彩超在下肢深静脉血栓中的临床应用研究

目的分析彩超在诊断下肢深静脉血栓中的临床应用其价值。方法选取58例患有下肢深静脉血栓的患者作为研究对象,对58例患者采取彩超检查,分析其检查结果。结果研究发现,58例患者的静脉血栓部位分布情况为：7例双下肢,20例右下肢,31例左下肢,58例患者的深静脉血栓情况均通过彩超诊断而被证实。结论在下肢深静脉血栓的临床诊断中,彩超检查具有无创、安全、准确等优点,且该检查方法可重复进行,对下肢深静脉血栓的临床诊断具有重要意义。     

顺行穿刺腔内治疗在下肢动脉硬化闭塞症中的应用价值及疗效观察

目的：对应用顺行穿刺腔内治疗技术对患有下肢动脉硬化闭塞症的患者实施治疗的临床效果进行研究。方法：抽取94例患有下肢动脉硬化闭塞症的患者,随机分为对照组和治疗组,平均每组47例。对照组采用常规下肢动脉硬化手术方式实施治疗;治疗组采用顺行穿刺腔内治疗技术实施治疗,穿刺成功后将6F血管鞘置入,并外接压力袋,加入肝素的平衡液灌注线持续高压滴注,通过造影进一步明确动脉狭窄的实际程度和具体部位,外周静脉给予5000IU肝素,用超滑微导丝配合微导管插入病变血管狭窄段的远端,对狭窄段进行扩张处理,扩张时间应该持续60s左右,尽量进行一次性扩张处理;对比两组患者的治疗效果。结果：治疗组患者下肢动脉硬化闭塞症治疗效果明显优于对照组;下肢功能复常时间和接受治疗总时间明显短于对照组;治疗前后下肢功能评分改善幅度明显大于对照组;围手术期不良反应率明显低于对照组。结论：应用顺行穿刺腔内治疗技术对患有下肢动脉硬化闭塞症的患者实施治疗的临床效果非常明显。     

彩色多普勒超声在糖尿病患者下肢血管病变中的应用

目的探讨彩色多普勒超声在糖尿病患者下肢血管病变中的应用价值。方法选择2010年10月至2012年12月期间广东省人民医院院收治的2型糖尿病患者96例作为研究组,另选同期在我院进行健康体检者100名作为对照组。采用彩色多普勒超声诊断仪对两组受检者行下肢动脉血管血流动力学检测。比较分析两组受检者下肢动脉血管病变发生情况以及下肢动脉血流变学情况。结果与对照组比较,研究组2型糖尿病患者硬化斑块、血管狭窄以及血管闭塞等下肢动脉血管病变的发生率均明显提高,分别达63．54％、23．96％和11．46％,两组组间差异均有统计学意义（P〈0．05）。与此同时,与对照组比较,研究组下肢股动脉、胭动脉、胫动脉以及足背动脉血管内径均明显缩小,血流量均明显减少,频谱宽度均明显提高,两组间差异均有统计学意义（P〈0．05）。结论彩色多普勒超声在2型糖尿病患者下肢血管病变的早期诊断、治疗以及相关并发症的预防中均具有重要的临床应用价值。     

Therapeutic efficacy of tocilizumab in patients with rheumatoid arthritis refractory to anti-tumor-necrosis-factor inhibitors: 1 year follow-up with low-field extremity MRI

Abstract

Objective Tocilizumab (TCZ) is effective in patients with rheumatoid arthritis (RA) who are refractory to anti-tumor-necrosis-factor (anti-TNF) biologics. The Rheumatoid Arthritis Society Disease Activity Score in 28 Joints (DAS28) is used to evaluate the response to TCZ. However, DAS28 is inappropriate marker because TCZ normalizes C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in the early stage of treatment. The aim of our study was to test the usefulness of magnetic resonance imaging (MRI)-based markers of response to TCZ treatment.

Methods Nine patients with RA who were refractory to anti-TNF inhibitors (six to infliximab, one to etanercept, one to adalimumab, and one to both) were assessed. MRI images of both hands were obtained by low-field extremity MRI at baseline, 20, and 44 weeks of treatment, in addition to assessment with DAS28–ESR. The effect of TCZ on RA was examined by compact MRI score (cMRIS).

Results All patients showed good or moderate response to TCZ treatment, as evaluated by significant reduction in DAS28–ESR at both 20 and 44 weeks (p < 0.001, each, relative to baseline). In contrast, MRI-based indexes (e.g., cMRIS, synovitis, edema, erosion scores) improved significantly at 44 weeks but not at 20 weeks.

Conclusion Differences in response to TCZ therapy were determined based on the method of evaluation, suggesting that MRI-based markers are potentially useful for evaluating RA response to TCZ therapy.     

Kinematic comparison of the wrist movements that are possible with a biomechatronics wrist prosthesis and a body-powered prosthesis: a preliminary study

Purpose: This study examined the kinematic differences between a body-powered prosthesis and a biomechatronics prosthesis as a transradial amputee performed activities that involve flexion/extension and supination/pronation of the wrist.

Method: The subject’s wrist movements were calculated and compared as he completed a wrist range of motion test involving simulated flexion/extension and supination/pronation.

Results: The results revealed that, under the test conditions, the body-powered prosthesis limits an individual’s ability to complete four different tasks of wrist movement especially when it comes to complete the supination/pronation movement. Conversely, while using biomechatronics wrist prosthesis, the user was able to compensate for limited wrist motion through an ability to achieve a greater range of wrist movement.

Conclusions: The biomechatronics wrist prosthesis provides a greater degree of freedom of wrist flexion/extension and supination/pronation movements.

Implications for Rehabilitation

• Body powered prosthesis for transradial amputees involved the wrist movement that focus on flexion/extension and supination/pronation.

• The biomechatronics wrist prosthesis is a combination of controller that controlled the servo motor at the wrist.

• The biomechatronics wrist prosthesis provides a greater degree of freedom of wrist flexion/extension and supination/pronation movements compare to the body powered prosthesis.

     

Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke

Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke. Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice. Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years. Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2?cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the “hot spot” of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20?min. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered. Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size. Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. While there were no significant correlation between changes in cortico-motor excitability and RTG kinematics, the decrease in cortico-motor excitability of the non-lesioned hemisphere showed a strong correlation with an increase in cross-correlation coefficient. Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation.

Implications for Rehabilitation

• Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance.

• The preliminary results have important implications for the use of LF-rTMS as conjunctive intervention for stroke rehabilitation.

     

以肺栓塞为首发表现的高嗜酸粒细胞综合征一例并文献复习

目的 分析高嗜酸粒细胞综合征伴多发血栓形成的临床特征,提高临床对嗜酸粒细胞增多导致血栓性疾病的认识.方法 以“嗜酸粒细胞增高、血小板减少、深静脉血栓形成”为中文关键词,“hypereosinophilic,thrombocytopenia,deep vein thrombosis"为英文关键词检索2002年1月-2012年1月万方数据库和Pebmed数据库的相关文献,共获得9篇,其中中文5篇,英文4篇,排除未明确诊断的2篇文献,共纳入7篇,报道了8例患者,其中男5例,女3例,年龄24-75岁,结合文献报道的病例特点及本病例特征进行文献复习.结果 患者男,27岁,以胸痛气短伴痰中带血起病,经胸部强化CT确诊肺栓塞,同时有下肢深静脉血栓形成,实验室检查提示血嗜酸粒细胞增高和血小板下降.结合文献嗜酸粒细胞增高可损伤血管内皮细胞,导致多发动静脉血栓形成,抗凝同时应用糖皮质激素治疗有效.结论 高嗜酸粒细胞综合征是嗜酸粒细胞增多症的一种,临床以多器官受累为表现,伴多发血栓形成,抗凝治疗同时应用皮质激素可降低嗜酸粒细胞计数,减少其血管内皮损伤对血栓形成的影响.     

探讨动员后外周血单个核细胞治疗糖尿病下肢动脉缺血性疾病的疗效及机制

目的分析研究动员后PBMC治疗糖尿病其下肢动脉缺血性的疾病治疗机制以及疗效。方法选取2011年1月到2011年12月在本院接受治疗的糖尿病下肢动脉缺血性疾病的患者50例（为观察组）,另外选取非糖尿病性的下肢动脉缺血性疾病患者60例（为对照组）,接受研究的两组人员都行骨髓干细胞的动员后自体PBMC移植治疗。并计数两组动员之前与之后PBMC数以及CD34+,再观察研究两组治疗之前、治疗之后七天以及治疗之后四个月的临床疗效的评分（组织缺损、冷痛以及无痛行走距离、静息痛）。结果其两组人员治疗之后的四个月其组织缺损、冷痛以及无痛行走距离、静息痛的评分比质量之前更低,P小于0.05;观察组动员前PBMC治疗其糖尿病下肢动脉缺血性疾病其疗效显著。结论其动员后自体单个核细胞的移植对于治疗糖尿病性下肢动脉的缺血性疾病有着非常好的效果。     

临时腔静脉滤器在产后下肢深静脉血栓形成患者中的应用

目的探讨临时性腔静脉滤器在治疗产妇合并急性深静脉血栓形成患者中的必要性及安全性。方法对46例产妇明确诊断有急性深静脉血栓形成患者,选择27例放置临时腔静脉滤器预防肺栓塞,辅以取栓、溶栓等综合治疗,术后随访。结果27例均成功置入临时性腔静脉滤器,置入时间15～41天,平均24天,取出时拦截有血栓17例（62.9％）,24例（88.8％）在预期时间一次取出。3例（11.1％）因拦截有较大血栓经再次溶栓后取出,取出后随访3～6个月,并行抗凝治疗,未发生致命性肺栓塞。结论临时性腔静脉滤器能有效减少产妇合并急性深静脉血栓形成患者患病治疗期间肺栓塞发病率及死亡率,并能避免永久性滤器置放的中远期并发症。     

16层螺旋CT血管成像对下肢动脉硬化性闭塞症的诊断价值

目的：探讨16层螺旋CT血管成像（MDCTA）对下肢动脉硬化性闭塞性疾病的诊断价值。方珐：比较25例临床疑有下肢动脉硬化性阻塞性病变患者的16层螺旋CT血管成像与数字减影血管造影（DSA）检查表现。以DSA表现作为金标准,来评估16层螺旋CT血管成像的临床价值。其中,CTA技术采用最大密度投影（MIP）和容积再现（VR）两种后处理方法。结朵：25例病例共263支动脉纳入本研究。其中,DSA发现193支狭窄或闭塞的血管（47支轻度狭窄,12支中度狭窄,20支重度狭窄,114支闭塞）;16层螺旋CTA发现192支狭窄或闭塞的血管（55支轻度狭窄,12支中度狭窄,24支重度狭窄,101支闭塞）。对于腹主动脉至足背动脉间中度及其以上狭窄（50％～100%）的血管,CTA的敏感度、特异度和准确度分别为87．7％、92．3％、89．7％;对于腹主动脉至胭动脉间中度及其以上狭窄（50％-100％）的血管,CTA的敏感度、特异度和准确度分别为92％、91．8％、91．9％。结论：16层螺旋CT血管成像是评估下肢动脉狭窄及闭塞程度的一种可靠的检查方法。