急性期介入低频重复经颅磁刺激对缺血性脑卒中患者上肢运动功能的影响

目的 探讨急性期介入低频重复经颅磁刺激(rTMS)对缺血性脑卒中患者上肢运动功能的影响。 方法 选取急性期缺血性脑卒中患者82例,按照随机数字表法将其分为对照组和试验组,每组41例,研究过程中每组均脱落1例,最终对照组和试验组各纳入40例。2组患者均给予常规康复治疗,试验组予以低频rTMS治疗,对照组予以rTMS假刺激治疗。治疗前、治疗4周后,采用Fugl-Meyer量表（FMA）上肢部分、Wolf运动功能评价量表（WMFT）、改良Barthel指数（MBI）、运动诱发电位(MEP)潜伏期和波幅评价2组患者的上肢运动功能。 结果 治疗前,2组患者FMA评分、WMFT评分、MBI评分、MEP波幅和潜伏期比较,差异均无统计学意义（P＞0.05）。治疗4周后,2组患者的FMA、WMFT、MBI评分和MEP波幅均较组内治疗前明显改善（P＜0.05）,且试验组治疗4周后的FMA［(39.20±7.36)分］、WMFT［(54.43±9.28)分］、MBI［(62.18±9.53)分］、MEP波幅［（0.74±0.08）mV］改善较对照组显著（P＜0.05）。 结论 急性期介入低频rTMS可改善缺血性脑卒中患者的上肢运动功能,提高日常生活活动能力。     

上肢机器人虚拟情景训练联合头针对脑卒中患者认知功能障碍的影响

目的 探讨上肢机器人虚拟情景训练联合头针对脑卒中后认知功能障碍的影响。 方法 选取脑卒中后认知功能障碍（PSCI）患者90例,按照随机数字表法分为对照组、头针组、综合组,每组30例。对照组给予常规认知和康复训练,头针组给予常规认知和康复训练联合头针治疗,综合组给予常规认知和康复训练、头针治疗和上肢机器人虚拟情景训练。治疗前和治疗4周后（治疗后）,采用简易精神量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估3组患者认知功能,同时采用改良的Barthel指数（MBI）评估3组患者日常生活活动能力。 结果 治疗后,3组患者的MMSE评分、MoCA评分和MBI评分较组内治疗前均明显改善（P<0.05）。头针组治疗后,仅MMSE评分和MBI评分显著优于对照组治疗后（P<0.05）。综合组治疗后的MMSE评分为（22.03±0.96）分,MoCA评分为（15.07±1.48）分,MBI评分为（73.10±8.45）分,均显著优于头针组和对照组治疗后（P<0.05）。 结论 上肢机器人虚拟情景训练联合头针可显著改善PSCI患者的认知功能,并提高其日常生活活动能力。     

应用小鼠胚胎肢芽培养方法研究重铬酸钾的发育毒性

采用小鼠胚胎前肢芽培养方法研究重铬酸钾对小鼠的发育毒性。结果表明:重铬酸钾浓度在2 .0mg .L- 1 以上时,前肢芽器官的发育和分化受到影响,并且随着重铬酸钾浓度的增加,肢体中各软骨的发育分化越差,Neubert 评分得分越少,呈剂量- 效应关系。说明重铬酸钾为小鼠胚胎发育毒性物质     

Differential cardiorespiratory response to combined exercise with different combinations of forearm and calf exercise

The purpose of this study was to examine whether cardiorespiratory responses to combined rhythmic exercise (60 contractions · min^–1) was affected by different combinations of upper and lower limb exercise in seven healthy women. Six different rhythmic exercises were compared: 6-min rhythmic handgrip at 10% of isometric maximal voluntary contraction (MVC) (H10); 6-min rhythmic plantar flexion at 10% MVC (P10); exhausting rhythmic handgrip at 50% MVC (H50); exhausting rhythmic plantar flexion at 50% MVC (P50); H50 was added to P10 (P1OH50); and P50 was added to H10 (H10P50). Exercise duration, after handgrip was combined with plantar flexion (P10H50), was shorter than that of H50, although the exercise duration of HIOP50 was not significantly different from P50. No significant difference was found between the difference from rest in oxygen uptake ( O₂) during H10P50 and the sum of O₂ during H10 and P50. Also, the differences from rest in forearm blood flow ( FBF) and calf blood flow ( CBF) during H10P50 were not significantly different from FBF in H10 and from CBF in P50. In contrast, O₂ in P10H50 was lower than the sum of O₂ in P10 and H50 (P < 0.05), and J FBF in P10H50 was lower than that in H50 (P < 0.05) , while CBF was not significantly different between P1OH50 and P10. The changes in heart rate from rest (d HR) during the combined exercises were lower than the sums of HR in the corresponding single exercises (P < 0.05). These results demonstrated an inhibitory summation of several cardiorespiratory responses to combined exercise resulting in a reduction in exercise performance which would seem to occur easily when upperlimb exercise is added to lower limb exercise.     

Experimental approach to the pathogenesis of the anomalies of amniotic disease

By intra-adnexal injection of glucose in the rabbit embryo, we were able to stimulate all the anomalies associated with "Amniotic Disease". Since we were even able to obtain amniotic bands, this study provides an excellent experimental model of this disease. Resulting lesions occur early in development, corresponding to the first trimester of human gestation. All of the anomalies can ultimately be explained by the destruction of the most superficial cells: epiblastic cells of the embryo and the amnion, subjacent mesenchyme, and endothelial cells. The subsequent lack of interaction between these cells and the importance of the anatomical localizations of resulting hematomas can lead to the pathogenetic approach to this disease. In light of the present study, the disease appears to be caused by an external factor within the amniotic fluid. The exact nature of the destructive agent(s) remains a mystery in man.     

Value of a radionuclide limb blood flow technique in the assessment of percutaneous balloon and dynamic angioplasty

In a prospective study, a radionuclide technique was used to evaluate the limb blood flow (LBF) changes in 30 patients undergoing dynamic (n=15) or balloon (n=15) angioplasty for arterial occlusions or stenoses, respectively. The results were compared with Doppler Ankle Brachial Index (DABI) and treadmill exercise tests. Whilst LBF values (ml of blood flow per 100 ml of limb volume per min) were significantly lower in limbs with arterial occlusion than stenosis (4.5±0.46 and 6.4±0.74, respectively; P<0.05), DABI provided no discrimination. Immediately after balloon angioplasty, there was a fall in DABI, from 0.60±0.05 to 0.47±0.04 (P<0.05), which rose 24 h later to 0.73±0.02 (P<0.01). Following dynamic angioplasty, DABI improved from 0.60±0.05 to 0.66±0.02 (P<0.05). At 3 weeks, the LBF improved from 4.6±0.66 to 11.1±0.53 (P<0.001) following dynamic angioplasty and from 6.2±0.68 to 8.53±0.81 (P<0.001) following balloon angioplasty. Normal LBF (> 10 ml/100 ml per min) was achieved in 80% of patients who underwent successful dynamic angioplasty but in only 36% of the balloon group (P<0.05, ²-test). Reproducibility of repeated LBF measurements in control limbs was superior to that of DABI. This was indicated by a lower coefficient of variation, 13.8% compared with 25.2%, and a higher correlation coefficient, r=0.79 compared with 0.27. Treadmill exercise tests were invalid or impossible in 30% of all occasions. There was a good correlation between the improvement in maximum walking distance on the treadmill and that in LBF (r=0.84, P<0.05). In conclusion, measurement of LBF using radionuclide technique is a potentially valuable method for the assessment of patients undergoing percutaneous angioplasty. LBF results are reproducible and correlate well with the improvement in walking ability, which cannot always be assessed objectively. Offprint requests to: A.A. Gehani     

Neoadjuvant chemotherapy for osteosarcoma of the extremities with metastases at presentation: recent experience at the Rizzoli Institute in 57 patients treated with cisplatin, doxorubicin, and a high dose of methotrexate and ifosfamide.

BACKGROUND: Effective adjuvant or neoadjuvant regimens of chemotherapy have dramatically improved the prognosis of patients with high-grade osteosarcoma of the extremity, localized at diagnosis. Currently, little is known about patients with metastatic disease at presentation. PATIENTS AND METHODS: From May 1995 to May 2000, 57 patients with osteosarcoma of the extremity, metastatic at presentation, were treated according to the following scheme: primary chemotherapy, restaging, simultaneous resection of primary tumor and metastatic lesions, and maintenance chemotherapy. RESULTS: Thirty-five patients achieved remission. At a follow-up ranging from 2 to 7 years, seven remained continuously free of disease, one died of chemotherapy-related toxicity and 27 patients relapsed. Twenty-one of the 22 patients who never achieved remission died as a result of the tumor, as well as 20 of the 27 who achieved remission but then relapsed. Of the remaining seven relapsing patients, six are alive with uncontrolled disease, while one is alive and free of disease 24 months after the last post-relapse treatment. Two-year event-free survival (EFS) and overall survival (OS) were 21% and 55%, respectively. These results are significantly poorer than those achieved in 128 contemporary patients with non-metastatic disease at presentation, treated with the same chemotherapy protocol (2-year EFS and OS of 75% and 94%, respectively). CONCLUSIONS: The results of our study confirm that the prognosis of patients with osteosarcoma of the extremity, metastatic at presentation, remains poor, despite the use of aggressive treatments.     

新型结膜瓣转位术治疗翼状胬肉

目的　探讨新型结膜瓣转位术治疗翼状胬肉的疗效。方法　采用传统翼状胬肉切除术 (A组 )、翼状胬肉切除联合球结膜移植术 (B组 )和新型的结膜瓣转位术 (C组 )治疗翼状胬肉方法学的研究 ,对比 3组手术方法 2a复发率及创面修复时间。结果　A组角膜创面修复时间平均为 8.5 2d ,B组 4 .85d、C组 4 .4 1d。经 2a以上随访 ,A组治愈率为77 8% ,B组为 10 0 %、C组为 10 0 % .结论　新型结膜瓣转位术治疗翼状胬肉 ,与传统方法相比 ,具有操作简单 ,创伤小 ,恢复快 ,复发率低等优点 ,是目前治疗翼状胬肉很有前途的手术方法。     

腔镜深筋膜下交通支静脉结扎治疗慢性下肢静脉溃疡

目的:探讨腔镜深筋膜下交通支静脉结扎治疗慢性下肢静脉性溃疡的疗效.方法:手术治疗26例下肢静脉曲张病人,该26例均同时存在浅静脉倒流、交通支静脉功能不全、深静脉功能不全和静脉性溃疡.手术方式为腔镜深筋膜下交通支静脉结扎、大隐静脉高位结扎并抽剥和小腿曲张的浅静脉经皮连续环形缝扎术,26例同时行股浅静脉瓣膜外包窄术.结果:术后肢体症状和浅静脉曲张消失,10例静脉性溃疡短期内愈合,16例明显缩小.结论:腔镜深筋膜下交通支静脉结扎术安全有效,损伤小,并发症小,是治疗下肢静脉功能不全性溃疡的有效方法和重要组成部分.     

下肢深静脉血栓辨证分型与超声表现的相关性

目的探讨下肢深静脉血栓辨证分型与超声表现之间的关系.方法根据辨证将96例患者分为3组:第1组为脉络湿热型;第2组为脉络湿瘀型,第3组为脾虚湿阻型.观察每组的超声表现.结果各组间在管腔直径、管腔内回声、彩色血流信号、管壁变化等方面差异有显著意义(P＜0.05).结论下肢深静脉血栓的辨证分型与超声表现之间有相关性,超声检查对下肢深静脉血栓的中医诊断及治疗有重要意义.