ABSTRACT
Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.
ABSTRACT
Objective:To systematically evaluate the efficacy and safety of precision thoracic radiotherapy (TRT) in the limited-stage small cell lung cancer (LS-SCLC) patients by network meta-analysis.Methods:Randomized controlled trials (RCTs) of TRT regimes in the LS-SCLC were electronically searched from PubMed, Web of Science, The Cochrane Library, CNKI and Wanfang Data from inception to September 1 st, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed by Stata 17 and R 4.1.1 software. Results:A total of 6 RCTs involving 1730 patients with six radiation regimens including hyperfractionated radiotherapy (HFRT): HFRT 45(45 Gy/30 F) and HFRT 60(60 Gy/40 F); conventional fractionated radiotherapy (CFRT): CFRT 70(70 Gy/35 F) and CFRT 66(66 Gy/33 F); moderately hypofractionated radiotherapy (MHFRT): MHFRT 65(65 Gy/26 F) and MHFRT 42(42 Gy/15 F) were included. The network meta-analysis showed that: in terms of improving progression-free survival and overall survival, there was no statistically significant difference among the six radiotherapy regimens. The probabilistic ranking results were: MHFRT 65> HFRT 60>CFRT 66>CFRT 70>MHFRT 42>HFRT 45, and HFRT 60>MHFRT 65>CFRT 66>CFRT 70>HFRT 45>MHFRT 42, respectively. The HFRT 60 regimen was superior to other regimens in reducing the incidence of grade ≥3 pneumonia, and there was no difference between the regimens in causing grade ≥3 radiation esophagitis, and the results of ranking probability were: HFRT 60> MHFRT 42>CFRT 66>CFRT 70>HFRT 45>MHFRT 65, and HFRT 60>CFRT 70>CFRT 66>HFRT 45>MHFRT 42>MHFRT 65, respectively. Conclusions:HFRT 60 radiotherapy regimen may be more effective and safer in the treatment of LS-SCLC patients as a priority choice for LS-SCLC TRT. Limited by the number and quality of included studies, the above conclusions need to be verified by more high-quality studies.
ABSTRACT
Objective:To investigate the effect of teriparatide on residual back pain (RBP) after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF).Methods:A retrospective cohort study was used to analyze the clinical data of 90 OVCF patients sustaining RBP after PKP admitted to Second Affiliated Hospital of Kunming Medical University from September 2015 to March 2019, including 18 males and 72 females, at age of 57-85 years［(68.0±5.9) years］. Teriparatide treatment was applied regularly in 32 patients (teriparatide group) and antiosteoporosis drug was administered routinely in 58 patients (routine treatment group). Visual analogue scale (VAS) and Oswestry disability index (ODI) were compared between the two groups before operation, at 24 hours, 1 month, 3 months, 6 months and 12 months after operation. Anterior vertebral body height (ABH), middle vertebral body height (MBH), kyphosis angle (KA), maintenance rate of anterior vertebral body height (MRABH), maintenance rate of middle vertebral body height (MRMBH) and difference of kyphosis angle (DKA) were measured at 24 hours and 12 months after operation to evaluate the maintenance of vertebral height and incidence of vertebral refracture. Levels of type I collagen carboxy-terminal peptide (β-CTX) and serum N-terminal osteocalcin (N-MID) were measured before operation and at 12 months after operation to evaluate the improvement of bone metabolism. The adverse reactions of teriparatide group were observed.Results:All patients were followed up for 12-36 months［(14.3±0.6)months］. VAS and ODI were decreased gradually with time in both groups (all P<0.01). There were no significant differences in VAS between the two groups before operation and at 24 hours after operation (all P>0.05). Teriparatide group showed VAS of (4.4±0.6)points, (3.2±0.5)points, (2.0±0.5)points, (1.1±0.1)points at 1, 3, 6 and 12 months after operation, significantly lower than those in routine treatment group［(4.9±0.6)points, (4.0±0.6)points, (3.2±0.7)points, (2.7±0.1)points, respectively］(all P<0.01). Teriparatide group showed ODI of 26.5±1.3 and 20.6±1.2 at 6 months and 12 months after operation, significantly lower than those in routine treatment group (28.2±1.6, 23.6±1.6) (all P<0.01). There were no significant differences in ODI between the two groups at other time points (all P>0.05). Both groups presented significantly lowered levels of ABH and MBH at 12 months after operation as compared with those at 24 hours after operation (all P<0.01). There were no significant differences in ABH or MBH between the two groups at 24 hours after operation (all P>0.05). ABH, MBH, MRABH and MRMBH in teriparatide group were (1.9±0.2)cm, (1.7±0.2)cm, 0.91±0.02 and 0.92±0.02 at 12 months after operation, significantly higher than those in routine treatment group［(1.7±0.2)cm, (1.6±0.2)cm, 0.86±0.02 and 0.87±0.02］(all P<0.01). KA in both groups showed significant increase at 12 months after operation as compared with that at 24 hours after operation (all P<0.01). There was no significant difference in KA between the two groups at 24 hours after operation ( P>0.05). KA in teriparatide group was (7.3±0.7)° at 12 months after operation, significantly lower than (9.5±0.5)° in routine treatment group ( P<0.01). DKA in teriparatide group was (5.3±1.3)° at 12 months after operation, significantly lower than (6.6±1.4)° in routine treatment group ( P<0.01). Incidence of vertebral refracture in teriparatide group was 7% (2/32), significantly lower than 35% (15/58) in routine treatment group ( P<0.05). Level of β-CTX was not significantly different between and within the two groups before operation and at 12 months after operation (all P>0.05). There was no significant difference in N-MID between the two groups before operation ( P>0.05). After treatment for 12 months, level of N-MID in teriparatide group was significantly increased［19.5 (17.6, 20.9)pg/ml］as compared with that before operation［18.2 (14.6, 21.0)pg/ml］( P<0.01), and was significantly higher than that in routine treatment group［17.6 (15.3, 19.9)pg/ml］( P<0.01). Routine treatment group showed no significant difference in level of N-MID before operation and at 12 months after operation ( P>0.05). Two patients in teriparatide group had orthostatic hypotension after treatment. Conclusion:For OVCF patients with RBP after PKP, teriparatide can effectively alleviate pain, improve motor dysfunction, maintain the height of bone cement vertebral body, reduce incidence of vertebral refracture and enhance the activity of osteoblasts, with less adverse reactions.
ABSTRACT
Objective:To explore the risk factors of adjacent segment diseases (ASDis) after lumbar fusion, summarize the prevention strategies and provide reference for clinical treatment.Methods:All of 258 patients who underwent lumbar interbody fusion from March 2014 to March 2019 were retrospectively analyzed, including 95 males and 163 females, the age of whom was 61.8±8.4 years (range, 39-77 years). The patients were divided into ASDis group and non-ASDis group according to whether ASDis occurred at the follow-up of 24 months after operation. The patient's individual factors [gender, age, body mass index (BMI), main diagnosis, preoperative paraspinal muscle fatty degree, etc.] and surgical factors (operation type, fixed segment, fusion segment, etc.), sagittal parameters [lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI-LL] were recorded. After univariate analysis of potential risk factors, the factors with P<0.05 were substituted into logistic regression model for multivariate analysis to determine the risk factors of ASDis after lumbar fusion. Results:ASDis occurred in 24 patients after lumbar fusion, with an incidence of 9.3% (24/258); univariate analysis showed that age ≥ 60 years old, complicated with osteoporosis, preoperative fatty degree of paraspinal muscle (GCS grade≥3), PLIF operation, suspension fixation, total laminectomy and multi-segment fusion (≥ 3 segments) were the potential risk factors for ASDis after operation (P<0.05); Gender, education level, partner status, type of work, BMI, obesity (BMI≥24 kg/m 2) , smoking, use of bisphosphonates, concomitant lumbar spinal stenosis, lumbar lordosis angle, pelvic incidence angle, pelvic tilt angle, sacral slope angle, and PI-LL had no significant correlation with ASDis. Logistic regression analysis showed that age ≥ 60 years ( OR=5.63, 95% CI: 1.56, 20.29, P=0.008), preoperative paravertebral muscle fatty GCS ≥ 3 ( OR=4.82, 95% CI: 1.36, 17.13, P=0.015), combined with osteoporosis ( OR=14.04, 95% CI: 2.53, 77.79, P=0.002), PLIF ( OR=9.69, 95% CI: 1.91, 49.03, P=0.001), and multi-segment fixation ( OR=9.36, 95% CI: 1.77, 49.41, P=0.008) were the risk factors for ASDis after lumbar fusion; Incomplete laminectomy ( OR=0.09, 95% CI: 0.02, 0.37, P=0.001) and suspension fixation ( OR=0.16, 95% CI: 0.02, 0.94, P=0.042) were the protective factors of ASDis after lumbar fusion. Conclusion:The patients with age ≥ 60 years old, osteoporosis and preoperative paraspinal muscle fatty degree ≥ 3 grade GCS should be more careful in choosing the surgical methods, and try to choose transforaminal interbody fusion, posterolateral fusion, short segment fusion, decompression with preservation of vertebral lamina, suspension fixation and other surgical methods to reduce the incidence of postoperative ASDis.
ABSTRACT
Objective To explore the correlation between thyroid function and cognitive ability in patients with subcortical arteriosclerotic encephalopathy.Methods Montreal cognitive assessment scale (Montreal Cognitive Assessment,MoCA) was used to evaluate the cognitive function of SAE patients with normal thyroid function and hypothyroidism.And the difference in the risk factors of SAE cognitive ability in patients with different thyroid functions was analyzed.Results There were no significant differences in gender,age,risk factors of hypertension,cerebral infarction,diabetes and smoking between the two groups (P＞0.05).The levels of FT3,FT4,TSH,MoCA and ADL in patients with hypothyroidism were (2.92±0.35) pmol/L,(15.61±2.76) pmol/L,(13.05± 1.64) mU/L,(12.73±5.75) points,(45.64±25.77) points,respectively.The levels of FT3,FT4 and TSH in normal thyroid function group and MoCA,ADL scores were (4.27±0.55)pmol/L,(16.74 ± 2.35) pmol/L,(2.73 ± 0.38) mU/L,(18.15 ± 5.35) points,(62.17 ± 26.72) points,respectively.The data of the hypothyroidism group was significantly lower than thst in the normal thyroid function group,and the difference was statistically significant (t =3.591,3.012,12.753,8.967,15.442,P＜0.05).FT3 levels in SAE patients were positively correlated with MoCA score and ADL score (r=0.518,0.617,P=0.026,0.018),while there was no significant correlation between FT4 level and MoCA and ADL score (r =0.015,0.007,P =0.852,0.074).MoCA score and ADL score were negatively correlated with TSH level (r=-0.651,-0.582,P=0.016,0.005).Conclusion Thyroid function is significantly correlated with cognitive ability of SAE patients.Thyroid function may be a clinical index for patients with subcortical arteriosclerosis,and provide a basis for rational drug use in patients with subcortical arteriosclerosis.
ABSTRACT
ObjectiveTo study the curative effect and safety of low dose of urokinase (UK) combined with low molecular heparin calcium.MethodsSixty-four cases of sudden cardiac arrest patients were divided into treatment group and control group by random digits table with 32 cases each.Two groups were given cardiopulmonary resuscitation according to the 2005 international guide for cardiopulmonary resuscitation and emergency cardiovascular care.Early in the recovery,the patients in treatment group were pumped in vein with low dose of UK(200 000 U) and injected subcutaneous with low molecular heparin calcium (4100 U ) in 30 minutes.The rate of return of spontaneous circulation (ROSC),survival rate longer than 24 hours and 30 days in two groups and patients dying of bleeding or bleeding conditions in treatment group were observed.ResultsThere were 11 cases (34.4％) of ROSC in control group,and compared with 20 cases (62.5％) in treatment group,there was significant difference (P＜0.05).There were 5 cases (15.6％) of survival longer than 24 hours in control group,and compared with 13 cases(40.6％) in treatment group,there was significant difference (P ＜ 0.05 ).There were 2 cases (6.2％) of survival 30 days in control group,and compared with 8 cases (25.0％) in treatment group,there was significant difference (P＜ 0.01 ).Nobody had subcutaneous bleeding or other organ hemorrhage in control group.But there was I patient who had subcutaneous limited ecchymosis in the injection site in treatment group.The difference of fibrinogen before and after treatment in treatment group was statistically significant(P ＜ 0.01 ),but there was no significant difference in prothrombin time and platelet count before and after treatment in treatment group (P ＞ 0.05).ConclusionsIt is safe and effective in cardiopulmonary resuscitation with low dose of UK combined with low molecular heparin calcium.
ABSTRACT
ObjectiveTo observe prophylactic effect and reliability of warfarin n preventing recurrant ischemic stroke.Methods168 patients identified as ischemic stroke admitted in Chaozhou Central Hospital from March 2001 to May 2004 were randomly divided into 2 groups,warfarin group and ticlopidine group (set as control).82 cases were in warfarin group,receiving warfarin 0.75~2.25mg/d orally.Prothrombin and international normalized radio (INR) were monitored,and INR was 1.5~2.0.86 cases were in ticlopidine group;they received 250mg/d ticlopidine orally.All patients were followed up every monty for 3 years,and recurrent ischemic stroke and drug side-effect were documented.ResultsThere were 8 cases (9.76%) of recurrence in warfarin group and 26 cases (30.02%) of recurrence in ticlopidine group.There was statistically significant difference between the two groups (P