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Objective :To analyze therapeutic effect of early standardized swallowing rehabilitation training combined acupuncture on patients with dysphagia after stroke .Methods :A total of 98 patients with dysphagia after stroke were selected ,randomly and equally divided into swallowing training group (received early standardized swallowing rehabilitation training) and combined treatment group (received acupuncture based on swallowing training group ). All patients were assessed by Scores of Kubota＇s water drinking test and Ichiro Fujishima dysphagia score and its re‐ sults were compared between two groups before and three months after treatment .Results :Compared with before treatment ,there was significant reduction in score of Kubota＇s water drinking test ,and significant rise in Ichiro Fu‐jishima dysphagia score after three‐month treatment in two groups , P＝0.001 all .Compared with swallowing train‐ing group after three‐month treatment , there was significant reduction in score of Kubota＇s water drinking test [ (1.83 ± 0.74) scores vs.(1. 41 ± 0. 63) scores] ,and significant rise in Ichiro Fujishima dysphagia score [ (8. 96 ± 1.23) scores vs.(9. 86 ± 1. 04) scores] in combined treatment group , P＜0.01 both .Dysphagia recover‐to‐normal rate of combined treatment group was significantly higher than that of swallowing training group (69.39% vs. 42. 6%, P＝ 0. 008 ).Conclusion : Early standardized swallowing rehabilitation training combined acupuncture can help to improve Clin symptoms and enhance therapeutic effect in patients with dysphagia after stroke .
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Objective To evaluate the efficacy and safety of percutaneous transluminal angioplasty and stenting of intravascular stenting (PTAS) and internal medicine in the treatment of secondary severe stroke in young patients with severe symptomatic middle cerebral artery stenosis.Methods The clinical data of 77 cases with severe symptomatic middle cerebral artery stenosis(ste nosis rate≥70％)confirmed by digital subtraction angiography(DSA) were collected retrospectively in our hospital from January 2011 to June 2015.The patients were divided into PTAS group and medical treatment group,and the data were collected including the modified Rankin Score (mRS score) at admission,the US National Institutes of Health Stroke volume neurological impairments score (NIHSS score)at admission,as well as mRS score,the recurrence of ischemic stroke,death and intracerebral hemorrhage within 1 year.Results The primary end-point rates within 30 days after enrollment in PTAS group and medical treatment group were 0％ and 5.77％ respectively,and the stroke recurrence rates within 1 year were 4.35％ and 13.46％ respectively,The differ ence was not statistically significant(P＞0.05).Meanwhile,there was no death and intracerebral hemorrhage in both two groups.The rates of mRS≤1 were 91.30 ％ and 69.23 ％ respectively in PTAS group and medical treatment group,and the difference was statistically significant (P＜0.05).The rates of mRS≤2 were 95.65 ％ and 84.62 ％ respectively in PTAS group and medical treat ment group,and the difference was not statistically significant(P＞0.05).Conclusion PTAS is safe for the severe symptomatic middle cerebral artery stenosis,and is more efficient in dectasing the risk of recurrent stroke in young population compared with medical treatment.
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Objective To investigate the best injection position and curative effect of ultrasound-guided thrombin injection (UGTI)on femoral pseudoaneurysm (FPA).Methods Review the data of FPA cases in the neurology department of southwest hospital from January 2010 to June 2015.Detailed clinical information of the patients,including the curative effect of local compression therapy,the position,meth-od,dosage and curative effect of ultrasound-guided thrombin injection were collected and analyzed.Results From January 2010 to June 2015,43 cases (1.20%)of FPA were diagnosed in 3573 patients undergoing cerebrovascular interventional operation.Local compression therapy was effective in 11 of 43 FPA patients.The remaining 32 patients who had no response to local compression therapy were treated by UGTI,and the average dosage of thrombin was (30 ±12)IU.All FPA were blocked successfully within 1 minute and without any distal em-bolism events after the first UGTI attempt.No relapse and complications occurred during the follow-up of 5 to 70 months,averagely (38.69 ± 20.79)months.Conclusion UGTI is effective for treatment of FPA who had no response to local compression therapy.Thrombin injection at position far away from the blood flow direction of pseudoaneurysm neck crevasse with ultrasound-guided could bring about highe success rate, less amount of thrombin,and less complications.
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Objective To investigate the diagnostic value of three-dimensional magnetic resonance imaging (MRV ) and digital subtraction arteriography (DSA ) in cerebral venous sinus thrombosis (CVST). Methods Twenty-nine patients with CVST admitted to the First Affiliated Hospital of the Third Military Medical University (Southwest Hospital)from January 2008 to February 2014 were enrolled retrospectively. Eleven of them were males and 18 were females. Their course of disease ranged from 3 days to 3 months. Nine patients were in the acute phase (2 weeks). All the patients were underwent magnetic resonance (MR)(T1 or T2 weighted image ),three-dimensional MRV,and DSA examinations. Results DSA detected 29 and MRV detected 24 patients. MRI revealed 12 patients had cerebral infarction and 7 had cerebral infarct and hemorrhage. On T2-weighted sequences,16 patients showed the flow void effect of venous sinus disappeared,and thromboses with different signals in the sinuses. MRV showed part development of the veins in 14 cases and no development in 10 cases,including 4 with collateral circulation. Compared with DSA,the positive detection rate of MRV was 82. 8%. The lesion sites of 3 patients involving the transverse sinus and 2 involving the sagittal sinus were not detected on MRV. Conclusion Compared with DSA,the MRV has a certain percentage of missed diagnosis rate for CVST. In clinical work,if MRV diagnosis is negative,it can not exclude the diagnosis of CVST,and further DSA examination is needed.
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The clinical internship is an important transitional period for humanistic spirit cultivation of the medical students.But in this period there are some problems exposed.For example,there is the lack of transitional link in management; the clinical instruction doctors lack educational consciousness or guidance ability,the medical students pay little attention to enhancing the individual humanistic spirit level and there is a gap between theory and practice of humanistic spirit for them.Strengthening training for students,attaching importance to training,selection and incentive of clinical instruction doctors and revising handbook of clinical internship will help to solve the problems.
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Objective To evaluate the effect of hyperbaric oxygen (HBO) therapy on pathological and ul-trastructure changes in cortical neurons after model focal cerebral isehemia. Methods Middle cerebral artery occlu-sion (MCAO) using the Zea-Longa method was administered to 48 Sprague-Dawley rats, who were subjected to cere-bral ischemia for 2 hours followed by reperfusion. They were then randomly divided into a treatment group and a con-trol group. HBO was applied to the rats in the treatment group, and any changes in the pathology and uhrastructure of neurons in the cortex were observed at preset time points. Results The infarct volume was significantly smaller inthe treatment group than in the control group, and pathological changes in brain tissue were also milder. Conclu-sions HBO could help protect cortical neurons in acute cerebral ischemia.
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Objective To study the relationship of bladder residual urine volume and renal function and urinary tract infection in patients with benign prostatic hyperplasia(BPH). Methods Eighty-one BPH eases from September 2005 to September 2008 were studied retrospectively. All the cases were divided into group A (53 cases, the residual urine volume <60 ml), group B (18 cases, the residual urine volume 60-200 ml),and group C (10 cases, the residual urine volume 200 ml). Blood urea nitrogen(BUN), serum ereatinine (Cr) and urine bacterial culture were observed. Results The BUN and serum Cr in group A, B and C were (5.90 ± 3.01) mmol/L, (90.13 ± 25.08)μmol/L, (7.85±3.53) mmol/L, (128.36 ±30.25) μmol/L and (10.57 ± 4.01)mmol/L, (152.11 ± 36.68) μmol/L, respectively. The BUN and serum Cr in group C were higher than those in group A and B (P < 0.01 or < 0.05). And there was significant difference between group A and group B (P< 0.05). The incidence of urinary tract infection in group A ,B and C was 28.3%(15/53), 44.4%(8/18), 50.0%(5/10), respectively. There was significant difference between group A and group B, C (P < 0.05). But there was no significant difference between group B and group C (P 0.05). Eacherichia was the main bacteria in urinary tract infection. Conclusion The increase of bladder residual urine volume in patients with BPH enhances renal failure and urinary tract infection.
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Neurology is an important clinical course. Because of old teaching contents,laggard teaching mode and single teaching goal,the students can not apply after learning neurology course. The curriculum reform of neurology should be carried out under the teaching thoughts of ‘student-centered and competency-based’,to make creation and development in teaching content,teaching style and teaching mode and so on,so as to complete teaching mission better.
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BACKGROUND: Botulinum toxin A has been applied to treat muscular convulsion by local injection and shows obvious effects in reducing muscular hypertonia with fewer side effects.OBJECTIVE: To assess the effect of botulinum toxin A on Meige's syndrome concerning facial convulsion, therapeutic effect, and side effects.DESIGN: Randomized self-control clinical study.SETTING: Neurological Department of Southwest Hospital Affiliated to the Third Military Medical University of Chinese PLA.PARTICIPANTS: Between June 2000 and May 2003, 24 outpatients were confirmed of having Meige's syndrome at the Neurological Department of Southwest Hospital, the Third Military Medical University of Chinese PLA and volunteered to receive botulinum toxin A (BTA) injection. Meige's syndrome was presented by convulsive eyelid closure in 10 cases, grinding teeth and smacking movement in 3 cases, involuntary blinking in 2 cases,frowning in 1 case, and mixed manifestations in 8 cases.METHODS: Totally 24 patients with Meige's syndrome were subjected to BTA injection at multiple spots of convulsive muscles by dosage of 2.5-5 U in each spot. Improvement of facial convulsion and curative effects were assessed at least once by clinical examination or telephone follow-up. Convulsion was graded in four degrees according to Cohen's scaling standard.Curative effects: [1] Complete alleviation: Convulsion was reduced to grade 0. [2] Obvious alleviation: Convulsion dropped by more than two grades. [3]Partial alleviation: Convulsion dropped by one grade. [4] Ineffective: Convulsion was not attenuated.MAIN OUTCOME MEASURES: [1] Changes of muscular convulsion intensity after BTA injection in patients with Meige's syndrome; [2] improvement of various symptoms after BTA injection; [3] side effects of BTA.RESULTS: Totally 24 patients entered the result analysis. [1] Before treatment, there were one case of grade 0- Ⅰ, 7 cases of grade Ⅱ, 10 cases of grade Ⅲ and 6 cases of grade Ⅳ, as compared to 16, 6, 2 and 0 cases, respectively, after treatment (χ2 = 95.489 4, P = 7.313 41×10-10). [2] BTA could alleviate eyelid convulsion in an average of 3 days, with curative effect reaching the peak in 2 weeks. Symptoms were found to be completely alleviated in 75% (18/24), obviously alleviated in 17% (4/24) and partially alleviated in 8% (2/24), with the total efficiency of 100%. The effective duration was 8-44 weeks with the average of 24.4 weeks. [3] Muscle weakness at the injected spot and incomplete muscular paralysis at the uninjected spots occurred for a short time after injection, but were alleviated automatically within 1-8 weeks.CONCLUSION: BTA can obviously reduce convulsive degree and enhance the effects in treating Meige's syndrome; moreover, selection of muscles to be injected into and injection spots will help reduce side effects.
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Objective To observe the effect of ecdysterone(EDS)on the level of VEGF protein in the brain,angiogenesis and neurologic function after focal cerebral ischemia in rats.Methods Rat with focal cerebral ischemia were established by occluding their middle cerebral artery.The established rats(n=36)were randomly and equally divided into EDS treatment group and ischemia group.EDS(20 mg?kg-1?d-1 for 7 d)was intraperitoneally injected into the rats of EDS treatment group 2 h after operation,and the animal of ischemia group received an intraperitoneal injection of the same solvent as in EDS group.Another 6 rats served as normal control.Rats were sacrificed in 7,14 and 21 d after operation,and the VEGF protein level and microvessel density(MVD)was detected with immunohistochemical methods and analyzed quantitatively with image system.Effect of EDS on neurologic recovery following brain ischemia were assessed using the neurologic severity scores(NSS).Results VEGF expression was not seen in normal control,and was higher in ischemia group than in the EDS treatment group at day 7 and 14,but the significant difference was only observed at day 7(P
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Objective To explore the curative effect and safety of CTLA-4Ig transgene for experimental autoimmune encephalomyelitis (EAE). Methods The adenovirus loaded CTLA-4Ig was injected into Wistar rat EAE models through the lateral cerebral ventricle. The clinical symptomatic and electrophysiological changes were observed to judge the efficiency of CTLA-4Ig. Results After injection of AdCTLA-4Ig into the lateral cerebral ventricle of Wistar rat EAE models, the time of EAE onset was delayed and the incidence rate was significantly reduced. And the transductive function tested by brain-stem auditory evoked potential (BAEP) and somatosensory evoked potential (SEP) was obviously improved. Conclusion CTLA-4Ig is effective in managing EAE.
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Objective To investigate the effectiveness,safety of the percutaneous transluminal angioplasty and stenting(PTAS) in the management of the vertebrobasilar stenosis.Methods From April 2003 to June 2004,the PTAS was performed in 28 patients with the vertebrobasilar stenosis.Results Among the 28 patients,the unilateral significant stenosis of the dominant vertebral artery was found in 18 patients,the bilateral stenosis of the vertebral artery in 4 patients,the tandem stenosis of the vertebral artery in 1 patient,the stenosis of the basilar artery in 2 patients.According to Mori's division,the type A occurred in 24 patients,the type B in 3 patients,the type C in 1 patient.The successful rate of stent implantation was 100% without any serious complication.Twenty-eight patients underwent PTAS with a mean pre-procedural vertebrobasilar stenosis of 81.3% and the residual stenosis was less than 10%.Over a mean 6-month follow-up in 17 patients,according to Malek's scale,the scale 1 was in 15 patients,the scale 2 in 2 patients.No restenosis was in 3 patients by the cerebral angiography.Conclusion PTAS in the management of the vertebrobasilar stenosis is a safe and effective method.Meanwhile,PTAS may alleviate the vertebrobasilar ischemia and prevent stroke of the vertebrobasilar system.
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Objective To detect the percentage of cultured neuron apoptosis after the neurons were treated with anoxia and specific inhibitors of protein kinase A (PKA) and protein kinase C (PKC). Methods After establishment of the model of neurons cultured under hypoxic condition, the neurons were cocultured with different concentrations of Rp-cAMP and Calphostin C, specific inhibitors of protein kinase A and C, respectively. Then neurons were cultured under an ischemic condition until the number of survived neurons, the activity of mPKA,and mPKC, and the apoptotic neurons stained by TUNEL in each group were observed. Results The activity of mPKA and mPKC significantly increased after the onset of hypoxia. With the increases in concentrations of Rp-cAMP or Calphostin C, the percentage of apoptotic neurons obviously decreased or increased, respectively. Conclusion The pathways of PKA and PKC signal transduction may participate in the hypoxic neuron injury. The functions of these two kinases are opposite for apoptotic regulation. It suggests that the signal transduction of PKA and PKC in hypoxic neurons belongs to a monophasic controlling system and the ratio of PKA to PKC in cells may determine the survival of hypoxic neurons.
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Objective To observe the effects of flunarizine on the intracerebral hemorrhage (ICH) of Wistar rats at different time points. Methods An ICH rat model was established by collagenase. The concentrations of intracellular free Ca 2+ at different time points after ICH were determined by the fluorescence detector with an indicator, Fura 2/AM. The effects of flunarizine on the concentrations at different time points were also observed. Results The concentration of intracellular free Ca 2+ began to increase at 0.5 h, increased significantly at 6 h, and peaked at 24 h (about 4 folds as high as that before hemorrhage), but began to decrease at 72 h after acute intracerebral hemorrhage. Flunarizine decreased the concentration of intracellular free Ca 2+ significantly ( P
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Objective To explore the possible mechanism by which protein kinase C (PKC) involves in the neuronal apoptosis induced by cerebral ischemia/reperfusion Methods After the model of ischemia/reperfusion was established in male Wistar rats, PKC activity, FOS protein expression and neuronal apoptosis in their brains were observed The effect of PKC inhibitor, Dengzhanghua, on above indexes were studied at the same time Results Cerebral ischemia/reperfusion resulted in transloactional activation of PKC, accompanied with the increase of FOS expression and neuronal apoptosis Dengzhanghua prevented against the above changes Conclusion Activated PKC is involved in ischemia/reperfusion induced neuronal apoptosis by regulating FOS expression
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Objective To establish a cerebral hemorrhage model in rats by local injection of type Ⅳcollagenase, and explore the factors affecting the speed and volume of hematoma formation Methods A total of 150 healthy male Wistar rats weighing from 200 to 250 g were randomly divided into 3 groups, control, collagenase, and collagenase/heparin groups Animals in those groups received injection of saline, collagenase (0 2 U/?l), and collagenase (same dose) and heparin (2 U/?l) with different volume respectively at the caudate nucleus The volume of the hematoma in the rats ( n =6 at each time point) was observed 6, 12, and 24 h, and 3, 7d after the injection Results Permeation of blood was found in 12 h after injection in control group Hematoma about 3 mm in diameter was found in 3 d after injection in collagenase group, while in collagenase/heparin group, it was found in 24 h Conclusion Cerebral hemorrhage model established by local injection of collagenase/heparin in saline solution is ideal and reliable, and the size of hematoma is in correlation with the volume of solutions injected into the brain
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Objective To explore the effect and possible mechanism of protein kinase C (PKC) on the apoptosis of cultured neurons after hypoxia Methods Model of cultured rat neurons under hypoxia condition was established. Calphostin C, an inhibitor for the catalytic subunit of PKC, at 4 different concentrations were separately cocultured for 2 h with the neurons having been cultivated under hypoxic condition for different times The activity of membrane PKC (mPKC), the expression of Bcl 2 and the situation of neuron apoptosis were studied Results With the prolonging of hypoxic time the activity of mPKC was increased significantly And the expression of Bcl 2 was decreased obviously and positive rate of TUNEL were significantly increased in a calphostin C concentration dependent manner Conclusion ① The activation of mPKC and Bcl 2 are involved in the apoptosis of neurons after hypoxia ② Hypoxia and calphostin C can aggravate the hypoxic neuronal apoptosis through the signal transduction of Bcl 2 ③ The activation of PKC can protect neuron against hypoxia
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Objective To investigate the relationship between the protein kinase A (PKA) and apoptosis of cultured neurons after hypoxia Methods Model of cultured rat neuron under hypoxia condition was established. Rp cAMP, a specific inhibitor for PKC, at 4 different concentrations were separately cocultured for 2 h with the neurons having been cultivated under hypoxic condition for different times The activity of PKA, the expression of caspase 3 and the situation of neuron apoptosis were studied Results With the prolonging of hypoxic time the activity of PKA was increased significantly And the expression of activated caspase 3 and apoptotic DNA were increased as well The positive rate of fluorescence staining and the average fluorescent intensity of caspase 3 and TUNEL were significantly decreased along with the increasing concentration of Rp cAMP Conclusion ① PKA and caspase 3 are involved in the neuronal apoptosis after hypoxia ② Rp cAMP can attenuate the hypoxic neuronal apoptosis through the signal transduction of caspase 3 ③ The activating of PKA can aggravate hypoxic neuron apoptosis
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Objective To investigate the medical cost of 70 patients with panic attack and efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment Methods The course, medical cost, types and times of main examination of all 70 patients were reviewed and analyzed The effect of SSRIs on the patients was studied with Anxiety and Depression Scale Results The 70 patients had long course, high medical cost and received many unnecessary medical examinations SSRIs were effective on patients with panic attack in light of Anxiety and Depression Scale Conclusion Patients with panic attack have long course and spend much unnecessary cost before final diagnosis SSRIs is useful and safe in the treatment of panic attack
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Objective To assess the advantages and disadvantages of urine drainage by double-J ureteral stent or by percutaneous indwelling stent for pyeloplasty. Methods A total of 62 patients who had undergone pyeloplasty (6 patients had undergone operation on both sides) were reviewed.These patients had 68 sides of drainage during operation.The therapeutic effects,relevant complications and recoveries of 31 sides with internal stent and 37 with external stent for pyeloplasty were analyzed retrospectively. Results The rate of total postoperative complications such as hematuria,urinary tract infection,anastomotic leakage of urine or stenosis and urinary salt deposit in the internal drainage group (7/31,22.6%) was remarkably lower than that of the external drainage group (17/37,45.9%), P