风池配合廉泉穴针灸治疗脑卒中后假性延髓性麻痹32例

目的观察风池配合廉泉针灸治疗假性延髓性麻痹的疗效。方法62例假性延髓性麻痹患者分为针灸治疗组32例和内科对照组30例,内科组采用药物治疗加鼻饲饮食、静脉营养支持疗法,针灸组在此基础上采用风池配合廉泉针灸治疗,3个疗程后比较2组患者的疗效。结果针灸组和内科组的总有效率分别为90.6%和73.3%,治疗组优于对照组(P<0.05)。结论风池配合廉泉针灸治疗可提高脑卒中后假性延髓性麻痹的疗效。     

针刺配合康复训练治疗假性延髓性麻痹30例观察

目的探讨针刺并康复训练对假性延髓性麻痹功能恢复的影响。方法60例假性延髓性麻痹患者随机分为两组。治疗组30例采用常规治疗加针灸、康复训练治疗;对照组30例采用常规治疗。结果两组治疗后功能均有改善,但治疗组临床治愈率为83．3％,对照组30％．两组比较有显著性差异。结论针灸并康复训练可显著提高假性延髓性麻痹的疗效。     

联合静注弥可保治疗脑梗死后假性延髓性麻痹疗效观察

目的 观察联合静注弥可保治疗脑梗死后假性延髓性麻痹的临床疗效.方法 将61例脑梗死后并发假性延髓性麻痹的患者随机分成治疗组31例和对照组30例,2组常规使用抗血小板、改善微循环、神经营养及综合康复治疗;治疗组在常规治疗的基础上静脉注射弥可保1 000 μg/d.2组治疗前和治疗后3周分别进行欧洲卒中量表评分（ESS）和吞咽功能评估.结果 治疗组ESS及吞咽困难恢复率较对照组显著增加（68.11±11.98 vs 59.45±12.02,81.10% vs 73.33%,P〈0.05）.结论 弥可保可能为脑梗死后并发假性延髓性麻痹治疗中有效的药物之一.     

中西医结合治疗假性延髓性麻痹综合征24例疗效观察

目的 观察中西医结合治疗假性延髓性麻痹的疗效是否优于纯西药组。方法 中西医结合组为观察组,西药组为对照组,观察组应用中药汤剂口服,胞二磷胆碱针1.0g,维脑路通针0.8g加入5％葡萄糖注射液250ml中静滴,14d为一疗程,开始用药1月后进行疗效对照。结果 观察组总有效率为95.8％,对照组总有效率为62.5％,两组比较有显著差异(P<0.05)。结论 中西医结合治疗假性延髓性麻痹疗效优于纯西药组。     

针刺配合吞咽治疗仪治疗脑卒中延髓性麻痹的临床效果

目的探讨针刺配合吞咽治疗仪对脑卒中延髓性麻痹的治疗效果。方法选取我院2013-06—2014-06收治的72例脑卒中延髓性麻痹患者为研究对象,按照随机数字表法分为对照组和观察组各36例,对照组采取吞咽治疗仪治疗,观察组采取针灸联合吞咽治疗仪治疗,比较2组临床效果。结果观察组治愈24例,有效10例,无效2例,总有效率为94.4%;对照组治愈14例,有效13例,无效9例,总有效率75.0%,2组比较差异有统计学意义(P0.05);治疗后观察组吞咽障碍评分明显优于对照组,2组比较差异有统计学意义(P0.05)。结论针灸联合吞咽治疗仪在治疗脑卒中延髓性麻痹患者方面效果明显,能有效改善患者吞咽功能障碍,值得临床推广应用。     

吞咽治疗仪联合使用针灸治疗脑卒中后假性球麻痹所致吞咽困难的疗效观察

目的 观察吞咽治疗仪联合针灸治疗脑卒中后假性球麻痹所致吞咽困难障碍的疗效。方法 将180例患者随机分为3组,采用吞咽治疗仪和针灸治疗相结合治疗的患者作为治疗组,对照组分为吞咽治疗仪治疗、针灸对照组,并将3组患者治疗后疗效进行评估及比较。结果 治疗组与对照组临床疗效比较,治疗组总有效率96.7%,吞咽治疗仪组总有效率86.7%,针灸治疗组总有效率88.3%,治疗组总有效率高于对照组(P<0.05),且3组治疗后洼田饮水实验评分均有改善,而以治疗组改善为优。结论 3组均能改善吞咽障碍,但吞咽治疗仪联合针灸治疗组的疗效优于单用吞咽治疗仪组和单用针灸治疗组。     

多靶点综合治疗脑梗死后延髓性麻痹疗效观察

目的探讨多靶点综合治疗脑梗死后延髓性麻痹患者的疗效。方法选择我科2014-03—2016-04收治的脑梗死延髓性麻痹患者196例,随机分为对照组、康复组、中药组、康复加中药组,于治疗前与治疗后30d参照藤氏吞咽障碍7级评价法进行评分测定。结果治疗后各组吞咽障碍评分均优于治疗前,差异有统计学意义(P0.05);中药组疗效优于康复组,康复加中药组疗效均优于其余3组。结论多靶点综合治疗脑梗死后延髓性麻痹患者疗效显著,值得临床推广应用。     

小剂量盐酸苯海索辅助治疗缺血性脑血管病假性延髓麻痹患者吞咽障碍临床分析

目的探讨小剂量苯海索辅助治疗缺血性脑血管病假性延髓麻痹患者吞咽障碍的临床疗效,以提高患者生活质量。方法对本科2005年至2012年收治的186例脑血管病假性延髓麻痹患者分为治疗组96例和对照组90例,遵照按脑卒中指南常规用药,治疗组在对照组治疗的基础上加用小剂量苯海索辅助治疗,治疗前后对患者进行标准吞咽功能评估(SSA)和洼田氏饮水试验评定。结果治疗组患者应用小剂量苯海索辅助治疗后有明显疗效,与对照组疗效差异有统计学意义(p<0.05)。结论小剂量苯海索辅助治疗能够更大程度的提高患者的吞咽功能,能改善患者的进食状况,提高患者的生活质量。     

咽部冷刺激治疗脑卒中后吞咽困难的临床观察

脑卒中是老年人的常见病和多发病 ,在急性脑卒中约 5 1%的患者发病后常伴有吞咽障碍 ,主要是吞咽、迷走和舌下神经的核性和核下性损害产生的真性延髓性麻痹和 /或双侧皮质脑干束损害产生的假性延髓性麻痹。我院对 2 80例延髓性麻痹患者应用咽部冷刺激治疗后 ,临床疗效显著。1　临床资料我科自 2 0 0 1-0 3～ 2 0 0 3-0 9使用咽部冷刺激方法治疗因卒中后致吞咽困难患者共计 2 80例 ,均经头颅CT证实 ,其中脑出血 81例 ,脑梗死 199例 ,男 2 2 6例 ,女 5 4例 ,年龄 43～ 77岁 ,使用咽部冷刺激治疗假性延髓性麻痹患者 2 40人当中有效率达99 % ,…     

哈伯因治疗卒中后假性球麻痹的临床研究

目前尚无针对假性球麻痹的特殊治疗方法。我们在使用哈伯因治疗一例血管性痴呆患者时，发现其假性麻痹的症状亦得到改善，受此启发，我们将哈伯因试用于卒中后假性球麻痹的治疗，取得良好疗效，总结报道如下：1资料与方法1．1一般资料治疗组38例，男29例，女9例，年龄46~84岁，平均64．2岁。对照组24例，男17例，女7例。年龄42~83岁，平均62岁。两组病人均有中风史并经CT确诊，部分病后经历MRI确诊，两组病例既往史及伴发疾病积分相似。两组共62例，占同期脑卒中病人的8．6％。1．2CT检查结果治疗组，双侧多发性腔隙性脑梗死18例，双侧单…     

Lupus anticoagulant testing with optical end point automation

The dilute Russell viper venom time and kaolin clotting time (KCT) are very sensitive screening tests for lupus anticoagulant activity. However, due to the high turbidity of the kaolin reagent it is difficult to accommodate the KCT on the optical end point automation of today. We evaluated five recently reported screening tests (the silica clotting time, the Textarin/Ecarin ratio, the Taipan venom time, the factor V ratio, and a kaolin clotting time using low-turbidity kaolin) as potential alternatives to the KCT. The sensitivity and specificity of the silica clotting time compared well to KCT, detecting 10/12 KCT positive samples and showing equal sensitivity to dilution of lupus positive plasma. In addition, the silica clotting time allows for a confirmatory phospholipid correction procedure. False-positive results were seen in 2 of 15 warfarinised samples. A second assay utilising the ratio of extrinsic/intrinsic factor V assays was not affected by either warfarin or heparin. This assay also gave positive results with 3 of 23 samples previously screened as lupus negative but exhibiting anticardiolipin positivity. It was therefore concluded that a combination of the silica clotting time and dilute Russell viper venom time met the requirements of lupus sensitivity with demonstration of phospholipid dependence and optical end point compatibility. The factor V ratio is a useful second-line screen for both anticoagulated patients and anticardiolipin antibody-positive samples.     

Maltreatment of children with disabilities: the breaking point

The maltreatment of children with disabilities is a serious public health issue. Children with disabilities are 3 to 4 times more likely to be abused or neglected than are their typically developing peers. When maltreated, they are more likely to be seriously injured or harmed. As alarming as these numbers are, they likely underestimate the problem. Children with disabilities encounter all 4 types of abuse: physical, sexual, neglect, and emotional. Here, the author discusses risk factors associated with the maltreatment of children with disabilities, which, as expected, include both child and family factors.     

Age-related mitochondrial DNA point mutations in patients with mitochondrial myopathy

Mutations in the control region (D-loop) of mitochondrial DNA (mtDNA) have been described in normal old individuals and it is suggested that they originated from oxidative damage. Respiratory chain defects may lead to increased free radical generation, increased susceptibility to oxidative damage and further increased accumulation of age-related mutations. The objective of this study was to verify whether patients with a mitochondrial disease are more predisposed to accumulate the A189G and T408A mutations in the D-loop and confirm their age-associated nature. We evaluated the presence and levels of heteroplasmy of these two mutations in muscle DNA of 52 individuals with different ages (21 age-matched controls and 31 patients with single or multiple mtDNA deletions). The frequency of both mutations was significantly increased with age, but no differences were observed comparing the group of patients with their age-matched controls. We could not observe correlation of levels of heteroplasmy with age. Our results confirm the age-related nature of the A189G and T408A mutations in the D-loop in controls and patients with mitochondrial disease, but do not suggest that patients are more predisposed to the development of age-related point mutations.     

Refining the phenotype associated with MEF2C point mutations

Up to now, only five-point mutations in the MEF2C gene have been described in patients with severe mental retardation with absent speech, limited walking abilities, epilepsy, and lack of gross malformations. In brain, MEF2C is essential for early neurogenesis, neuronal migration, and differentiation. Here, we present a new patient with severe mental retardation, epilepsy, and hand stereotypies associated with a novel MEF2C frameshift mutation c.457delA. The purpose of this work was to clarify criteria for the selection of patients with severe intellectual disability to screen for deficiency in the MEF2C gene. By combining the clinical data of all patients with MEF2C point mutations published so far with the phenotype of our patient, a targeted search for MEF2C mutations could be applied to patients with a severe intellectual deficiency associated with absence of language and hypotonia, strabismus, and epilepsy (started after 6 months, often well controlled by valproate).     

Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point: comparison with the Hoku hand point sympathetic effects

Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point were evaluated by thermography in 19 normal subjects under the same procedure used in a previous study using the Hoku hand point. A generalized long-lasting warming (sympathetic inhibition) effect was observed under manual and electrical acupuncture of the Tsusanli point. In addition, a segmentally related short-lasting cooling (sympathetic activation) effect occurred with Tsusanli electrical acupuncture only. The warming effect is consistent with the results of the Hoku study and appears to be a central sympathetic inhibition evoked by acupuncture. The cooling effect was segmentally related to the acupuncture site in both studies. This cooling effect most likely reflects a segmental activation of vasomotor spinal reflexes and not a general emotional arousal. These sympathetic mechanisms may be functionally correlated with central and peripheral mechanisms of acupuncture analgesia.     

A point mutation associated with a severe phenotype of neurofibromatosis 2

Neurofibromatosis 2 (NF2) is an autosomal dominant disease characterized by bilateral vestibular schwannomas and other nonmalignant tumors of the brain, spinal cord, and peripheral nerves. Although the average age of onset of NF2 is 20 years, some individuals may become symptomatic in childhood. We studied 5 unrelated NF2 patients who became symptomatic before age 13. All 5 had multiple tumors in addition to vestibular schwannoma, and none had a positive family history. Sequence analysis of the NF2 gene revealed identical nonsense mutation of exon 6 in 3 patients. Because this mutation destroys a restriction site, genomic DNA from the 2 other children was directly tested for this change and identical alterations were detected. Although the work of our laboratory and others has not, in general, detected identical mutations in unrelated patients, this mutation seems to occur particularly frequently in the pediatric population and thus may be associated with an especially severe phenotype. Restriction analysis in children with NF2 may be a cost effective way of identifying their mutation. Further work is needed to characterize the effects of this change on the NF2 protein product and its relationship to this severe phenotype.     

MELAS syndrome in a patient with a point mutation in MTTS1

Background, Objective and Methods –  We describe a female patient with a mitochondrial encephalopathy, lactic acidosis and stroke-like episodes syndrome. As a child, she developed epilepsy and stroke-like episodes giving cognitive impairment and ataxia but no hearing impairment. At the age of 44 years, she suffered a cerebral sinus thrombosis which was warfarin treated. One month later, she developed an episode of severe acidosis associated with encephalopathy and myelopathy.
Results –  She was found to harbour a 7512T>C mutation in the mitochondrial encoded tRNA^Ser(UCN) gene ( MTTS1 ). The mutation load was 91% in muscle and 24% in blood. Enzyme histochemical analysis of the muscle tissue showed numerous cytochrome c oxidase (COX)-negative fibres. Restriction fragment length polymorphism (RFLP) analysis of single muscle fibres showed significantly higher level (median 97%, range: 94–99%) of the mutation in the COX-negative fibres compared with COX-positive fibres (median 36%, range: 12–91%), demonstrating the pathogenic effect of the mutation. Different levels of heteroplasmy (range 34–61%) were detected in hair shafts analysed by RFLP.
Conclusion –  This case adds to the spectrum of clinical presentations, i.e. sinus thrombosis, in patients having MTTS1 mutations.     

MELAS with the mitochondrial DNA 3243 point mutation: a neuropathological study

We performed a neuropathological examination of the central nervous system from seven autopsied patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Five of the seven cases were confirmed to have the mitochondrial DNA (mtDNA) 3243 point mutation. In addition to the changes reported previously, diffuse atrophy of the cerebral and cerebellar cortices, diffuse gliosis of cerebral and cerebellar white matter, and cactus formation of Purkinje cells were observed. Electron microscopy revealed accumulation of mitochondria in the cactus formations. These lesions are common in MELAS with the mtDNA 3243 point mutation, but cannot be explained solely by mitochondrial angiopathy, and suggest that intrinsic mitochondrial malfunction contributes to neuronal damage in MELAS pathology. Moreover, the pathological changes observed in the cerebellum suggest that cerebellar function should be evaluated more carefully at the clinical level. Received: 3 December 1998 / Accepted: 21 April 1999