推拿疗法对亚健康状态人群心身症状的调理作用

目的:采用自拟躯体症状量表和评价心理卫生状况的90项症状自评量表评价推拿疗法对亚健康人群心身的调理作用。方法:纳入2003-8/2004-8广西中医学院第一附属医院特色医疗健康中心就诊的,符合中国亚健康学术研讨会上专家们提出的30项症状诊断法亚健康状态判定标准的亚健康人群500例。对患者采取俯卧位与仰卧位两种操作方法进行推拿调治。俯卧位:施以常规推拿手法及以踩压点按腧穴、滑抹分理肌肉为主的踩背。仰卧位:按头面→颈→胸→腹→上肢→下肢顺序施以常规推拿手法。以上调治50～70min/次,隔日1次,5次为1个疗程,调治1～3个疗程。于推拿前后分别对亚健康的躯体和精神亚健康状况进行评分,躯体亚健康采用自行拟制的症状量表进行评价(观察疲劳感与失眠两项,每项按症状程度分5级,分别为0～10、11～20、21～30、31～40和41～50,总分为100分,积分越高,症状越重);精神亚健康采用90项症状自评量表躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性和其他共10项因子积分进行评价。应用配对t检验或非参数检验的配对符号秩和检验(Wilcoxon配对法)。结果:500例参与者中进入结果分析425例,脱落的75例中,调治过程中出现新发疾病者11例,中途主动退出者47例,未能完成评分测定者17例。①推拿治疗后患者主要躯体症状疲劳感、失眠记分差异均显著降低(18.28±7.03,35.72±8.89;17.22±6.91,22.65±7.31;t=59.773,77.791,P<0.001)。②推拿治疗后90项症状自评量表各因子中躯体化症状、抑郁、焦虑、精神病性及其他共5项因子评分均显著降低穴1.72±0.43熏2.52±0.48鸦1.66±0.61熏2.74±0.70鸦1.81±0.53熏2.62±0.70鸦1.81±0.45,2.06±0.48鸦1.82±0.65熏2.23±0.73鸦t=43.785～12.178,P<0.001雪。结论:推拿对亚健康的调理作用主要表现在改善睡眠和消除疲劳感以减轻亚健康人群的躯体症状,同时还可以改善心理亚健康症状。     

老年脊髓型颈椎病患者脊髓功能受损特征:84例回顾性分析

目的:探讨老年脊髓型颈椎病患者的脊髓功能受损特征及干预方式。方法:哈尔滨医科大学第二临床医学院脊柱外科1999-01/2003-12获得随访的脊髓型颈椎病患者84例,根据患者年龄分为老年组和对照组,进行回顾性研究。对两组患者的围手术期表现、临床表现及影像学表现等方面进行对比。结果:与对照组相比,老年组患者多有其他系统伴发疾病。两组患者术前、术后的日本矫形外科学会(JOA)评分,老年组为(6.2±3.2)分和(10.7±2.9)分;对照组为(9.0±3.3)分和(13.1±3.5)分。两组患者的轮替运动速度(AMR)老年组为(11.7±3.6)分和(16.8±4.2)分;对照组为(13.9±4.2)分和(19.5±5.1)分。术后结果均有明显改善(P<0.01),但老年组不如对照组。影像学资料显示,老年组中存在椎间不稳的患者(15/22)明显多于对照组(11/62)。结论:老年脊髓型颈椎病患者围手术期多合并有其他系统疾病。椎间不稳可能是老年脊髓型颈椎病的重要发病机制之一。合理的干预方式选择及正确的围手术期处理是取得满意疗效的关键。     

心脏转移癌的超声心动图诊断

本文对经病理证实的２４例心脏转移癌进行超声心动图研究分析，总结其声像图特征，提出了超声诊断依据。认为超声心动图是临床及早发现诊断心脏转移癌的重要技术手段。     

Effects of multiple virus coinfections on disease progression in HIV-positive patients

OBJECTIVE: Since virus infections in AIDS patients are mostly inevitable and as they frequently cause disease deterioration and therapeutic failures, a comprehensive investigation was made of the influence of the coinfections of 9 well-known viruses on disease progression in patients infected with human immunodeficiency virus type 1 (HIV). METHODS: A cross-sectional study of 62 HIV-positive patients was conducted to correlate the prevalence rates for the 9 viruses with the alanine aminotransferase (ALT) levels and CD4 cell counts of the patients. RESULTS: The rates of HIV-positive patients infected with the 9 viruses are significantly higher than those of the control groups. Furthermore, almost one third of the patients in the studied group was coinfected with transfusion-transmitted virus (TTV) and manifested significantly higher ALT levels (p = 0.020), and these were raised further if coinfection with TTV and human hepatitis C virus had occurred (p = 0.010). By analyzing CD4 cell counts, the only significant effect on AIDS progression which could be detected was coinfection with human herpesvirus 8. CONCLUSION: This result confirmed that immune-suppressed persons are more vulnerable to common virus infections. Unlike hepatitis B or C virus, TTV seems to accelerate the progression of chronic hepatitis in HIV-infected patients.     

Active specific immunotherapy in patients with melanoma. A clinical trial with mouse antiidiotypic monoclonal antibodies elicited with syngeneic anti-high-molecular-weight-melanoma-associated antigen monoclonal antibodies.

In two clinical trials the mouse antiidiotypic monoclonal antibody (MAb) MF11-30, which bears the internal image of human high-molecular-weight-melanoma-associated antigen (HMW-MAA) was administered by subcutaneous route without adjuvants to patients with stage IV malignant melanoma on day 0, 7, and 28. Additional injections were administered if anti-antiidiotypic antibodies were not found or their titer decreased. In the first phase I trial with 16 patients the initial dose was 0.5 mg per injection and escalated to 4 mg per injection. Neither toxicity nor allergic reactions were observed despite the development of anti-mouse Ig antibodies. Minor responses were observed in three patients. In a second clinical trial MAb MF11-30 was administered to 21 patients at a dose of 2 mg per injection, since this dose had been shown in the initial study to be effective in inducing anti-antiidiotypic antibodies. Two patients were inevaluable; in the remaining 19 patients, the average duration of treatment was 34 wk. In this trial as well, neither toxicity nor allergic reactions were observed. 17 of the 19 immunized patients increased the levels of anti-mouse Ig antibodies and 16 developed antibodies that inhibit the binding of antiidiotypic MAb MF11-30 to the immunizing anti-HMW-MAA MAb 225.28. One patient increased the level of anti-HMW-MAA antibodies. One patient achieved a complete remission with disappearance of multiple abdominal lymph nodes for a duration of 95 wk. Minor responses were observed in three patients. These results suggest that mouse antiidiotypic MAb that bear the internal image of HMW-MAA may be useful reagents to implement active specific immunotherapy in patients with melanoma.     

Body composition assessment in Taiwanese individuals with poliomyelitis

Chang K-H, Lai C-H, Chen S-C, Hsiao W-T, Liou T-H, Lee C-M. Body composition assessment in Taiwanese individuals with poliomyelitis.

Objectives

To measure the changes in the total and regional body fat mass, and assess the clinical usefulness of the body mass index (BMI) in detecting overweight subjects with sequelae of poliomyelitis.

Design

Prospective, cross-sectional study.

Setting

General community.

Participants

Subjects with poliomyelitis (n=17; age range, 42–57y; mean, 47y; 12 men, 5 women) and able-bodied people (n=17) matched by sex, age, body weight, and body height participated in the study.

Interventions

Not applicable.

Main Outcome Measures

Total and regional body composition was measured with dual-energy x-ray absorptiometry. Clinical characteristics such as blood pressure, serum biochemical studies, and habitual behaviors (daily cigarette smoking, alcohol consumption, and exercise regimen) of all participants were evaluated.

Results

Compared with able-bodied controls, subjects with poliomyelitis had a 50% greater total body fat mass, significant increases in the regional fat mass in every part of the body, and had the greatest increase of fat mass in the thorax. Nearly all the subjects (94%) with poliomyelitis were obese according to standards of body composition. However, one third of them had a BMI value of less than 25.0kg/m².

Conclusions

People with poliomyelitis have a higher prevalence of obesity and a significant increase in total and regional fat mass. Current BMI underestimates the total body fat mass percentage compared with the control; therefore, a population-specific BMI should be used to address the prevalence of obesity in postpolio survivors.     

Human secondary somatosensory cortex is involved in the processing of somatosensory rare stimuli: an fMRI study

In the human somatosensory system, the contralateral primary somatosensory cortex (SI) is presumed to process and encode type and intensity of the sensory inputs, whereas the bilateral secondary somatosensory cortex (SII) is believed to perform higher order functions including sensorimotor integration, integration of information from the two body halves, attention, learning and memory. In this fMRI study we investigated the effect of attention on the activation of SI and SII, as induced by nonpainful and painful rare deviant electric stimuli during somatosensory oddball tasks. The working hypothesis is of stronger effects of attention on SII with respect to SI. Four runs were acquired according to an oddball scheme. Frequent nonpainful electrical stimuli were delivered to the ulnar nerve at motor threshold, whereas rare/deviant stimuli were delivered to median nerve in four conditions (one condition per run): nonpainful, painful, counting nonpainful, and counting painful. Results showed a statistically significant fMRI activation in bilateral SII but not in contralateral SI when the rare/deviant median nerve stimuli were delivered at nonpainful and painful levels as well as at the two levels of attention considered (i.e., associated with counting and non-counting tasks). Furthermore, fMRI activation in SII did not differ across the different levels of stimulus intensity (nonpainful, painful) and attention (non-counting, counting). These results corroborate the notion that SII is the target of independent pathways for the processing and integration of nonpainful and painful somatosensory stimuli salient for further high-order elaborations.     

Serum anticardiolipin antibodies in patients with neuromyelitis optica spectrum disorder

The presence of anticardiolipin antibodies (ACLA) in multiple sclerosis (MS) patients has been reported, but there are some debates on the relationship between ACLA and MS. We assessed the clinical features of neuromyelitis optica spectrum disorders (NMOSD) patients with ACLA. A consecutive cohort of 480 subjects with NMOSD (n = 70), MS (n = 90) and control (n = 220) were analysed retrospectively. Patients’ serum was tested by a dot-immunogold filtration assay for the presence of ACLA-IgG, IgM and IgA antibodies. In MS patients, 5 (5.6 %) of the 90 patients showed ACLA-IgG reactivity in the serum. In NMOSD patients, 32 (45.7 %) of the 70 patients showed ACLA reactivity in the serum, among which ACLA-IgG seropositivity was 45.7 % (32/70), ACLA-IgG + IgM seropositivity was 8.6 % (6/70), and ACLA-IgG + IgA seropositivity was 4.3 % (3/70). NMOSD patients were higher in ACLA-IgG (p < 0.0001) and ACLA-IgG + IgM (p = 0.006) than the MS patients. NMOSD patients had higher ACLA-IgG than the control patients (p < 0.0001). In comparison with the controls, the MS patients were lower in ACLA for IgG (p = 0.014) and IgM (p = 0.004). Seropositive ACLA patients increased in age (p = 0.013) and had higher D-dimer levels (DD) (p = 0.002) than the seronegative NMOSD patients. Furthermore, positive ACLA-IgG + IgM patients were increased in age (p = 0.001), had higher baseline EDSS (p = 0.001), antithrombin III activity (p = 0.04), and DD levels (p = 0.005) than the pure positive ACLA-IgG NMOSD patients. Patients with NMOSD had more occurrences of ACLA than patients with MS. NMOSD patients with positive ACLA-IgG + IgM had a worse outcome that may be associated with elder age and abnormal coagulation parameters in blood.     

The relation of serum leptin to body mass index and to serum cortisol in men with spinal cord injury

OBJECTIVE: To investigate the relations among serum leptin, body mass index (BMI), and various hormone levels in men with spinal cord injury (SCI). DESIGN: Cross-sectional. SETTING: University hospital that is a tertiary referral center. PARTICIPANTS: Forty-seven men with traumatic neurologically complete SCI and 47 age- and BMI-matched male controls. MAIN OUTCOME MEASURES: Baseline levels of various hormones were measured in subjects with SCI. Serum leptin and cortisol levels and BMI were measured in both groups. RESULTS: Serum leptin was significantly higher in the group with SCI than in the control group. A linear relation was found between serum leptin and BMI in both groups separately. A polynomial relation was found between serum leptin level and BMI in the group with SCI. A "J" phenomenon is noted at the lowest BMI. Serum cortisol correlated significantly with serum leptin level in the group with SCI. CONCLUSION: Sympathetic denervation, peripheral nerve palsy, recurrent infections, and possible central neurotransmitter alterations after SCI may contribute to the elevation of serum leptin level in men with SCI.