An outline of the current orthopaedic management of haemophilic disease of the upper limb

There remains a relative paucity in the literature regarding upper limb manifestations of haemophilic arthropathy. Haemophilia has a wide range of clinical manifestations, often presenting with orthopaedic complications. These arise from multiple haemarthroses which exact a cumulative toll on the fabric of the joints. Although the lower limbs are predominantly affected due to their load-bearing nature, upper limb disease is common. This arises from the mechanical demands on the upper limb as the elbow and shoulder become partially weight bearing on use of walking aids such as elbow crutches.     

糖尿病上肢动脉病变并指端坏疽1例及文献复习

<正>目前2型糖尿病(type 2 diabetes mellitus,T2DM)患病率越来越高,2010年中国慢性病监测糖尿病专题调查中国成人糖尿病患病率为11.6%,糖尿病前期人群达50.1%[1]。大血管并发症包括心脑血管和周围动脉病变(peripheral atterial disease,PAD)是糖尿病患者致死和致残的主要病因。PAD、周围神经病变和继发感染是糖尿病患者发生肢端坏     

基于运动想象的脑机接口康复训练对脑卒中患者上肢运动功能的影响

目的探讨基于运动想象的脑机接口康复训练对脑卒中患者上肢运动功能的影响。方法将14例有严重上肢运动功能障碍的老年脑卒中患者随机分为BCI组（7例）和对照组（7例）,均接受常规的康复治疗和药物治疗,BCI组进行为期2m,隔天1．5h的BCI的康复训练。治疗期间BCI组患者在线的运动想象的准确率被记录,在治疗前,治疗1m后,治疗2m后,以及治疗结束一个月随访时分别对两组患者上肢运动功能进行Fugl--Meyermotoras—sessment（FMA）和上肢动作研究测试（action research arm test,ARAT）的评定。结果经过2m的BCI康复训练,BCI组患者在线的运动想象准确率有显著提高fP〈0．05）;治疗结束后lm随访两组患者FMA和ARAT评分较治疗前均有提高,BCI组较对照组提高更明显,有统计学差异（P〈0．05）。结论基于运动想象的BCI康复训练可增强脑卒中患者运动想象的能力,进而提高脑卒中患者上肢的运动功能。     

Effects of brain-computer interface training on upper limb function recovery in stroke patients: A protocol for systematic review and meta-analysis

Background:In recent years, with the development of medical technology and the increase of inter-disciplinary cooperation technology, new methods in the field of artificial intelligence medicine emerge in an endless stream. Brain-computer interface (BCI), as a frontier technology of multidisciplinary integration, has been widely used in various fields. Studies have shown that BCI-assisted training can improve upper limb function in stroke patients, but its effect is still controversial and lacks evidence-based evidence, which requires further exploration and confirmation. Therefore, the main purpose of this paper is to systematically evaluate the efficacy of different BCI-assisted training on upper limb function recovery in stroke patients, to provide a reference for the application of BCI-assisted technology in stroke rehabilitation.Methods:We will search PubMed, Web of Science, The Cochrane Library, Chinese National Knowledge Infrastructure Database, Wanfang Data, Weipu Electronics, and other databases (from the establishment to February 2021) for full text in Chinese and English. Randomized controlled trials were collected to examine the effect of BCI-assisted training on upper limb functional recovery in stroke patients. We will consider inclusion, select high-quality articles for data extraction and analysis, and summarize the intervention effect of BCI-assisted training on the upper limb function of stroke patients. Two reviewers will screen titles, abstracts, and full texts independently according to inclusion criteria; Data extraction and risk of bias assessment were performed in the included studies. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X8 will be applied in selecting the study, Review Manager 5.3 will be applied in analyzing and synthesizing.Results:The results will provide evidence for judging whether BCI is effective and safe in improving upper limb function in patients with stroke.Conclusion:Our study will provide reliable evidence for the effect of BCI technology on the improvement of upper limb function in stroke patients.PROSPERO registration number:CRD42021250378.     

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。     

Electrocupuncture combined rehabilitation therapy for upper limb spasticity after stroke: A protocol for systematic review and meta-analysis

Background:The purpose of this study was to evaluate the effectiveness and safety of electroacupuncture combined with rehabilitation in the treatment of spasticity after stroke.Methods:To collect relevant literature, we will research following databases: Medicine, PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Database, Chongqing VIP Chinese Science and Technology Periodicals Database and China Biomedical Database; the time is from its creation to May 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register and conference papers. Two reviewers will independently complete the literature screen and data extraction, and quality assessment of the included studies will be independently completed by two other researchers. The primary outcomes included the Modified Ashworth scale (MAS) and the simplified Fugl-Meyer Assessment scale (SFMA). The Modified Barthel Index (MBI), the China Stroke Scale (CSS), and adverse reactions as secondary outcomes were assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to assess the quality of evidence.Results:This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of electroacupuncture combined with rehabilitation therapy in the treatment of upper limb spasticity after stroke, providing a reference for the safe and effective treatment of upper limb spasm after stroke.Conclusion:This study provides evidence that electroacupuncture combined with rehabilitation therapy is effective.Ethics and dissemination:The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.Systematic review registration:INPLASY202160005.     

虚拟现实技术结合综合疗养康复对脑卒中患者上肢功能恢复的临床研究

目的观察虚拟现实(VR)技术结合综合疗养康复对脑卒中后上肢功能障碍的患者运动功能恢复的影响。方法将40例脑卒中后上肢功能障碍的患者随机分为2组,治疗组患者给予常规作业训练并进行VR技术结合综合疗养康复,对照组患者仅给予常规作业训练。观察两组患者治疗前后运动功能Fugl-Meyer评分、日常生活能力改良Barthel指数、患侧上肢肌力评分的变化情况。结果与治疗前相比,两组患者在治疗10周时Fugl-Meyer评分、改良Barthel指数、患侧上肢肌力评分均高于治疗前(P0.05),且治疗10周时,治疗组上述指标均明显高于对照组(P0.05)。结论 VR技术结合综合疗养康复可以显著改善脑卒中后上肢功能障碍患者的上肢运动功能、日常生活能力和上肢肌力,值得临床推广应用。     

Vagus nerve stimulation for upper limb motor impairment after ischemic stroke: A meta-analysis

Background:Upper limb motor impairment is a common complication following stroke. Although few treatments are used to enhance motor function, still approximately 60% of survivors are left with upper limb motor impairment. Several studies have investigated vagus nerve stimulation (VNS) as a potential technique for upper limb function. However, the efficacy and safety of VNS on upper limb motor function after ischemic stroke have not been systematically evaluated. Therefore, a meta-analysis based on randomized controlled trial will be conducted to determine the efficacy and safety of VNS on upper limb motor function after ischemic stroke.Method:We searched PUBMED, MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Library (CNKI), and Wan Fang Database until April 1, 2021.Results:Six studies consisting of 234 patients were included in the analysis. Compared with control group, VNS improved upper limb function via Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.26, 95% confidence interval [CI] [2.79, 3.74], P < .00001) and Functional Independence Measurement (mean difference = 6.59, 95%CI [5.77, 7.41], P < .00001), but showed no significant change on Wolf motor function test (standardized mean difference = 0.31, 95%CI [–0.15, 0.77], P = .19). The number of adverse events were not significantly different between the studied groups (risk ratio = 1.05, 95%CI [0.85, 1.31], P = .64).Conclusion:VNS resulted in improvement of motor function in patients after ischemic stroke, especially in the sub-chronic stage. Moreover, compared with implanted VNS, transcutaneous VNS exhibited greater efficacy in poststroke patients. Based on this meta-analysis, VNS could be a feasible and safe therapy for upper limb motor impairment.     

Impact of Pediatric Inflammatory Bowel Disease on Linear Growth: Data from a National Cohort Study in Saudi Arabia

Background/Aim:

Linear growth impairment (LGI) is one of the most important features peculiar to children with inflammatory bowel disease (IBD). The aim of this report is to define the impact of IBD on the linear growth of children in the Kingdom of Saudi Arabia (KSA).

Setting and Design:

Multicenter retrospective study.

Patients and Methods:

Data from a cohort of newly- diagnosed children with IBD from 2003 to 2012 were analyzed retrospectively. The diagnosis of IBD was confirmed in accordance with the published criteria. Length/height for age was measured at diagnosis. The World Health Organization (WHO) reference was used and LGI was defined by length/height for age <-2 standard deviation.

Results:

There were 374 children from 0.33 to 16 years of age, including 119 ulcerative colitis (UC) (32%), and 255 Crohn''s disease (CD) (68%) patients. The prevalence of LGI was 26%, 28%, and 21% in IBD, CD, and UC, respectively. In children below 10 years, LGI was significantly more common in CD (P = 0.010), while in UC children, it was more common in older children (P = 0.011).

Conclusion:

This study demonstrates a prevalence of LGI consistent with that reported in the literature, but higher in CD children with early onset (<10 years) and in older children with UC, underscoring the importance of monitoring growth in children with IBD in the Saudi population. Prospective studies are needed to define the impact of IBD on growth velocity, puberty, and final adult stature.     

Prevalence of abnormal upper limb arterial anatomy and its correlation with access failure during transradial coronary angiography

ObjectiveThe study aimed at to find out prevalence of abnormal upper limb arterial anatomy and its correlation with access failure during transradial coronary angiography.MethodThis was a prospective observational study of 1512 patients who had undergone transradial coronary angiography (CAG). Angiographic assessment of upper limb arterial tree was performed when the angiographic guidewire or the diagnostic catheter followed an abnormal path or got stuck in its course.ResultsAbout 5.29% patients (80/1512) were noted to have abnormal upper limb arterial anatomy. The most common abnormality detected were radio-ulnar loop in 22 (1.46%) patients, tortuous upper limb arteries 19 (1.25%) and abnormal high origin of radial artery 10 (0.66%) patients. Access failure was encountered in 4.4% (67/1512) of total patients and 64.17% (43/67) access failure was due to abnormal upper limb arterial anatomy.ConclusionAbnormal upper limb arterial anatomy was the most common cause of access failure in transradial coronary angiography in this study.     

Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial

Purpose:Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke.Methods:This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI).Results:Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05).Conclusions:The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.     

超声引导下预注射生理盐水及注射凝血酶治疗上肢动脉假性动脉瘤

目的探讨超声引导下预注射生理盐水及注射凝血酶治疗上肢动脉假性动脉瘤的疗效。方法选择2006年2月～2007年5月住我院行冠状动脉介入诊疗后并发的5例上肢动脉假性动脉瘤患者进行瘤腔内凝血酶注射治疗,并对其疗效进行分析。结果 5例患者均即刻治疗成功,未见明显并发症。随访14～30天无复发。结论超声引导下预注射生理盐水及注射凝血酶能精确定位针头位置,避免远段动脉栓塞的严重并发症发生,是一种安全、有效、快速的治疗上肢动脉假性动脉瘤的首选方法。     

A型肉毒素治疗卒中后上肢痉挛疗效的Meta分析

目的系统评价A型肉毒素治疗卒中后上肢痉挛的临床疗效。方法计算机检索Pub Med、EMbase、Cochrane Library、CBM、中国知网(CNKI)和万方数据库。搜集A型肉毒素结合康复训练与常规康复治疗卒中后上肢痉挛疗效比较的随机对照试验或两组病例对照研究,检索时限均从建库至2016年9月1日。由至少2名评价员按纳入与排除标准进行文献筛查、资料提取和质量评价。利用Cochrane协作网提供的Rev-Man 5.3软件进行Meta分析。结果共检出相关文献356篇,最终11篇文献符合纳入标准,改良Jadad评分显示9篇文献在4分以上,属高质量文献。11篇文献共含614例患者,其中肉毒素治疗组316例,对照组298例。Meta分析结果显示,肉毒素治疗组在Fugl-Meyer评分[标准化均数差(SMD)=0.94,95%CI:0.75~1.12]、改良Ashworth评分(SMD=-1.59,95%CI:-1.78~-1.40)及改良Barthel指数(SMD=0.86,95%CI:0.65~1.08)方面均优于对照组,差异均有统计学意义(均P0.05),两组不良事件发生率(RR=1.06,95%CI:0.78~1.45)相似,差异无统计学意义(P0.05)。结论 A型肉毒素治疗卒中后上肢痉挛疗效确切,安全性高,配合适当的康复训练,能够有效地改善患者肢体运动功能、肌肉紧张状态及生活质量。     

A型肉毒毒素局部注射治疗脑卒中后上肢痉挛

目的:探讨A型肉毒毒素(商品名:保妥适)治疗脑卒中后上肢痉挛的有效性和安全性。方法 :13例脑卒中后上肢痉挛患者行局部注射A型肉毒毒素,在治疗前、治疗后6周和12周采用改良Ashworth量表(MAS)评估痉挛程度,功能残疾评定量表评估上肢相关的日常生活功能,进行疗效比较。治疗前及治疗后12周随访血生化及心电图,评价药物安全性。结果:治疗后6周,患者腕屈肌、四指屈肌和拇指屈肌肌张力的MAS评分[(2.08±0.64)、(2.08±0.64)、(1.23±0.60)分]相对治疗前[(3.00±0.41)、(2.92±0.28)、(2.08±0.49)分]显著改善,差异有统计学意义(P<0.01);治疗后12周,腕屈肌和拇指屈肌肌张力改善,MAS评分[(2.5±0.52)、(1.58±0.69)分]明显改善(P<0.05),四指屈肌肌张力改善不明显。治疗后6周功能残疾评定量表中与上肢痉挛相关的穿衣、疼痛和个人修饰评分[(1.46±0.52)、(1.62±0.51)、(1.69±0.48)分]与基线[(2.08±0.28)、(2.00±0.41)、(2.23±0.44)分]相比显著改善(P<0.05)、治疗后12周,穿衣和个人修饰评分[(1.75±0.45)、(1.83±0.39)分]显著改善(P     

Prevalence of nutritional disorders in Saudi children with inflammatory bowel disease based on the national growth reference

Background and study aimThe prevalence of nutritional disorders in Saudi children with inflammatory bowel diseases (IBDs) has been reported using the World Health Organization (WHO) reference. Our aim was to provide more accurate definition of the prevalence of nutritional impairment in Saudi children with IBDs based on the national growth reference and to demonstrate the effect of using a reference from other populations on the prevalence rates.Patients and MethodsWeight, height, and body mass index data, from the multicenter study of IBDs in Saudi children and adolescents, were plotted on the new Saudi national growth reference. Statistical analyses included frequency calculations and z-test for proportions to investigate the significance of the difference in prevalence. A p-value of < 0.05 was considered significant.ResultsAmong a total of 374 patients, 119 (32%) had ulcerative colitis (UC) and 255 (68%) had Crohn’s disease (CD). Compared with the WHO reference, the Saudi national reference produced a significantly lower prevalence of thinness in patients with UC (24% vs. 8%, p = 0.001), CD (35% vs. 20%, p = 0.002), and of short stature in patients with CD (28% vs. 11%, p < 0.001). The difference in the prevalence of overweight was not significant.ConclusionsWe provide more accurate prevalence estimate of nutritional disorders in Saudi children with IBDs based on national reference. The use of the WHO reference overestimated the prevalence of thinness and short stature in Saudi children. Prevalence estimates based on references from other populations should be interpreted with caution.     

不同剂量生长抑素治疗肝硬化并发上消化道大出血的疗效分析

[目的]观察生长抑素不同剂量治疗肝硬化并发上消化道大出血的临床效果。[方法]将确诊的32例肝硬化并发上消化道大出血患者随机分为高剂量组和常规剂量组。高剂量组、常规剂量组分别采用生长抑素6mg/q12h、3mg/q12h持续静脉泵入的治疗方案,直至出血停止。[结果]高剂量组在平均止血时间、输血量、止血有效率上均明显优于常规剂量组(P0.05)。[结论]加倍应用生长抑素的止血效果优于常规剂量,在出血量较大时更显示出增加剂量的重要性。     

第三代功能性电刺激联合任务导向训练对卒中后上肢功能的康复作用

目的探讨第三代功能电刺激(FES)联合任务导向训练对卒中后上肢功能恢复的作用。方法选择病程3~12个月的初发卒中患者40例,按病例单双号分为FES组和对照组,每组20例。两组患者均接受传统的康复训练,1次/d,30 min/次,5 d/周,共12周。FES组另给予12周的FES治疗,1次/d,15 min/次,5 d/周;根据上肢功能状况给予患者被动电刺激、触发反馈电刺激、助力反馈电刺激结合任务导向训练(杯子训练)的作业治疗。疗效评定采用改良的Ashworth量表(MAS)、Brunnstrom分级量表、Fugl-Meyer运动功能量表(上肢部分,FMA)及腕关节背伸的主动关节活动度(WEAROM)测评。结果 (1)治疗前FES组与对照组各项观察指标差异均无统计学意义。(2)治疗后两组MAS和Brunnstrom量表评分均较治疗前有所改善,差异有统计学意义(P0.01);但FES组与对照组比较,MAS和Brunnstrom量表的治疗前-后评分差值[分别为(0.7±0.3)、(0.8±0.4)分和(0.6±0.2)、(0.7±0.4)分]差异均无统计学意义。(3)两组FMA评分和WE-AROM均较治疗前提高,差异有统计学意义(P0.05);FES组FMA评分的治疗前-后差值为(8.3±4.0)分,高于对照组的(4.3±2.5)分;FES组WEAROM的治疗前-后差值为(21±10)度,高于对照组的(14±6)度,差异均有统计学意义(P0.05)。结论与传统的康复训练相比,结合了FES治疗的康复训练对于卒中患者上肢运动功能改善及腕关节背伸的关节活动度提高效果更明显。但对上肢痉挛改善效果不明显。     

Prediction of 10-year risk of hard coronary events among Saudi adults based on prevalence of heart disease risk factors

Aim

Cardiovascular disease is becoming the lead cause of mortality and morbidity worldwide, and developing countries are the main contributors to this trend. Saudi Arabia, which is considered a rapidly developing country, faces progressive urbanization and the adoption of a westernized lifestyle, factors which contribute to the rising burden of cardiovascular disease. Our study evaluates the prevalence of coronary risk factors and predicts hard coronary artery events over 10 years in an urban Saudi cohort.

Methods

A cross-sectional observational study was conducted on a Saudi population. The study involved Saudi subjects aged more than 20 years without a history of coronary heart disease. Demographic variables and hard coronary events (HCE) risk factors were measured. Each subject’s 10-year HCE risk was estimated by means of the Framingham Risk Score (FRS).

Results

A total of 4932 subjects (2215 men and 2717 women) were examined, the majority (85%) of whom were less than 40 years old. The risk of developing HCE within the next 10 years was low in 92.6% of subjects, intermediate in 3.2% and high in 4.1%. On considering diabetes as coronary heart disease (CHD) risk-equivalent, 26% of subjects were at high risk for hard coronary events in 10 years. The HCE risk progressively increased with age and was higher in men.

Conclusions

Our study, the first to estimate the 10-year risk of HCE among adults in an emerging country, determined that a significant proportion of a younger aged population is at risk for the development of hard coronary events. Public awareness programs to control risk factors are warranted.