刺络拔罐联合局部振动法治疗脑卒中后 上肢痉挛的临床疗效观察

目的 观察刺络拔罐联合局部振动治疗对脑卒中后上肢痉挛患者的临床疗效。方法 选取2020年6月至2021年12月温州中医院收治的单侧脑卒中后上肢痉挛患者60例,采用数表法随机分为对照组（局部振动治疗组）和试验组（刺络拔罐联合局部振动治疗组）,每组各30例,疗程均为4周。比较两组治疗前后改良Ashworth量表评定（modified Ashworth scale,MAS）分级、临床疗效、上肢功能Fugl–Meyer评分（Fugl–Meyer assessment,FMA）、肱二头肌、肱三头肌积分肌电值（integrated electromyogram,iEMG）的变化情况。结果 与治疗前相比,两组患者的MAS分级、上肢功能FMA评分及肱二头肌、肱三头肌iEMG较各组治疗前均有显著改善,差异有统计学意义（P<0.05）;与对照组相比,试验组治疗后的MAS分级、临床疗效、上肢功能FMA评分、肱二头肌及肱三头肌iEMG的改善均不同程度优于对照组,其中试验组的临床疗效、上肢功能FMA评分及肱二头肌iEMG改善,差异有统计学意义（P<0.05）。结论 刺络拔罐联合局部振动法对脑卒中患者的上肢痉挛疗效显著,可有效降低痉挛上肢肌张力,同时改善上肢运动功能。     

醒脑开窍针刺法联合中枢性促进技术对脑卒中后患者的疗效观察

目的 探究醒脑开窍针刺法联合中枢性促进(Brunnstrom)技术应用于脑卒中后患者的疗效,观察其对认知功能,日常生活能力及肢体功能的影响.方法 选取2018年10月—2019年10月辽宁中医药大学附属营口医院康复科收治的脑卒中后行康复治疗的患者86例,随机分为治疗组和对照组,每组各43例.对照组予以基础康复训练和醒脑...     

Associated injuries in patients with spinal injury

The associated injuries found in 100 consecutive spinal injuries are described. Fifty-one of the patients had injuries of the cervical cord, 31 per cent complete. A total of 75 per cent of the patients had associated injuries, the commonest being a head injury. Chest injuries were the next most frequent. The management of these injuries in the presence of a severe spinal injury is described. The importance of early tracheostomy and prophylactic anticoagulant therapy is stressed in reducing the mortality to the order of 2 per cent. The value of spinal injury units is emphasized.     

Quantifying comorbidity in peritoneal dialysis patients and its relationship to other predictors of survival.

BACKGROUND: Comorbidity is the single most important determinant of outcome in patients on renal replacement therapy. The aims of this study were to evaluate a semi-quantitative approach to comorbidity scoring in predicting survival of patients commencing peritoneal dialysis (PD), and to establish the interaction between this and other known predictors of patient outcome, in particular membrane function, residual renal function (RRF) and plasma albumin. METHODS: Comorbidity was recorded in a prospective, single centre cohort study of 303 patients commencing on PD. Using seven disease domains, chosen to reflect the dominance of cardiovascular morbidity in the end-stage renal failure population, comorbidity was graded as '0' when absent, '1' when one or two, and '2' when three or more conditions were present. The Wright comorbidity index, which includes age within the scoring method, was also evaluated. RRF, plasma albumin and peritoneal solute transport were measured every 6 months. Patients were censored at death. RESULTS: Median survival according to grade of comorbidity was 105, 42 and 29 months, respectively (P<0.0001), with good separation of the actuarial survival curves. Using Cox regression, the addition of age and the grade of comorbidity to Kt/V(urea), solute transport and plasma albumin increased the predictive power of the model. All were independent predictors of outcome with the exception of albumin. The Wright comorbidity index also enhanced the Cox model, although was not as powerful as when age and comorbidity were considered independently. At baseline, RRF was not different according to comorbidity unless diabetes was considered separately. Diabetics started with higher RRF, but after 6 months on PD this was the same as non-diabetic patients. Otherwise, initial rate of decline of RRF was similar across the comorbid grades, although the impact of higher drop-out due to earlier loss in patients with more comorbidity may have disguised earlier loss in these patients. Peritoneal solute transport tended to be higher in patients with increased comorbidity at baseline, chi(2) 13.8, P=0.032, and this was sustained with time on treatment. CONCLUSION: Comorbidity has a quantitative effect on survival that is independent of age, RRF and membrane function in PD patients. Comorbidity also appears to be associated with increased solute transport at the start of treatment, which is sustained. With the exception of diabetes, grade of comorbidity does not have a profound effect on loss of RRF.     

An unusual penetrating injury of the cheek: a case report

The immediate management of an unusual penetrating injury of the cheek is described. The early problems that arose following operation and their management are discussed. There is very little residual disturbance of function and surgical revision of the facial scars is being deferred for the time being.     

An approach to the treatment of hand burns

Burns of the dorsum of the hand may occur in isolation or as part of a more extensive burn. In planning treatment we are guided by the general condition of the patient as well as the local condition of the hand. The depth of these burns is often in doubt and a conservative policy is often indicated.

If infection is avoided many deep burns heal spontaneously. Intensive physiotherapy from the outset reduces oedema and rapidly restores mobility. A Bunyan bag technique using sulphamylon as the antibacterial agent has minimized infection and allowed free movement of the hands.

Using this method the large majority of dorsal burns of the hands heal in 4–5 weeks and show almost normal mobility.     

上肢功能测试量表的汉化及其在脑卒中患者中的信效度研究

背景 功能评估是康复治疗的基础,可协助临床制订康复方案,提高康复效率。目前用于脑卒中后上肢功能评估的量表较少且维度单一。目的 汉化上肢功能测试量表（TEMPA）,并评价该量表在脑卒中患者中的信度和效度。方法 遵循Brislin原则,按照直译、回译、审查、文化调试、预试验的程序对英文版TEMPA进行翻译及修订,形成中文版TEMPA。于2021年8月至2022年1月招募在唐山市工人医院康复科就诊的40例脑卒中患者,评价者分别用中文版TEMPA、上肢运动功能Fugl-Meyer评定法（FMA-UE）、简易上肢功能评定量表（STEF）对患者上肢功能进行评估,并于首次评估后1周内,使用TEMPA进行第2次评估。采用组内相关系数（ICC）检验TEMPA各维度的评估者内信度和评估者间信度;采用Cronbach’s α系数检验TEMPA的内部一致性信度;对患者的中文版TEMPA各维度总分和各条目得分分别与FMA-UE、STEF得分进行Pearson相关分析,检验TEMPA的效标效度。结果 TEMPA功能评级总分的评估者内信度ICC=0.992,TEMPA功能评级总分的评估者间信度ICC=0.982。T...     

Dickkopf-1 in ankylosing spondylitis: Relation to spinal dysmobility and radiographic findings

Back groundDickkopf-1 (DKK-1) is an inhibitory molecule that regulates Wnt pathway, which is critically important in osteoblastic new bone formation, therefore it may play a role in the process of new bone formation in Ankylosing Spondylitis (AS).Aim of the workTo measure serum level of DKK-1 in AS patients and study the relation between these levels with disease activity, spinal dysmobility and radiographic findings.Patients and methodsThirty AS patients as well as 20 healthy subjects as a control group were included in this study. DKK-1 serum levels were measured using ELISA technique, disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, radiographic assessment by Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).ResultsDKK-1 was not correlated to ESR, CRP or BASDAI (p > 0.05) and was negatively correlated to BASRI-s and mSASSS (p < 0.001), though DKK-1 serum level was unexpectedly higher in patients versus control (p < 0.001). On comparing HLA-B27 positive and HLA-B27 negative patients, there were a significant increase in BASRI-s and mSASSS and decrease in DKK-1 level in those with positive HLA-B27 (p < 0.05). On comparing patients received anti TNF therapy and those not received anti TNF therapy, there was no significant difference in DKK-1 level (p > 0.05).ConclusionOur finding suggests dysfunction of DKK-1 in patient with AS.     

阿托伐他汀对缺血性脑卒中患者血管内皮生长因子和一氧化氮的影响

目的:探讨不同剂量阿托伐他汀对缺血性脑卒中患者血清血管内皮生长因子(VEGF)、一氧化氮(NO)的影响。方法:83例缺血性脑卒中患者随机分为两组:治疗Ⅰ组43例,常规治疗基础上口服阿托伐他汀20 mg/d;治疗Ⅱ组40例,常规治疗基础上口服阿托伐他汀10 mg/d。治疗4周后观察疗效,并测定治疗前、后患者血清VEGF和NO水平的变化。结果:治疗4周后,两组神经功能缺损评分差异有统计学意义(P<0.05);治疗Ⅰ组总有效率(93.0%)明显高于治疗Ⅱ组(80.0%)(P<0.05)。治疗后两组血清VEGF和NO表达均有增强,与治疗前比较差异均有统计学意义(P均<0.05),治疗Ⅰ组提高更为明显,与治疗Ⅱ组比较差异均有统计学意义(P<0.05)。结论:阿托伐他汀20 mg/d可明显提高缺血性脑卒中患者血清VEGF和NO水平,从而达到治疗和预防脑卒中的目的。     

颈动脉粥样硬化易损斑块影像学诊断研究进展

缺血性脑卒中具有较高的发病率、致残率、死亡率及高复发率,颈动脉易损斑块是其主要原因.因此早期正确诊断易损斑块,对于急性脑卒中的防治具有重大意义.该文从超声、CT、MRI、脑血管造影等方面对易损斑块的诊断进展进行综述.