Outcomes after occupational therapy intervention for traumatic brachial plexus injury: A prospective longitudinal cohort study

Study DesignProspective longitudinal cohort study.IntroductionTraumatic brachial plexus injuries (BPIs) can be devastating and negatively impact daily function and quality of life. Occupational therapists play an important role in rehabilitation; however, studies identifying outcomes are lacking.PurposeThis study aims to describe outcomes including motor recovery, upper limb function, participation, pain, and quality of life for people receiving occupational therapy intervention.MethodsA convenience sample of English-speaking adults (n = 30) with a traumatic BPI, attending the clinic between December 1, 2014, to November 30, 2016, participated. Participants received occupational therapy focusing on sensorimotor retraining and activity-based rehabilitation. Data on active range of motion (goniometry), strength (Medical Research Council (MRC)), upper-limb function (UEFI15, QuickDASH), participation (PSFS), pain (Brief Pain Inventory), and quality of life (EQ-5D-3L) were collected at baseline, 3, 6, 9, and 12 months.ResultsElbow flexion strength showed significant improvement at all time-points, average increase 2.17 (MRC) (95% confidence interval: 1.29-3.04; P < .001) and mean final MRC grading 3.86 (standard error: 0.44). Significant improvements at 12 months were seen in: shoulder abduction strength and range, flexion strength and range, external rotation range; elbow extension strength and flexion range; thumb flexion and extension strength. Upper limb function (QuickDASH) showed significant improvement (mean change = 18.85; 95% confidence interval: 4.12-33.59; P = .02). Forearm protonation range and finger flexion strength were significantly worse. Remaining outcomes did not show significant improvement.ConclusionsOccupational therapy with surgical intervention can improve strength, range, and upper limb function with people following traumatic BPI. Further investigations into impact on participation, pain, and quality of life are required.     

Pain-related somatosensory evoked potentials following CO2 laser stimulation in peripheral neuropathies

Pain-related somatosensory evoked potentials (pain SEPs) following CO2 laser stimulation were examined in 30 patients with peripheral neuropathies, and the results were compared with clinical sensory findings. Pain SEP findings showed a significant correlation with the clinical impairment of pain sensation, but not with the impairment of deep sensations. In contrast, conventional electrically-stimulated SEPs (electric SEPs) showed a significant correlation with deep sensations, but not with the impairment of pain sensation. Examinations of both pain SEPs and electric SEPs, therefore, are considered to be very useful to evaluate physiological functions of sensory nerves in patients with peripheral neuropathies.     

Plasma C3c in immune-mediated neurological diseases: a preliminary report

Plasma C3c levels were examined in 56 patients with immune (27) and non-immune (29) mediated neurological diseases by crossed immunoelectrophoresis. Plasma samples were collected during the active phase of illness in both groups, usually within 7 days of admission. 11 patients (4 Guillain-Barré Syndrome-GBS, 3 chronic inflammatory demyelinating polyneuropathy-CIDP, 4 myasthenia gravis-MG) had their plasma saved sequentially during the active and the recovery phase. Plasma C3c levels were elevated in the group with immune mediated diseases when compared with those of non-immune mediated diseases. The sensitivity and specificity of C3c as a diagnostic test for immune mediated neurological diseases were 61.4 and 100% respectively with a positive and negative predictive value of 100 and 41%. the C3c levels in plasma correlated well with disease severity in MG and GBS patients. Such a correlation was also evident in all CIDP patients except one that had persistent elevation in the presence of clinical improvement. Results suggest that the plasma C3c level may be useful for differentiating immune from non-immune mediated neurological diseases. Plasma C3c may also be used for monitoring disease severity, particularly in myasthenia gravis.     

福欣康林与维生素B12治疗糖尿病周围神经病变的疗效比较

2型糖尿病伴糖尿病肾病患者应用福欣康林（46例）和维生素B12（46例）治疗4周。福欣康林改善自发性疼痛、肢体麻木、神经反射和神经传导速度的好转率均明显高于维生素B12且未引起明显的不良反应。     

p38丝裂原活化蛋白激酶在糖尿病大鼠神经病理性痛中的作用

目的探讨p38丝裂原活化蛋白激酶（p38MAPK）在链脲菌素诱导的糖尿病大鼠神经病理性痛中的作用。方法雌性Wistar大鼠31只，3月龄，体重180～220g，随机分为3组：对照组（C组，n=10）、糖尿病神经病理性痛组（D组，n=11）和p38MAPK抑制剂组（Ⅰ组，n=10）。D组、Ⅰ组单次腹腔注射链脲菌素65mg／kg制备糖尿病模型。糖尿病模型制备成功后，Ⅰ组尾静脉注射p38MAPK抑制剂SB203580 0．5mg／kg，1次／周，连续4周；C组和D组尾静脉注射等体积的生理盐水。给药4周后，测定机械缩足反应阈值（MWT）、左侧坐骨神经传导速率（NCV）、背根神经节（DRG）和脊髓的磷酸化p38MAPK水平。结果与C组比较，D组、Ⅰ组MWT下降，NCV减慢，伴有脱髓鞘现象，DRG和脊髓的磷酸化p38MAPK水平升高；与D组比较，Ⅰ组MWT升高，NCV增快，脱髓鞘程度减轻，DRG和脊髓的磷酸化p38MAPK水平下降。结论p38MAPK信号转导通路参与了糖尿病大鼠神经病理性痛的形成。     

12例腰椎间盘突出合并腰骶神经背根节嵌压

目的：了解腰椎间盘同合并腰骶神经背根节（ＤＲＧ）嵌压的机制。方法：１２例腰椎间盘突出患者术中发现：髓核切除后神经根张力仍较大并固定,沿神经根探查发现腰骶神经ＤＲＧ充血并肿大,直径０．８－１．２ｃｍ,平均１．１ｃｍ。嵌压物为增生的上关节突和增生肥厚的关节囊韧带。１２例病人共探查１５个ＤＲＧ,其中位于椎间孔６例,椎管和椎间孔交界７例,椎间孔外２例同时合并腰神经在椎间孔外嵌压。     

慢心律联合丹参治疗糖尿病周围神经病变的疗效观察

目的 :为糖尿病周围神经病变探讨有效的治疗方法。方法 :选择 65例糖尿病周围神经病变患者 ,随机分为两组 ,一组为慢心律治疗组 ,另一组为慢心律联合丹参注射液治疗组 ,以临床表现改善客观指标及运动传导速度 (MCV)、感觉传导速度 (SCV)测定做为判定标准。结果 :两组经治疗 4wk后 ,慢心律组总有效率为76 7% ,慢心律联合丹参注射液组总有效率为 94 3 %。两组肌电图显示神经传导异常率均下降 ,而以慢心律联合丹参注射液组作用较强 (P <0 0 5 )。结论 :慢心律联合丹参注射液治疗糖尿病周围神经病变更有效     

Autonomic involvement in inherited neuropathies

The inherited peripheral neuropathies constitute a large group of disorders, in some of which the causative metabolic defect has been identified whereas in the majority it is still unknown. Amongst the former, autonomic involvement is an important component in porphyric neuropathy, in the familial amyloid polyneuropathies, in Fabry's disease and in dopamine-hydroxylase deficiency. The latter group includes the hereditary sensory and autonomic neuropathies in some of which, such as the Riley-Day syndrome, autonomic disturbances are prominent, whereas in others they constitute only a minor component of the symptomatology. Autonomic dysfunction is an important component of the neurological manifestations in multiple endocrine neoplasia type IIB.     

大鼠实验性长期糖尿病周围神经病的诱发及其形态学观察

目的：制备大鼠实验性长期糖尿病周围神经病(DNP)模型，观察其周围神经的形态学改变。方法：链脲佐菌素(STZ)注射造模后维持5个月，电镜下观察腓肠神经超微结构改变，光镜下计数有髓神经纤维。结果：STZ糖尿病大鼠出现了血糖及糖化血红蛋白升高、体重下降和多食多饮多尿，周围神经出现了髓鞘明显变性即髓鞘板层结构破坏和瓦勒氏变性，但有髓神经纤维计数无明显变化。结论：模型成功地维持了5个月，STZDNP大鼠周围神经主要形态学改变为髓鞘变性。     

针刺对糖尿病大鼠坐骨神经过度非酶性糖基化的调节

目的　神经蛋白的非酶性糖基化水平异常升高是糖尿病神经病变的重要病理机制之一 ,本文旨在探讨针刺防治糖尿病神经病变的疗效是否与改善坐骨神经蛋白非酶性糖基化水平有关。方法　将腹腔注射链脲佐菌素造成血糖高于 16.7m m ol/ L 的糖尿病大鼠分为模型对照组、针刺治疗组和胰岛素治疗组 ,另设正常组 ,每组 6-7只。造模四周末开始治疗 ,针刺组隔日治疗 1次 ;胰岛素组每天皮下注射胰岛素 ( 4U/ 10 0 g) ,共治疗 2个月。其间动态监测血糖 ,并采用竞争性 AGE EL ISA法测定坐骨神经中 AGEs含量。结果　在造模 6周末 ,针刺组和胰岛素组大鼠的空腹血糖水平比模型组略有降低 ,没有统计学意义 ,而在 12星期末均比模型组明显降低 ( P<0 .0 5 ) ;模型组坐骨神经 A GEs水平为 0 .34 6± 0 .0 5 9U/ ml,比正常组( 0 .197± 0 .0 2 7U/ ml)明显升高 ,而针刺组 ( 0 .170± 0 .0 2 7U/ m l)和胰岛素组 ( 0 .194± 0 .0 34 U/ ml)均比模型组明显降低 ( P<0 .0 5 ) ,与正常组相比无统计学差异 ( P>0 .0 5 )。结论　在糖尿病的早期给与针刺或胰岛素治疗可以防止坐骨神经 AGEs含量的异常增加和积聚 ,使之接近正常水平。说明电针可以通过遏制 AGEs的形成和积聚 ,达到防治糖尿病神经病变的发生发展