Résumé
Objective To systematically review the clinical efficacy of botulinum toxin A for the treatment of upper limb spasticity after stroke. Methods PubMed,EMbase,Cochrane Library,CBM, China National Knowledge Internet (CNKI),and Wanfang Data were retrieved by a computer. The randomized controlled trials and Case-control study of comparing botulinum toxin A combined with rehabilitation training and routine rehabilitation treatment for upper limb spasticity after stroke were collected. The retrieval time was from the foundation of the database to September 1,2016. At least two reviewers conducted literature screening,data extraction,and quality evaluation according to the inclusion and exclusion criteria. The Rev-Man 5. 3 software provided by the Cochrane Collaboration was used to conduct the Meta-analysis. Results A total of 356 articles were retrieved. Finally,11 articles met the inclusion criteria. The modified Jadad score showed that the scores of 9 articles were more than 4,which belonged to high-quality literature. Eleven articles included 614 patients,in which 316 were treated with botulinum toxin A. There were 298 patients in the control group. The results of Meta-analysis indicated that the Fugl-Meyer score (SMD =0. 94,95% CI 0. 75 to 1. 12),modified Ashworth score (SMD = - 1. 59,95% CI - 1. 78 to - 1. 40),and modified Barthel index (SMD = 0. 86,95% CI 0. 65 to 1. 08)in the botulinum toxin treatment group were superior to the control group. There were significant differences (all P 0. 05). Conclusion The efficacy of treatment of upper limb spasticity after stroke with botulinum toxin A is exact,and the security is high. The appropriate rehabilitation training can effectively improve the limb motor function,muscle tension,and quality of life of patients.
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Objective:To study the effect of the three kinds of EE on the cognitive function and the expression of SYN and MAP-2,and the dentritic growth of pyramidal cells of the cerebral cortex in rats.Method:Forty-eight male SD rats were divided into preserving the physique EE group (EE1),preserving the spirit EE group (EE2),preservation for both physique and spirit EE group(EE3) and standard group (SE),12 rats in each group.Rats were put into the three kinds of EE or standard cages after pre-training.The environmental enrollment lasted for 14 days and followed by a 6-days Morris water maze test.After the Morris water maze test,all the rats were sacrificed for histological study,including using the immunohistochemistry method to detect the expression of SYN and MAP-2,and using the Golgi-Cox staining to study the dentritic growth of pyramidal cells in cerebral cortex.Result:In the Morris water maze,the EE3 group exhibited shorter escape latency than the MCAO+SE group (P<0.05) on day 5,while no significant differences were seen for the time spent in the target quadrant among the 4 groups (P> 0.05).The results of immunohistochemical staining of SYN showed that the expression of SYN was the lowest in the SE group,and there was no significant difference between EE1 and EE3 groups but significantly higher than the EE2 group.The expression of MAP-2 was the lowest in the SE group,and there was no significant difference of expression between EE1 and EE2 groups but significantly lower than the EE3 group.The results of Golgi-Cox staining showed that there was no difference of the dentritic branch among groups in mPFC (P> 0.05) while the spine density of the EE1 group was significantly greater than that of the SE and EE2 groups (P < 0.05),but significantly lower than that of the EE3 group (P < 0.05).Conclusion:Two weeks of preservation from both physique and spirit EE can improve the cognitive function,and promote the expression of MAP-2 and SYN and the dentritic growth of pyramidal cells in normal rats.
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ObjectiveTo study the characteristics and explore risk factors of traffic injuries in Wenzhou part of the Ningbo-Taizhou-Wenzhou (Yong-tai-wen for short) highway during 2005-2009 so as to provide scientific evidence for promoting prevention and cure level of highway traffic injury.Methods The original data of traffic accident in Wenzhou part of the Yong-tai-wen highway during 2005-2009 were collected to carry out the descriptive epidemiological investigation of the injury characteristics.Simultaneously,multi-factor analysis was conducted to screen out the risk factors for traffic accidents.Results A total of 308 traffic accidents involving 603 casualties (157 deaths) were interviewed during 2005-2009.The casualties from expressway traffic accidents declined yearly,but annual death rate was still very high (26.04%).Meanwhile,the males were more likely subjected to traffic injuries than females.The most common injury sites were the head and limb and the main fatal injuries were the head and pelvic injuries.Accident-prone period was from 0:00 to 8:00 in the morning and traffic scenarios were mainly characterized by rear collision (39%).Risk factors for traffic accidents included poor lighting conditions,overloaded vehicles on the road sections,male drivers,driving without a license,fatigue driving and speeding.ConclusionsTraffic accidents present high incidence and casualty rates,and are mainly resulted from overloaded and fatigue driving.Therefore,the training and education on safe driving should be done particularly for the males and low driving age drivers to strictly forbid the overload driving,fatigue driving or overspeed driving.
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Objective To investigate the risk factors for nosocomial infections in rehabilitation department of a general hospital. Methods The infection rate, underlying diseases and infection sites were retrospectively reviewed in 1243 patients hospitalized in rehabilitation department of the Second Affiliated Hospital of Wenzhou Medical College from July 1, 2004 to June 30, 2008. Risk factors were determined by multivariate analysis with Logistic regression. Results The infection rate and the frequency of nosocomial infections in rehabilitation department were 18. 34 % (228/1234) and 21. 40 % (266/1243), respectively. Patients with spinal cord injury and those with cerebrovascular diseases accounted for 41.67% (95/228) and 31. 14% (71/228) of the total nosocomial infections, respectively. Urinary tract and lower respiratory tract were the frequent infection sites. The incidence of nosocomial infections was correlated with underlying diseases, age, length of stay, invasive operation, nutrition, sensory or movement disturbance and dysphagia. Conclusions Rehabilitation department has high nosocomial infection rate. Relevant risk factors should be carefully monitored to prevent or reduce the occurrence of the infections.