快速康复护理、中医特色护理对卵巢癌的效果

目的分析快速康复护理联合中医特色护理在卵巢癌围手术期护理中应用效果。方法选择本院100例2018年7月-2019年2月卵巢癌患者。随机分组,快速康复护理组采取快速康复护理,快速康复护理联合中医特色护理组则采取快速康复护理联合中医针灸推拿护理。比较两组护理满意度;卵巢癌疼痛以及不良反应好转的时间;治疗前后患者中医证候积分、QOL量表评分值。结果快速康复护理联合中医特色护理组护理满意度、卵巢癌疼痛以及不良反应好转的时间、中医证候积分、QOL量表评分值相比较快速康复护理组更好,P <0.05。结论快速康复护理联合中医针灸推拿护理卵巢癌效果确切,可改善并发症和缓解疼痛,改善生存质量。     

Surviving a stroke in South Africa: outcomes of home-based care in a low-resource rural setting

Background: Little is known of stroke outcomes in low- and middle-income countries with limited formal stroke rehabilitation services and of homebased-stroke services delivered within the primary health care (PHC) context by community health workers (CHWs).

Objectives: To describe and analyze the outcomes of patients with stroke from a rural PHC setting in the Western Cape, South Africa.

Methods: In a longitudinal survey, 93 stroke patients, referred to home and community-based care services (HCBC) between June 2015 and December 2017, were assessed at baseline, one month and three months. Changes in function (Barthel Index (BI)), caregiver strain (Caregiver Strain Index (CSI)), impact of environmental factors and satisfaction with stroke care were measured.

Results: HCBC was delayed, fragmented and brief (median session duration 20 minutes (IQR 15.0–30.0)). Although function improved significantly, dependence remained high: median BI score changed from 40.0 (IQR 15.0–70.0) to 62.5 (IQR 30.0–81.25) (p = .019). A third (33.0% (30/91)) of caregivers initially experienced strain and the median CSI score remained 3.0 (IQR 0.0–7.0) (p = .672). Overall, patient and caregiver satisfaction with HCBC was low with only 46.9% (31/66) of caregivers and 17.4% (12/69) of patients satisfied with all aspects of care. Only 47.6% of assistive product needs were met. Environmental factors negatively impacted on patient function and caregiving.

Conclusions: Clinical practice pathways and referral guidelines should be developed for the HCBC platform. Specific training of CHWs, focusing on how to educate, support and train family caregivers, provide assistive devices and refer to health services is needed.     

快速康复内窥镜椎间盘切除术治疗腰椎间盘突出症的临床观察

目的:探讨快速康复外科理念联合内窥镜椎间盘切除术治疗腰椎间盘突出症的疗效。方法:选取2018年4月—2019年4月本院收治的86例腰椎间盘突出症患者,随机分为两组,每组43例,对照组通过内窥镜椎间盘切除术治疗,观察组予以快速康复外科理念联合内窥镜椎间盘切除术治疗,对比两组疗效和并发症发生情况。结果:观察组并发症发生率(4.65%)较对照组(18.60%)低,差异有统计学意义(P 0.05);观察组下床活动时间、住院时间较对照组短,术后7天的疼痛评分较对照组低,差异有统计学意义(P 0.05);术后3个月,观察组的Oswestry功能障碍指数问卷表评分较对照组低,日本骨科协会评估治疗分数较对照组高,差异有统计学意义(P 0.05)。结论:探讨快速康复外科理念联合内窥镜椎间盘切除术治疗腰椎间盘突出症可减少并发症,缩短术后恢复时间,进而促进患者功能有效康复。     

Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.     

Lumbar Spinal Cord Stimulation Can Improve Muscle Strength and Gait Independently of the Analgesic Effect: A Case Report

Spinal cord stimulation (SCS) is widely used for pain relief in patients with failed back surgery syndrome (FBSS), and muscle weakness is a common finding in patients with chronic pain. We present here a single case report of a 47‐year‐old woman, who, after SCS for FBSS, had continuous improvement in lower leg muscle strength and gait, but only transient and minimal pain relief. To the authors’ knowledge, this is only the second published case report of significant improvement in “motor” function, independent of the analgesic effect following SCS in FBSS. If SCS, in fact, does improve muscle strength, new strategies for the management of patients with chronic pain might be opened up. Further studies are needed to verify this hypothesis.     

汉语失写症的神经心理学研究及其意义

目的 探讨汉语失写症的神经心理语言学机制以及该研究对于汉语失写症病理行为的康复学意义。方法 采用汉语失语检查法和汉语失写检查法测试口语和书写能力，详细记录患者的书写、失写行为特征，区分言语障碍类型；运用计算机图像处理技术对病灶CT／MRI图像进行标准化、二维叠加、三维重建等处理，并与非失写对照组相减，显示不同失写类型病变的集中趋势。结果 左侧半球损害48例，其中失语30例，失写32例，后者中纯失写1例，失读并失写1例；右侧半球损害15例，其中失语失写3例。具体的资料分析表明：不同的失写类型有不同的病理行为特点。计算机图像处理结果显示：失语性失写病灶较集中的区域为左额顶叶深部白质。惰性失写主要集中在左外侧裂的前方、从额中下回向后部延伸。镜像书写则分散于左丘脑、基底节附近。结论 汉语失写症的病理行为特点与病损定位有密切的关系；双通道理论有可能符合汉语语言学机制；汉语失写症的神经心理学研究对汉语失写康复模式的制定有重要意义。     

Lymphoid Neogenesis in Murine Cardiac Allografts Undergoing Chronic Rejection

Lymphoid neogenesis is the process by which ectopic lymphoid accumulations that resemble lymph nodes arise in nonlymphoid tissues. Such lymphoid accumulations, known as tertiary lymphoid organs (TLO), are observed in chronic autoimmunity and they propagate immune pathology by setting up local antigen presenting sites. Whether lymphoid neogenesis occurs in transplanted organs and contributes to rejection is not well understood. To begin to address this question, we retrospectively analyzed 319 murine cardiac allografts for microscopic evidence of lymph-node-like structures. We found 78 allografts that had either classical TLO, characterized by discrete T- and B-cell zones and high endothelial venules (HEV) expressing peripheral node addressin (PNAd) (n = 34), or PNAd(+) HEV without organized lymphoid accumulations (n = 44). These changes were present in both short- and long-lived allografts and were invariably associated with rejection. Importantly, they occurred in 78% of allografts undergoing chronic rejection (n = 85) but in only 7% of allografts undergoing primarily acute rejection (n = 184). These findings indicate that, like autoimmunity, alloimmunity is associated with lymphoid neogenesis in the target organ and suggest a role for local T-cell activation in chronic allograft rejection.     

护理干预对2型糖尿病患者康复作用的研究

目的 探讨护理干预在2型糖尿病患康复中的作用。方法 对80例2型糖尿病患，随机分成干预组和对照组，干预组实施全程护理干预，对照组实施常规的治疗护理。结果 干预组血糖控制良好，并发症发生率明显降低。结论 护理干预是2型糖尿病康复治疗的有效方法。     

对冠心病患者实施康复护理的现状与进展

众所周知，在大多数国家中，冠心病已经成为普遍存在的发病率较高的疾病和主要的致死疾病之一。对冠心病的主要危险因素调查通过康复护理治疗，有效的社区普及卫生教育，同时对高危个体进行目标跟踪管理，这三者相结合形成了一个有效的治疗监督手段。