柴半六合汤对慢性肾衰竭合并胃肠道症状患者胃泌素、胃动素及生长抑素的作用

目的:观察柴半六合汤对慢性肾衰竭(CRF)合并胃肠道症状患者的作用以及对胃泌素(GAS)、胃动素(MTL)及生长抑素(SS)的影响。方法:将60例CRF合并胃肠道症状患者随机分为两组,治疗组30例给予柴半六合汤,对照组30例给予尿毒清颗粒口服,2月后观察两组疗效、实验室指标以及血浆GAS、MTL及SS的变化。结果:临床综合疗效治疗组90.0%,明显优于对照组73.3%;治疗组治疗后胃肠道症状有明显改善或缓解,与对照组相比差异有统计学意义(P<0.05)。治疗组的血尿素氮(BUN)、肌酐(Scr)、GAS和MTL水平下降,内生肌酐清除率(Ccr)、及SS水平提高,与对照组比较差异均有统计学意义(P<0.05或P<0.01)。结论:柴半六合汤能调节胃肠激素水平,减轻CRF患者胃肠道症状,延缓CRF的进展。     

精神分裂症患者语音信号的临床分析

背景：语音参数是精神分裂症生物学指标研究的一个全新领域,其中一些已被证明与情感反应相关,情感反应是精神分裂症患者显著受限制的一个特点,特别是对那些具有突出阴性症状的患者。
　　目标：评估慢性精神分裂症患者的选择性语音参数与临床症状严重程度之间的关系,并比较患者与所匹配的健康对照者的这些特征。
　　方法：对26例住院慢性精神分裂症患者（入组时和一周后）和30名健康对照者（仅在入组时）通过电话采集的15分钟语音样本,对该样本进行10项语音测量参数的评估,包括6个语音韵律参数、共振峰带宽和振幅、以及2个频谱特征。采用阳性与阴性症状量表(Posiitve and Negaitve Syndrome Scale)、阴性症状评估量表(Scale for the Assessment of Negaitve Symptoms)、临床总体印象量表-精神分裂症分量表(the Clinical Global Impression-Schizophrenia scale)分别在基线和1周后进行患者临床特征的评估。
　　结果：患者组症状在1周的时间间隔中保持稳定,并且10项语音参数的前后一周重测信度良好（内部相关系数[intraclass correlation coefficient, ICC]介于0.55到0.88之间）。语音参数中6项韵律参数、共振峰带宽和振幅参数在患者组和对照组之间没有显著差异,但2项光谱参数在组间有差异：患者组美尔频率倒谱系数(the Mel-frequency cepstral coefficient, MFCC)评分显著低于对照组,并且患者组的线性预测系数(linear prediction coding, LPC)评分显著高于对照组。在患者组中,在10个本研究所考虑的语音参数和17个所考虑的临床参数之间构成的170个相关性中,有10个达到了p<0.05的统计学显着性水平（相关系数>0.40)。结论：这项研究支持了语音参数具有作为精神分裂症阴性症状严重程度指标（即,生物指标）的潜在价值,但在这些语音参数的潜在效用获充分评估前,我们需要对更多样化的患者进行更大样本量、更详细的随访研究。     

腕管综合征主要症状体征敏感性与特异性的比较

目的　比较腕管综合征 (carpaltunnelsyndrome ,CTS)主要症状、体征的敏感性与特异性。方法　对 10 1例 ( 162只手 )进行症状严重程度与功能状况的询问 ,感觉、运动功能的检查 ;其中 62只手在术后 6周再次测定。结果　 162只患手中 15 8只具有典型症状 ( 98% )。Phalen征、前臂正中神经加压征、Semmes Weinstein单丝纤维测试阳性率分别为 98%、96%、82 %。 87%的患手出现肌力下降 ,拇短展肌肌力测定 (定量法 )结果显示 ,与徒手法相比 ,不同性别间、术前与术后的差异均具非常显著意义 (P <0 .0 1)。结论　典型症状、Phalen征、前臂正中神经加压征、拇短展肌肌力变化的敏感性与特异性最高 ,拇短展肌肌力定量法测定是判断腕管综合征严重程度、评定疗效的一个良好的客观指标。     

万艾可治疗ED时对BPH引起LUTS改善的研究

目的 :探索、研究万艾可在治疗阴茎勃起功能障碍 (ED)时对由良性前列腺增生 (BPH)引起的下尿路症状(LUTS)的影响。　方法 :32例ED同时伴有BPH的研究对象 ,采用IIEF 5问卷表和IPSS评分表 ,在服用万艾可前和服药后 6个月分别各填写一次 ,应用单因素方差分析对所得到的前后评分进行统计学分析。结果 :在服药前32例ED中 ,轻、中、重分别为 14、13、5例 ,BPH中轻、中、重分别为 3、15、14例 ;服药后IIEF 5评分平均上升4 2 .36 % ,IPSS评分平均下降 2 0 .14 % ,两者在统计学上都有显著性差异 ,P <0 .0 1。　结论 :在治疗中老年性ED合并BPH中 ,应用万艾可既能治疗ED ,取得完美的性生活 ,又能达到改善由BPH引起的LUTS。万艾可是一治疗ED有效的药物 ,但对于前列腺基质平滑肌亦有辅助性松弛作用 ,因此也有助于BPH时LUTS的缓解。     

"锚定法"改良单开门椎管成形术及其临床应用

目的评价“锚定法”改良单开门椎管成形术的疗效。方法对129例颈椎病患者常规行后正中入路单开门椎管成形术,在门轴一侧的侧块上选择钻孔点,采用Magerl方法置入直径为3.5mm、长度10~12mm的钛质松质骨螺钉。先将粗丝线系在螺钉的根部,螺钉置入侧块后将丝线一端经棘突根部的预穿孔穿过,开门后拉紧丝线并打结,使椎板保持在开门状态。术后颈围领保护2周。结果平均随访14个月(6~18个月)。术前平均JOA评分7.8分、40分法评分14.5分,术后平均JOA评分15.5分、40分法评分35.5分。术后2个月时颈部疼痛、僵硬感和活动受限者轻度84例、中度32例、重度13例。术后6个月时仅23例仍然有轻度颈部疼痛、僵硬感和活动受限。未见螺钉松动和再“关门”现象。结论“锚定法”改良单开门椎管成形术操作简单、维持“开门”效果好。术后患者颈部症状恢复快,早期效果满意。     

Long-term impacts of different posterior operations on curvature,neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy

Purpose

To investigate the long-term impacts of different posterior operations on curvature, neurological improvement and axial symptoms for multilevel cervical degenerative myelopathy (CDM), and to study the relationship among loss of cervical lordosis, recovery rate and axial symptom severity.

Methods

We retrospectively reviewed 98 patients with multilevel CDM who had undergone laminoplasty (Group LP, 36 patients), laminectomy (Group LC, 30 patients), or laminectomy with lateral mass screw fixation (Group LCS, 32 patients) between January 2000 and January 2005. Loss of curvature index (CI) was measured according to the preoperative and final follow-up radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. Axial symptom severity was quantified by Neck Disability Index (NDI).

Results

Analysis of final follow-up data showed significant differences among the three groups regarding loss of CI (F = 41.46, P < 0.001) between preoperative and final follow-up JOA scores (P < 0.001), final follow-up JOA score (F = 7.81, P < 0.001), recovery rate (F = 12.98, P < 0.001) and axial symptom severity (χ² = 18.04, P < 0.001). Loss of CI showed negative association with neurological recovery (r = −0.555, P < 0.001) and positive correlation with axial symptom severity (r = 0.696, P < 0.001).

Conclusions

Excellent neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while loss of CI in groups LP and LC caused a high incidence of axial symptoms. Loss of CI was correlated with poor neurological recovery and axial symptom severity. Lateral mass screw fixation can effectively prevent loss of postoperative cervical curvature and reduce incidence of axial symptoms.     

Analysis of youtube as a source of information for peripheral neuropathy

Introduction: YouTube is an important resource for patients. No study has evaluated the information on peripheral neuropathy disseminated by YouTube videos. In this study, our aim was to perform a systematic review of information on YouTube regarding peripheral neuropathy. Methods: The Web site ( www.youtube.com ) was searched between September 19 and 21, 2014, for the terms “neuropathy,” “peripheral neuropathy,” “diabetic neuropathy,” “neuropathy causes,” and “neuropathy treatment.” Results: Two hundred videos met the inclusion criteria. Healthcare professionals accounted for almost half of the treatment videos (41 of 92; 44.6%), and most came from chiropractors (18 of 41; 43.9%). Alternative medicine was cited most frequently among the treatment discussions (54 of 145, 37.2%), followed by devices (38 of 145, 26.2%), and pharmacological treatments (23 of 145, 15.9%). Conclusions: Approximately half of the treatment options discussed in the videos were not evidence‐based. Caution should be exercised when YouTube videos are used as a patient resource. Muscle Nerve 53 : 27–31, 2016     

MDS-UPDRS to assess non-motor symptoms after STN DBS for Parkinson's disease

Objective: To determine if the non-motor sections of the Movement Disorder Society's (MDS) version of the Unified Parkinson's Disease Rating Scale (UPDRS) could supplement the original UPDRS as a patient completed assessment of changes in non-motor symptoms in Parkinson's disease (PD) patients after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS). Methods: Thirty PD patients who underwent bilateral STN DBS were assessed using the total UPDRS and the non-motor sections of the MDS-UPDRS prior to surgery and one year following surgery. This study focuses on non-motor symptoms as assessed by Part I of the UPDRS and Part 1A and 1B of the MDS-UPDRS. Results: One year following surgery, no individual non-motor symptoms or the total mentation score of the UPDRS were significantly changed. In comparison, the MDS-UPDRS showed significant improvements in sleep and urinary problems and a trend towards improvement in anxiety, constipation, daytime sleepiness, fatigue and pain. Conclusions: This study provides evidence that the MDS-UPDRS non-motor sections, when completed by the patients, can supplement the original version of the UPDRS as an effective method of measuring changes in non-motor symptoms after DBS. It also reinforces the benefits of bilateral STN DBS on non-motor symptoms of PD.     

综合医院和精神专科医院心理咨询门诊的焦虑主诉患者症状学调查

目的:比较综合医院和精神专科医院心理咨询门诊以焦虑为主诉的患者症状学特点及相关因素。方法:采用自编调查表对以焦虑为主诉就诊于综合医院及精神专科医院心理门诊的患者进行人口学及症状学调查和分析。结果:综合医院组(449例)与精神专科医院组(972例)间性别、年龄、文化程度、婚姻、工作、经济状况比较差异有统计学意义(χ2=5.743~54.181,P0.05或P0.001)。患者例数50%的症状两组相同,依次为睡眠症状、疲劳、担忧、情绪低落、紧张、犹豫不决、急躁和心慌;紧张、犹豫不决、急躁的频数综合医院组明显高于专科医院组(χ2=6.078,χ2=4.954,χ2=4.034;P均0.05)。多元回归分析显示,初中文化、已婚、经济状况差是情绪症状影响因素(t=-1.983,t=-2.335,t=3.805;P0.05或P0.001);出生地、工作或学习、经济状况差是躯体症状影响因素(t=-3.205,t=2.469,t=4.051;P0.05或P0.001)。结论:综合医院和精神专科医院以焦虑为主诉的患者主要症状相同;综合医院患者情绪症状更突出;经济状况差是情绪及躯体症状的共同影响因素。