及对症处理,对照组予Bobath技术疗法,治疗组在上述基础上予透穴针刺,以4周为1个疗程,两组均治疗3个疗程。使用美国国立卫生研究院卒中量表(NIHSS)评估神经缺损功能、改良Ashworth痉挛量表(MAS)评估肢体痉挛状况、简化Fugl-Meyer量表(FMA)量表评估肢体运动功能、改良Barthel指数量表(MBI)评估日常生活能力,比较两组临床疗效。结果与治疗前比较,两组治疗后4周、8周、12周NIHSS评分降低(P 0.05),上肢、下肢MAS及FMA评分均降低(P 0.05),MBI评分降低(P 0.05);与同时间对照组比较,治疗组治疗后4周、8周、12周NIHSS评分较低(P0.01),上肢、下肢MAS及FMA评分均较低(P 0.05),MBI评分较低(P 0.05)。治疗组总有效率高于对照组(P 0.05)。结论透穴针刺联合Bobath技术可显著改善脑卒中病人偏瘫肢体的痉挛状态。     

克痉方湿热敷治疗脑卒中痉挛性偏瘫的疗效观察

目的观察克痉方湿热敷治疗脑卒中痉挛性偏瘫的临床疗效。方法将80例脑卒中痉挛性偏瘫患者随机分为治疗组和对照组各40例,治疗组在常规治疗的基础上采用克痉方湿热敷治疗,对照组单纯采用神经内科常规治疗,治疗30d采用Ashmorth痉挛量表(MAS)评定肢体痉挛状态和改良的Barthel指数评定肢体运动功能水平、日常生活能力。结果治疗30d后两组Ashmorth痉挛量表评分比较有显著差异,治疗组与对照组相比差异均有统计学意义,治疗30d后治疗组Ashmorth痉挛量表评分、Barthel指数评分均明显高于对照组。结论克痉方湿热敷可有效缓解脑卒中偏瘫的痉挛状态。     

中医推拿结合现代康复对老年脑卒中患者痉挛状态、肢体运动功能及生活质量的影响

目的探讨中医推拿结合现代康复对老年脑卒中患者痉挛状态、肢体运动功能及生活质量的影响。方法 80例老年脑卒中偏瘫痉挛期患者按随机数字表法分为对照组和研究组,每组40例。对照组应用现代康复治疗,研究组在此基础上联合中医推拿治疗,疗程均为1个月。观察并对比两组的临床疗效,治疗前后采用改良Ashworth量表、Fugl-Meyer量表、神经功能缺损程度评分量表(NDS)评价患者的痉挛状态、肢体运动功能和神经功能,采用日常生活能力(ADL)量表评价患者的生活质量。结果研究组治疗后的总有效率(87. 50%)高于对照组(62. 50%)(P0. 05)。治疗后两组改良Ashworth量表分级均显著改善,且研究组优于对照组(P0. 05);两组Fugl-Meyer量表评分均显著升高,研究组高于对照组(P0. 05)。研究组ADL评分优良率为62. 50%,显著高于对照组的37. 50%(P0. 05)。治疗后两组NDS评分均显著降低,研究组NDS评分低于对照组(P0. 05)。结论中医推拿结合现代康复对老年脑卒中患者痉挛状态和神经功能有明显的改善作用,同时能提高患者肢体运动功能、提升生活质量。     

银丹心脑通软胶囊联合拜阿司匹林治疗急性缺血性卒中的临床疗效观察

目的：观察银丹心脑通软胶囊联合拜阿司匹林治疗急性缺血性卒中的临床疗效。方法：100例患者随机分为治疗组和对照组,治疗组70例口服银丹心脑通软胶囊和拜阿司匹林片;对照组30例仅口服拜阿司匹林片,疗程均为30d．比较治疗前后患者神经功能缺损评分量表（SSS）、生活能力状态量表、Barthel指数、改良Rinkin评分。结果：治疗组SSS、生活能力状态量表、Barthel指数、改良Rinkin评分4项疗效指标均优于对照组。结论：银丹心脑通软胶囊对急性缺血性卒中有显著疗效,值得临床推广使用。     

电针外关、外劳宫穴联合康复训练治疗缺血性脑卒中后手指屈曲痉挛的疗效观察

目的 观察电针外关、外劳宫穴联合康复训练对缺血性脑卒中手指屈曲痉挛的临床疗效。方法 选取2019年10月—2020年12月在常熟市第一人民医院康复科就诊的缺血性脑卒中后手指屈曲挛缩的病人50例,采用随机数字表法分为观察组与对照组,每组25例,观察组取患侧外关、外劳宫穴接电针治疗,配合手三里、曲池等穴位针刺,针刺结束行康复训练,对照组单纯行康复训练。治疗前、治疗1个疗程及3个疗程后分别对两组病人进行改良Ashworth量表、Fugl-Meyer评价量表(FMA)、改良Barthel指数量表(ADL)评分。结果 两组治疗1个疗程及治疗3个疗程后改良Ashworth评分、FMA评分、ADL评分均较治疗前改善(P<0.01),且观察组治疗1个疗程及治疗3个疗程后改良Ashworth评分、FMA评分、ADL评分均优于对照组(P<0.05)。结论 电针外关、外劳宫穴结合康复训练治疗缺血性脑卒中后手指屈曲痉挛,可有效减轻缺血性脑卒中后手痉挛,改善手功能,提高日常生活能力。     

Botox注射剂治疗卒中痉挛状态有效

17％～30％的卒中存活者存在致残性痉挛状态，可导致功能受限、不适和疼痛。上肢痉挛状态可影响患者的活动、舒适及其穿衣、洗漱或自行进餐和进行其他日常生活活动的能力。在美国费城召开的2005年美国物理医学与康复（American Association of Physical Medicine and Rehabilitation,AAPM＆R）协会年会上，印地安那州大学医学院Brashear等报道的一项研究表明，卒中后1年反复应用A型肉毒杆菌毒素（botulinum toxin type A，BoNTA）治疗可改善肌张力并减轻上肢疼痛，患者自己穿衣和整理个人卫生更加容易。     

Botox注射剂治疗卒中痉挛状态有效

17%～30%的卒中存活者存在致残性痉挛状态,可导致功能受限、不适和疼痛。上肢痉挛状态可影响患者的活动、舒适及其穿衣、洗漱或自行进餐和进行其他日常生活活动的能力。在美国费城召开的2005年美国物理医学与康复(AmericanAssociationofPhysicalMedicineandRehabilitation,AAPM&R)协会年会上,印地安那州大学医学院Brashear等报道的一项研究表明,卒中后1年反复应用A型肉毒杆菌毒素(botulinumtox intypeA,BoNTA)治疗可改善肌张力并减轻上肢疼痛,患者自己穿衣和整理个人卫生更加容易。这是评价BoNTA反复治疗卒中后痉挛状态的第1项长期…     

醒脑通督针法联合养血荣筋丸干预卒中后痉挛状态的疗效评价

目的评价醒脑通督针法联合养血荣筋丸治疗卒中后痉挛状态的疗效。方法将80例缺血性中风后痉挛性偏瘫病人,按照随机数字表法分为对照组和治疗组,各40例。两组均以西医常规治疗为基础,对照组采用传统针刺方法联合乙派立松口服治疗,治疗组采用醒脑通督针法联合养血荣筋丸治疗,以改良痉挛评定Ashworth痉挛评定量表(MAS)、日常生活活动能力量表(ADL)Barthel指数、简式Fugl-Meyer评价法(FMA)等项目为观察指标,观察其临床疗效。结果治疗组和对照组病人均可改善痉挛状态,但治疗组较对照组疗效显著,差异有统计学意义(P0.05)。结论醒脑通督针法联合养血荣筋丸能有效改善中风后偏瘫痉挛状态,改善日常生活能力。     

上肢康复机器人辅助训练对卒中后上肢痉挛伴肩关节半脱位患者运动功能的作用

目的探讨上肢康复机器人辅助训练对卒中后上肢痉挛伴肩关节半脱位患者运动功能的康复作用。方法回顾性纳入2015年3月至12月卒中后上肢痉挛伴肩关节半脱位的患者40例,采用数字表法将患者随机分为机器人组和对照组各20例。对照组患者采用常规康复治疗,40 min/次。机器人组在常规康复的基础上增加上肢康复机器人训练,30 min/次。两组患者训练均为2次/d,10次/周。均于治疗前及治疗后6周进行运动功能及日常生活能力评定。通过测量患者坐位患肩肩峰至肱骨头间距(AHI)评定肩关节半脱位距离;采用改良Ashworth量表(MAS)评定痉挛程度;采用简式Fugl-Meyer运动功能评分(FMA)评价上肢运动功能;改良Barthel指数(MBI)量表评价日常生活能力。结果治疗前两组患者基线指标比较,差异无统计学意义(P0.05)。治疗后6周,机器人组的AHI值从治疗前的(22.7±1.2)mm降至(10.6±1.2)mm;MAS评分从治疗前的(2.01±0.28)分降至(0.59±0.23)分,差异均有统计学意义(均P0.05);FMA从治疗前的(30±9)分升至(54±8)分;MBI从治疗前的(44±8)分升至(83±10)分;差异均有统计学意义(均P0.05)。治疗后机器人组的AHI值及MAS、FMA和MBI评分明显优于对照组(t值分别为-4.009、-6.846,2.938和5.548,均P0.05)。结论上肢康复机器人辅助训练能够改善卒中后患者的上肢痉挛伴肩关节半脱位状态,促进患者运动功能和日常生活能力的提高。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.