强制性诱导运动疗法在偏瘫儿童中的临床应用

目的探讨强制性诱导运动疗法对偏瘫患儿功能恢复的影响。方法30例小儿脑瘫痉挛型偏瘫、颅脑外伤偏瘫患儿，随机分为治疗组和对照组。两组均进行有目的作业治疗。治疗组使用连手棉袖套限制健侧上肢。疗程12周。在治疗前1周及治疗后，用上田敏偏瘫上肢功能评价法分级与Brunnstrom偏瘫手功能评价法进行评测。结果治疗组患肢及手功能的恢复程度优于对照组。结论强制性诱导运动疗法对改善患侧肢体运动功能有显著疗效。     

Subclinical Atherosclerosis In Young β-thalassemia Major Patients

Subclinical atherosclerosis in young β-thalassemia major (β-TM) patients and its risk factors including dyslipidemia compared to type 1 diabetic patients were assessed. Ninety subjects were included and divided into three groups: group I comprised 30 β-TM patients with a mean age of 18.4 ± 6.18 years; group II comprised of 30 type 1 diabetic patients with a mean age of 19.23 ± 4.25 years, and 30 healthy subjects served as controls in group III. Fasting lipid profiles, hemoglobin (Hb) electrophoresis, serum ferritin and high resolution ultrasound for the measurement of carotid artery intima media thickness (CIMT) were done. Serum triglycerides, total cholesterol, apoprotein A (ApoA), and CIMT were significantly elevated, while high density lipoproteins (HDL) were significantly lowered in thalassemic and diabetic patients compared to controls. In thalassemic patients, CIMT was positively correlated with age, Hb F, ferritin and cholesterol levels. Atherogenic lipid profiles in young thalassemic patients with increased CIMT highlights their importance as prognostic factors for vascular risk stratification.     

Cellular and cytokine-based inflammatory processes as novel therapeutic targets for the prevention and treatment of atherosclerosis

Cardiovascular disease is the largest cause of morbidity and premature mortality and its major underlying pathology is atherosclerosis. Atherosclerosis commences with the deposition of lipids in the artery wall due to trapping by proteoglycans. Trapped lipoproteins are chemically and enzymatically modified to yield pro-inflammatory species that induce adhesion molecule expression on endothelial cells leading to the recruitment of multiple species of immune cells and a chronic inflammatory response. Ongoing remodelling of the vessel and later morphological changes generate “vulnerable” plaques, the acute rupture of which generates the clinical event.The major medical therapies are anti-hypertensives and lipid lowering agents. Although these therapies are amongst the most efficacious in cardiovascular medicine, in optimised well-controlled clinical trials the maximum effect is limited to an approximately 30% reduction in cardiovascular events. Hence, a huge burden of disease remains refractory to current therapies and atherosclerosis and its sequelae persist as a therapeutic target of immense importance.Potential therapeutic targets include the proteoglycan: lipoprotein interaction in the vessel wall, circulating and vessel wall associated atherogenic lipid species and the immune system. Anti-inflammatory therapies include specific cytokine antagonists and cytokine neutralizing antibodies, specific immune cell depleting antibodies and cell therapies using antigen specific regulatory T-cells and regulatory B-cells.In this review, we describe the process of atherosclerosis as it involves the role of chronic inflammation in the development and progression of atherosclerotic plaques and then the manner in which some of these inflammatory processes represent therapeutic targets.     

Thickened carotid intima media thickness and carotid atherosclerosis among lupus nephritis patients: the role of traditional and lupus-specific factors

Aim: The objectives of this study were to investigate the frequency of thickened carotid intima media thickness (CIMT) and atherosclerosis among lupus nephritis (LN) patients and to study their associated risk factors. Method: In this cross‐sectional study, carotid ultrasonography was performed on consecutive LN patients to determine CIMT and presence of carotid plaques. CIMT was considered to be abnormally thickened if it was more than the 75th percentile matched for age and sex from the ‘Carotid Atherosclerosis Progression Study’. The association between thickened CIMT with traditional cardiovascular risk factors and lupus characteristics were examined. A total of 83 patients with the mean age of 33.6 ± 10 years were recruited. Results: Fourteen patients (16.9%) had thickened CIMT and three (3.6%) had carotid plaques. On univariate analysis, traditional risk factors significantly associated with thickened CIMT (P < 0.05) were patient’s current age, diabetes mellitus and waist circumference. Meanwhile, a lower serum C4 levels and higher serum C‐reactive protein levels were the lupus‐specific factors associated with thickened CIMT (P < 0.05, P < 0.05 and P < 0.01, respectively). In logistic regression analysis, the independent predictors of thickened CIMT were age of diagnosis, lower serum C4 levels and waist circumference (P < 0.05). Conclusion: More lupus specific factors were independently associated with thickened CIMT, suggesting that a multi‐targeted approach of treatment addressing both the lupus and traditional cardiovascular risks are very important. Larger prospective studies of these special risk factors are indicated.     

Urinary miRNA-377 and miRNA-216a as biomarkers of nephropathy and subclinical atherosclerotic risk in pediatric patients with type 1 diabetes

Background

Urinary microRNAs (miRNAs) play a role in the pathogenesis of chronic kidney disease (CKD).

强制诱导运动对脑卒中患者运动功能及胰岛素抵抗的影响

目的：探讨强制诱导运动治疗（CIMT）对无糖尿病病史的空腹血糖正常的脑卒中患者运动功能及胰岛素抵抗的影响。方法：脑卒中住院患者30例,随机分为CIMT组和对照组各15例,2组患者均进行运动平板训练、步行练习、上下楼梯训练、运动再学习疗法等常规康复治疗,CIMT组患者同时健侧下肢每日穿戴改良膝夹板≥90％清醒时间,治疗前后对2组患者进行Fugl-Meyer运动功能（FMA）、Barthel指数（BI）、Berg平衡量表（BBS）评定以及测定稳态模型胰岛素抵抗指数（HOMA-IR）值。结果：治疗4周后,2组患者HOMA-IR值较治疗前比较差异无统计学意义;2组FMA、BBS及BI评分均较治疗前明显提高（均P〈0．05）,且CIMT组显著高于对照组（均P〈0．01）。结论：CIMT对空腹血糖正常的脑卒中患者胰岛素抵抗无影响,但能有效改善脑卒中患者下肢运动功能、日常生活活动能力及平衡能力。     

维持性腹膜透析患者颈动脉粥样硬化程度及相关危险因素分析

目的研究终末期肾功能衰竭（ESRD）行维持性腹膜透析患者颈动脉粥样硬化程度及相关危险因素分析。方法选择75例终末期肾功能衰竭行维持性腹膜透析患者为PD组及46例健康对照者为对照组。检测血红蛋白（Hb）、血尿素氮（BUN）、血肌酐（SCr）、白蛋白（ALB）、总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、C反应蛋白（CRP）、血钙（Ca）、血磷（P）、甲状旁腺激素（PTH）、血压;用彩色多普勒超声测量双侧颈动脉内中膜厚度（CIMT）及斑块情况。结果PD组患者和对照组CIMT分别是（0．84±0．12）mm和（0．53±0．04）mm,PD组的CIMT较对照组明显增厚（P〈0．05）,PD组和对照组颈动脉粥样斑块发生率分别是36％和13％,PD患者组斑块的发生率明显高于对照组（P〈0．05）。CIMT和斑块发生率与下列因素相关：分别是年龄（r=0．46,P〈0．001）,CRP（r=0．51,P〈0．05）,ALB（r=-0．29,P〈0．05）。结论维持性腹膜透患者颈动脉粥样硬化发生率明显高于正常对照组;除传统的人危险因素外,我们认为尿毒症内环境紊乱、微炎症状态、营养不良等也是加速粥样硬化过程的重要因素。     

Combination of early constraint-induced movement therapy and fasudil enhances motor recovery after ischemic stroke in rats

Purpose: Constraint-induced movement therapy (CIMT) is a promising technique for the recovery of upper extremity movement in chronic stroke patients. However, the effectiveness of its use in acute ischemia has not been confirmed. Myelin-associated inhibitors, which have upregulated functions in tissues affected by acute focal infarction, limit axonal regeneration via activation of the Rho–Rho-associated protein kinase (ROCK) pathway. The present study examined whether early CIMT combined with the ROCK inhibitor fasudil promotes motor recovery after acute ischemic stroke. Materials and Methods: Rats were trained to perform the skilled-reach test and then subjected to middle cerebral artery occlusion (MCAO), producing a stroke affecting the preferred forelimb. Rats were assigned to one of four groups (N = 6/group): (nontreated) Control, CIMT, Fasudil, or CIMT+fasudil. CIMT and/or intraperitoneal infusion of fasudil were initiated 1 day postMCAO. Skilled reach and foot fault test data were collected once before and repeatedly over 4 weeks after the operation. Infarct volumes were calculated. Results: All four groups showed similar forelimb impairment before treatment. The performance of CIMT alone group was similar to that of controls on both tests. Fasudil alone facilitated recovery in the foot-fault test, but not in the skilled-reach test. Rats in the CIMT+fasudil group demonstrated enhanced recovery in both tests, including better performance over time than the Fasudil group on the foot-fault test. Infarct size did not differ significantly between the groups. Conclusions: Early CIMT promotes motor recovery after acute ischemic stroke when it is administered with fasudil pharmacotherapy, but not without it.