Neurodynamic Techniques Versus “Sham” Therapy in the Treatment of Carpal Tunnel Syndrome: A Randomized Placebo-Controlled Trial

Objective

To evaluate the efficacy of neurodynamic techniques used as the sole therapeutic component compared with sham therapy in the treatment of mild and moderate carpal tunnel syndromes (CTS).

日本积水公司血浆全程C-反应蛋白胶乳免疫比浊法最低检测限和功能灵敏度的确认

目的 对日本积水医疗株式会社全程CRP检测试剂盒的最低检测限和功能灵敏度进行确认。方法 参照相关文献,用日本积水医疗株式会社全程C-反应蛋白检测试剂盒和雅培生化分析仪对空白样本和系列稀释的低浓度样本进行C-反应蛋白检测,计算吸光度均值、标准差和变异系数,确定该方法的检测低限和功能灵敏度。结果 日本积水医疗株式会社全程C-反应蛋白检测试剂盒的最低检测限0.21 mg/L,功能灵敏度0.27 mg/L。结论 各实验室进行hs-CRP检测时,应自行建立所用方法的最低检测限和功能灵敏度,以保证检测结果能够满足临床对心血管疾病危险评估的需要。     

基于正常行走模式的功能性电刺激对脑卒中患者行走功能即时影响的随机对照研究

目的:通过三维步态分析系统,观察基于正常行走模式的功能性电刺激(FES)对脑卒中患者行走功能的即时影响,为其临床应用及推广提供依据。方法:将符合入组条件的47例脑卒中患者随机分为电刺激组(16例)、安慰电刺激组(15例)和对照组(16例)。电刺激组给予基于正常行走模式设计的四通道FES助行仪治疗,患者戴机行走5min;刺激肌肉分别为偏瘫侧胫前肌、股四头肌、腓肠肌及腘绳肌。安慰电刺激组的电刺激位置及行走时间与电刺激组相同,行走(5min)过程中没有电流输出;对照组不给予电刺激,只让患者行走5min。三组患者分别在治疗前及治疗5min后接受三维步态检查,并对结果进行分析。结果:三组组内治疗后与治疗前比较:电刺激组的步行周期、支撑时间、步行速度、步频、踝背伸角度、踝关节触地时角度均有改善(P0.05);安慰电刺激组仅在踝关节背伸和踝关节触地时角度有改善(P0.05);对照组所有参数均无改善,且跨步长缩短、踝关节背伸角度降低(P0.05)。三组组间比较:治疗后只有触地时踝关节背伸角度差异有显著性意义(P0.05)。进一步进行治疗前后变化率的组间比较,发现三组患者患侧步行周期、支撑时间、步行速度、步频、步长、跨步长、触地时踝关节背伸角度的差异均有显著性意义(P0.05)。结论:应用基于正常行走模式的FES治疗5min即可改善脑卒中患者的即时步行功能,长期效果尚待研究。     

静息态fMRI在无痴呆型血管性认知障碍基线脑活动变化中的初步研究

目的 利用基于低频振幅算法(ALFF)的静息功能磁共振成像(fMRI)技术探讨无痴呆型血管性认知障碍(VCIND)与正常老年人静息状态下默认网络的改变情况.方法 将22例VCIND患者作为研究对象,23名正常老年人作为对照组,采用ALFF分析方法,比较两组平均脑ALFF图的差异.结果 VCIND患者在静息状态下较对照组在以下脑区ALFF值增高:左额下回/左颞上回(Maximum Z=-4.0682)、右额下回/右颞上回(Maximum Z=-3.9720)、左侧岛叶(Maximum Z=-3.5773);VCIND组患者在以下脑区出现ALFF值减低:舌回/小脑后叶(Maximum Z =3.8921)、前扣带皮层(Maximum Z=3.8081)、右楔叶/右舌回(Maximum Z=4.8272)、后扣带回/楔前叶(Maximum Z=3.9741)(P＜0.05).结论 VCIND患者在静息状态下ALFF有显著改变,主要表现为语言中枢等认知区域的局部ALFF增强及默认网络等功能连接点的ALFF减低.     

图片命名任务在额颞叶激活区的fMRI研究

目的 通过功能磁共振成像(fMRI)分析图片命名(PN)任务在额颞叶激活情况.方法 19例健康志愿者,其中男8例,女11例,平均年龄(29.5±11.3)岁.在3.0T GE M750 MR上对被试者进行PN任务状态下的血氧水平依赖(BOLD) fMRI,采用组块设计方案,利用SPM8软件进行预处理和统计参数分析.结果 额颞叶主要激活区有双侧颞上回(BA22)、颞中回(BA21)、左侧额下回(BA47)、左侧梭状回(BA37),其最大激活区为左侧梭状同(BA37),激活体素为1 165,激活强度为4.48,主要负激活区有左侧颞上回(BA22)、右侧额上回(BA10)、左侧额中回(BA10).结论 PN刺激方案能有效激活额颞叶相关语言功能区,量化激活强度,技术简单可行,便于临床应用.     

排便造影动态观察盆底形态对功能性出口梗阻所致便秘的诊断价值

目的探讨仅在排便过程中才表现出来的直肠、肛管的一系列功能性异常. 资料与方法通过钡灌肠,于坐位进行排便,动态下透视、点片. 结果 520例中,发现直肠黏膜脱垂、套叠416例,直肠前突281例,盆底及会阴下降229例,盆底肌失弛缓综合征170例,盆底疝113例,骶直分离等其他盆底病变43例.合并上述两项以上病变者多见. 结论排便造影动态观察盆底形态是较传统的钡灌肠、临床指诊、内镜检查更为敏感可靠的方法,能为临床诊治功能性出口梗阻所致便秘等肛肠疾病及选择手术治疗提供可靠的依据.     

Tau and amyloid β proteins distinctively associate to functional network changes in the aging brain

Introduction

Misfolded tau and amyloid β (Aβ) proteins progressively accumulate in the human brain, causing altered neuronal function and neurodegeneration. This study sought to investigate whether the wide spectrum of functional reorganization in aging brains of cognitively normal individuals relates to specific pathological patterns of tau and Aβ deposits.

Individual prediction of chronic motor outcome in the acute post‐stroke stage: Behavioral parameters versus functional imaging

Several neurobiological factors have been found to correlate with functional recovery after brain lesions. However, predicting the individual potential of recovery remains difficult. Here we used multivariate support vector machine (SVM) classification to explore the prognostic value of functional magnetic resonance imaging (fMRI) to predict individual motor outcome at 4–6 months post‐stroke. To this end, 21 first‐ever stroke patients with hand motor deficits participated in an fMRI hand motor task in the first few days post‐stroke. Motor impairment was quantified assessing grip force and the Action Research Arm Test. Linear SVM classifiers were trained to predict good versus poor motor outcome of unseen new patients. We found that fMRI activity acquired in the first week post‐stroke correctly predicted the outcome for 86% of all patients. In contrast, the concurrent assessment of motor function provided 76% accuracy with low sensitivity (<60%). Furthermore, the outcome of patients with initially moderate impairment and high outcome variability could not be predicted based on motor tests. In contrast, fMRI provided 87.5% prediction accuracy in these patients. Classifications were driven by activity in ipsilesional motor areas and contralesional cerebellum. The accuracy of subacute fMRI data (two weeks post‐stroke), age, time post‐stroke, lesion volume, and location were at 50%‐chance‐level. In conclusion, multivariate decoding of fMRI data with SVM early after stroke enables a robust prediction of motor recovery. The potential for recovery is influenced by the initial dysfunction of the active motor system, particularly in those patients whose outcome cannot be predicted by behavioral tests. Hum Brain Mapp 36:4553–4565, 2015. © 2015 Wiley Periodicals, Inc .     

Early‐life adversity,epigenetics, and visceral hypersensitivity

Abdominal pain is associated with many gastrointestinal dysfunctions, such as irritable bowel syndrome (IBS), functional dyspepsia, and inflammatory bowel disease (IBD). Visceral hypersensitivity is a key reason for development of abdominal pain that presents in these gastrointestinal disorders/diseases. The pathogenesis of visceral hypersensitivity is complex and still far from being fully understood. In animal studies, visceral hypersensitivity has been linked to several early‐life adverse (ELA) events. In humans, IBD, functional dyspepsia, and IBS can have adult onset, though the adverse events that lead to visceral hypersensitivity are largely uncharacterized. In this issue of the journal, Aguirre et al. report the interesting finding that epigenetics underlies the effects of ELA events on visceral hypersensitivity. This mini‐review examines models of ELA events leading to visceral hypersensitivity and the potential role of epigenetics, as reported by Aguirre et al. and others.     

精神病托管机构抗精神病药物使用情况调查

目的了解北京市朝阳区精神病托管中心抗精神病药物使用情况,为托管机构患者的药物管理提供参考。方法选取2017年6月在北京市朝阳区精神病托管服务中心住院、符合《国际疾病分类(第10版)》(ICD-10)精神疾病诊断标准并接受抗精神病药物治疗的患者为研究对象,采用自编调查问卷收集患者的社会人口学资料、临床诊断及用药情况。结果共197例患者纳入研究,其中使用单一抗精神病药物的患者共180例(91. 4%),联合使用两种及以上抗精神病药物的患者17例(8. 6%)。使用频率最高的抗精神病药物前五位依次是氯丙嗪[54例次(25. 0%)]、氯氮平[37例次(17. 1%)]、氟哌啶醇[26例次(12. 0%)]、利培酮[23例次(10. 6%)]和舒必利[22例次(10. 2%)]。接受第一代抗精神病药物治疗的患者病程(Z=-3. 260,P0. 05)和住院时间更长(Z=-3. 531,P0. 01)。Logistc回归分析显示:住院时间是使用第一代抗精神病药物的相关因素(β=0. 099,OR=1. 104,95%CI=1. 033～1. 179,P0. 05)。结论北京市朝阳区精神病托管中心住院患者以使用单一抗精神病药为主,使用第一代抗精神病药物更多,住院时间长的患者倾向于使用第一代抗精神病药物。