Hip Displacement in Cerebral Palsy: The Role of Surveillance

IntroductionHip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.Hip surveillance programmesSeveral population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients’ age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.ConclusionDespite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.     

基于DTI评价急性缺血性脑卒中运动功能缺损程度与肾虚髓亏证的相关性研究＊

目的 运用核磁共振弥散张量成像技术（DTI），从皮质脊髓束损伤程度评价的角度，探讨肾虚髓亏证与急性缺血性脑卒中运动功能缺损程度相关性，丰富中风病病机及证候诊断，拓宽缺血性脑卒中的中医药防治思路，为急性缺血性脑卒中肾虚髓亏证患者运动功能损伤程度提供临床依据，强调肾虚髓亏证在急性缺血性脑卒中运动功能损伤中的重要意义。方法 纳入符合诊断标准的90例病例，根据证候分别归入肾虚髓亏组和非肾虚髓亏组，每组各45例。每组患者均给予常规西药治疗。对两组患者入院后行弥散张量成像检测，同时分别于治疗前及治疗后14天，记录两组患者NIHSS评分、改良Barthel指数量表及简化Fugl-Meyer运动功能评分量表评分，比较两组病例发病时的轻重程度及治疗前后两组病例组间的恢复差异。结果 研究显示，治疗前肾虚髓亏组在NIHSS评分方面高于非肾虚髓亏组（P<0.05）；治疗前肾虚髓亏组在改良Barthel指数量表及简化Fugl-Meyer运动功能评分方面低于非肾虚髓亏组（P<0.05）。治疗前后NIHSS评分、改良Barthel指数评分及简化Fugl-Meyer运动功能评分改善情况，非肾虚髓亏组要优于肾虚髓亏组（P<0.05）。治疗前两组患者在健侧内囊后肢及大脑脚外侧处FA值及ADC值无明显差异；肾虚髓亏组在患侧内囊后肢及大脑脚外侧处FA值及ADC值均低于非肾虚髓亏组（P<0.05）。相关性分析得出，两组患者患侧内囊后肢FA值与患者治疗前NIHSS评分呈负相关；两组患者患侧内囊后肢FA值与患者改良Barthel指数评分及简化Fugl-Meyer运动功能评分呈正相关；肾虚髓亏组患者患侧内囊后肢FA值与肾虚髓亏证中医证候评分呈负相关。结论 肾虚髓亏是急性缺血性脑卒中运动功能障碍的重要病机。研究结果显示，两组皮质脊髓束损伤程度与神经功能及运动功能损伤存在相关性，且肾虚髓亏组在皮质脊髓束的损伤程度方面与其中医证候评分呈负相关。     

角膜电刺激对糖尿病大鼠前部缺血性视神经病变模型的影响

观察并评估角膜电刺激对糖尿病大鼠前部缺血性视神经病变（AION）模型的影响。方法：实验 研究。健康雄性Sparague-Dawley大鼠40只，随机分组后抽出8只作为正常大鼠组。余下32只先予 以链脲佐菌素腹腔注射建立糖尿病大鼠模型，将造模成功的大鼠随机抽出8只作为糖尿病组，余下 24只糖尿病大鼠采用孟加拉玫瑰红联合532 nm激光方法建立AION大鼠模型。将24只造模成功的 AION大鼠随机分成3组，每组8只，分别为AION模型组，不予任何处理；电刺激组，予以角膜电刺 激（刺激参数为：电流1 mA，频率20 Hz，波宽1 ms/phase，刺激时间1 h，隔日1次，刺激2周）；假电 刺激组，电极安放位置与电刺激组相同，仅不接通电源。2周后5组大鼠进行眼底照相、光学相干断 层扫描和视觉诱发电位，然后处死，行视网膜及视神经冰冻切片，苏木精伊红染色观察。数据采用 单因素方差分析和LSD-t检验进行分析。结果：正常大鼠组视盘上半部视网膜厚度为（211±13）μm， 糖尿病大鼠组为（206±16）μm，AION模型组为（240±54）μm，假电刺激组为（216±11）μm，电刺 激组为（198±4）μm，5组视盘上半部视网膜厚度差异有统计学意义（F=2.854，P=0.038）。其中AION 模型组视盘上半部视网膜厚度高于正常组、糖尿病组、电刺激组，差异均有统计学意义（P<0.05）； 正常组与糖尿病组差异无统计学意义，AION模型组与假电刺激组未见明显差异。视觉诱发电位示 AION模型组N1潜伏期较电刺激组延长，差异有统计学意义（t=4.1，P<0.001）；AION模型组P1潜伏 期较正常组、糖尿病组、假电刺激组、电刺激组延长，差异均有统计学意义（t=4.1、2.5、2.6、3.2， P<0.05）；电刺激组N1-P1波幅大于假电刺激组，差异有统计学意义（t=4.0，P<0.001）。结论：角膜电 刺激能促进糖尿病大鼠前部缺血性视神经病变模型肿胀的视盘变薄，加速视盘水肿的消退，同时在 一定程度上改善视功能。     

奥扎格雷联合低分子肝素钙治疗脑血栓的临床研究

目的：对应用低分子肝素钙与奥扎格雷联合对患有脑血栓疾病的患者实施治疗的临床效果进行研究。方法整群选择在该院2012年12月—2014年12月就诊的患有脑血栓疾病的患者86例，随机分为对照组和治疗组，每组43例。采用奥扎格雷对对照组患者实施治疗；采用低分子肝素钙与奥扎格雷联合对治疗组患者实施治疗。对比神经功能缺损评分在药物治疗前后的变化幅度、脑神经功能恢复正常时间和脑血栓药物治疗计划实施总时间、脑血栓疾病药物治疗效果、用药期间的不良反应人数。结果治疗组患者神经功能缺损评分在药物治疗前后的变化幅度明显大于对照组；脑神经功能恢复正常时间（9.66±2.41）d和脑血栓药物治疗计划实施总时间（13.28±2.14）d明显短于对照组（13.62±3.47）、（17.39±3.20）d；脑血栓疾病药物治疗效果（总有效率90.6%）明显优于对照组（总有效率69.8%）；用药期间的不良反应人数（1例）明显少于对照组（8例）。结论应用低分子肝素钙与奥扎格雷联合对患有脑血栓疾病的患者实施治疗的临床效果非常明显。     

Efeitos Terapêuticos da Tripla Antiagregação Plaquetária em Pacientes Femininas Idosas com Diabetes e Infarto Agudo do Miocárdio

BackgroundDual antiplatelet therapy (DAPT) is the cornerstone treatment of acute myocardial infarction (AMI).ObjectiveThe present study aimed to investigate the efficacy and safety of triple antiplatelet therapy (TAPT) in elderly female patients with diabetes and ST segment elevation myocardial infarction (STEMI), who had undergone percutaneous coronary intervention (PCI).MethodsWe designed a randomized, single-blind study. Control group A (97 elderly male patients with diabetes and STEMI, whose CRUSADE scores were < 30) received aspirin, ticagrelor, and tirofiban. A total of 162 elderly female patients with diabetes and STEMI were randomly divided into two groups according to CRUSADE score. Group B (69 patients with CRUSADE score > 31) received aspirin and ticagrelor. Group C (93 patients with CRUSADE score < 30) received aspirin, ticagrelor and tirofiban. P values < 0.05 were considered statistically significant.ResultsCompared to the findings in group A, post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow and TIMI myocardial perfusion grade 3 were significantly less prevalent in group B (p < 0.05). When compared to groups A and C, the incidence of major adverse complications was significantly higher in group B (p < 0.05).ConclusionTAPT could effectively reduce the incidence of major complications in elderly female patients with diabetes and STEMI. However, close attention should be paid to hemorrhage in patients receiving TAPT. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)     

Intraoperative cerebral blood flow monitoring in neurosurgery: A review of contemporary technologies and emerging perspectives

Intraoperative monitoring of cerebral blood flow (CBF) has become an invaluable adjunct to vascular and oncological neurosurgery, reducing the risk of postoperative morbidity and mortality. Several technologies have been developed during the last two decades, including laser-based techniques, videomicroscopy, intraoperative MRI, indocyanine green angiography, and thermography. Although these technologies have been thoroughly studied and clinically applied outside the operative room, current practice lacks an optimal technology that perfectly fits the workflow within the neurosurgical operative room. The different available technologies have specific strengths but suffer several drawbacks, mainly including limited spatial and/or temporal resolution. An optimal CBF monitoring technology should meet particular criteria for intraoperative use: excellent spatial and temporal resolution, integration in the operative workflow, real-time quantitative monitoring, ease of use, and non-contact technique. We here review the main contemporary technologies for intraoperative CBF monitoring and their current and potential future applications in neurosurgery.     

Intra-arterial administration of cell-based biological agents for ischemic stroke therapy

Introduction: Ischemic stroke is becoming a primary cause of disability and death worldwide. To date, therapeutic options remain limited focusing on mechanical thrombolysis or administration of thrombolytic agents. However, these therapies do not promote neuroprotection and neuro-restoration of the ischemic area of the brain.

Areas covered: This review highlights the option of minimal invasive, intra-arterial, administration of biological agents for stroke therapy. The authors provide an update of all available studies, discuss issues that influence outcomes and describe future perspectives which aim to improve clinical outcomes. New therapeutic options based on cellular and molecular interactions following an ischemic brain event, will be highlighted.

Expert opinion: Intra-arterial administration of biological agents during trans-catheter thrombolysis or thrombectomy could limit neuronal cell death and facilitate regeneration or neurogenesis following ischemic brain injury. Despite the initial progress, further meticulous studies are needed in order to establish the clinical use of stem cell-induced neuroprotection and neuroregeneration.     

Barriers and characteristics for successful transition to adult healthcare for individuals with cerebral palsy: a systematic review

Abstract

Background: Cerebral palsy (CP) is a common childhood disability. However, these individuals are now living longer lives, participating in adult roles, and seeking healthcare services. The transition from pediatric to adult healthcare for adolescents with CP is a challenging yet significant time. Adolescents experience several barriers during transition.

Objectives: To utilize the environmental and personal dimensions of the ICF model in order to explore barriers when transitioning to adulthood as well as discuss characteristics and physical therapy implications needed to succeed within transition.

Methods: Electronic searching of PubMed, CINAHL, ERIC, Scopus, ProQuest, and the Cochrane Library databases was concluded on January 9, 2019 for studies including transition between pediatric and adult healthcare in individuals diagnosed with CP. Two independent reviewers agreed upon inclusion, eligibility, and quality assessment of each study using the Mixed-Methods Appraisal Tool (MMAT).

Results: Seven studies were included in the systematic review. Results for each study were separated based on the personal and environmental contextual factors of the ICF model and solutions to the barriers were then discussed.

Conclusions: Research has provided proposed solutions to select barriers, however, other barriers have yet to be addressed. More research is needed to address these barriers and provide a model program that can be implemented within the healthcare systems to promote a successful transition for adolescents with CP from pediatric to adult services.     

Angiopathie amyloïde cérébrale ou atteinte des microvaisseaux cérébraux en rapport avec l’HTA : un challenge clinique

Cerebral amyloid angiopathy (CAA) is a entity characterized by degenerative Amyloïd deposits in the walls of the meningeal and cortical vessels. It is considered as the second cause of primitives cerebral hemorrhage in elderly. The differential diagnosis between AAC and hypertension-related cerebral small vessel diseases is difficult and represent a true challenge for the clinician. We report two cases of cerebral small vessel diseases revealed by malignant hypertension.