多发性硬化型脊髓炎MRI研究进展

脊髓炎是一种脊髓炎性病变导致运动、感觉及自主神经功能障碍的综合征,常常给患者带来不同程度的残疾,其主要包括疾病相关性脊髓炎和特发性横贯性脊髓炎。临床中对多发性硬化(multiple sclerosis,MS)型脊髓炎的诊断存在一定的困难,但随着神经高级影像学的快速发展,MRI已成为MS型脊髓炎诊断的重要手段。现就MS型脊髓炎MRI研究进展进行综述。     

Strategies for myelin regeneration: lessons learned from development

Myelin regeneration is indispensably important for patients suffering from several central nervous system （CNS） disorders such as multiple sclerosis （MS） and spinal cord injury （SCI）, because it is not only essential for restoring neurophysiology, but also protects denuded axons for secondary degeneration. Understanding the cellular and molecular mechanisms underlying remyelination is critical for the development of remyelination-specific therapeutic approaches. As remyelination shares certain common mechanisms with developmental myelination, knowledge from study of developmental myelination contributes greatly to emerging myelin regeneration therapies, best evidenced as the recently developed human anti-Nogo receptor interacting protein-1 （LINGO-1） monoclonal antibodies to treat MS patients in clinical trials.     

急性颅脑外伤后视神经病变23例临床诊治分析

目的探讨急性颅脑外伤后视神经病变的临床诊断与治疗方法。方法选取我院2012-01—2012-08收治的23例急性颅脑外伤后视神经病变患者为研究对象,按入院顺序分为治疗组12例,对照组11例。对照组采用常规药物保守治疗,治疗组采用颅视神经管减压术治疗。观察2组治疗后的临床疗效与不良反应。结果治疗组临床治疗效果优于对照组,差异有统计学意义（P〈0.05）。结论应用颅视神经管减压术治疗急性颅脑外伤后视神经病变临床效果显著,疗效确切,值得临床推广应用。     

胫骨远端锁定加压钢板治疗高能量Pilon骨折

目的探讨胫骨远端锁定加压钢板(LCP)治疗高能量Pilon骨折的临床疗效。方法对30例高能量Pilon骨折均行胫骨远端LCP内固定术,其中25例应用MIPPO技术治疗。结果 29例切口一期愈合,1例出现2 mm的切口边缘坏死,经换药后愈合。30例均获随访,时间8~16个月。骨折愈合时间8~24周。根据Teeny-Wiss评分系统进行评定,踝关节功能:优24例,良4例,可2例,优良率为93.3%;放射学评价:优17例,良9例,可4例,优良率86.7%。结论胫骨远端LCP治疗高能量Pilon骨折疗效满意,但应注重术前软组织处理,术中采取正确的骨折固定顺序,术后及时进行合理的功能锻练。     

光动力疗法治疗中、重度痤疮的疗效观察

目的:观察光动力疗法在中、重度痤疮治疗中的疗效及不良反应。方法:选取90例中重度痤疮患者,应用易妍光能净颜调护组结合光动力治疗仪进行治疗,对疗效及不良反应进行观察和记录。结果:经过3次光动力治疗后,90例中、重度痤疮患者,痊愈58例,显效25例,有效7例,无效0例,总有效率为92%。治疗过程中,仅有部分患者出现红斑、灼热感、轻度水肿、脱皮等不良反应,能自行缓解,且不影响后续治疗。结论:光动力疗法治疗中、重度痤疮简单、有效、安全,值得临床推广。     

重症脑梗死患者的早期肠内营养支持的应用

目的:研究重症脑梗死患者早期应用肠内营养支持对机体营养指标及胃肠道功能的临床效果。方法:对确诊为重症脑梗死的患者62例,以抽签法随机分为治疗组与对照组,分别用改良与传统方法实施鼻饲。结果:治疗组患者治疗前后血清白蛋白、非瘫痪侧上臂三头肌肌围(moveablearmmuscularcirculation,MAMC)和三头肌皮褶厚度(tricepsskinfold,TSF)等营养指标值在14d与1d比较时有统计学意义(t=2.32～11.75,P<0.05),各营养指标变化值在14d时治疗组较对照组差异有显著性意义犤血清白蛋白:(33.3±2.5)比(29.5±2.3)g/L;TSF:(13.51±2.27)比(12.35±2.13)mm;MAMC:(21.35±2.43)比(18.89±1.78)cm犦(P<0.05)。治疗组的上消化道出血、呕吐反流、腹胀和拒食等胃肠胃功能障碍的发生率均显著低于对照组(P<0.05)。结论:早期肠内营养支持可减轻重症脑梗死患者的营养状况恶化程度,有助于胃肠道功能的改善。     

Responsiveness of selected outcome measures of participation restriction and quality of life in patients with multiple sclerosis

Purpose: To evaluate the responsiveness of two outcome measures of participation restriction [as measured by the Community Integration Questionnaire (CIQ)] and quality of life [as measured by the Multiple Sclerosis Quality of Life (MSQOL)] following a physiotherapy intervention in patients with multiple sclerosis (MS). Method: A sample of 265 patients completed both instruments first at the time of initial visit and then after 4–6 weeks physiotherapy. In addition, patients were asked to complete the 7-point global rating scale as an external criterion of change at the post-intervention time. The responsiveness was evaluated using the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics were area under the ROC curve (AUC) and the minimally clinically important difference (MCID). The AUC and correlation coefficient greater than 0.70 were considered as acceptable responsiveness. Results: The CIQ achieved the acceptable responsiveness with an AUC of 0.81. However, the AUCs of 0.61 and 0.66 were obtained for the MSQOL physical and mental, respectively. Moreover, good correlation coefficient was obtained for the CIQ (Gamma?=?0.76) while fair correlations of 0.28 and 0.33 were obtained for the MSQOL physical and mental, respectively. The MCIDs were approximately 0.50, 1.5 and 2.5 points for the CIQ, MSQOL physical and mental, respectively. Conclusions: In contrast to the MSQOL, the CIQ was responsive outcome measure in detecting changes in participation restriction of patients with MS. Moreover, the MCID values obtained in this study will help the clinicians and researchers to determine if a patient with MS has experienced a true change following physiotherapy intervention.

• Implications for Rehabilitation

• The results provide valuable information regarding to the ability of two outcome measures (i.e. the CIQ and MSQOL) to detect treatment effects in patients with MS.

• In contrast to the MSQOL, the CIQ is a responsive measure to changes in participation restriction due to physiotherapy.

• A patient with MS had to change at least 0.50 point on the CIQ, 1.5 points on the MSQOL physical and 2.5 points on the MSQOL mental to be judged as having clinically changed.