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Objective:To investigate the impact of group-based rehabilitation exercise on motor and non-movement symptoms of Parkinson's disease(PD).Methods:A total of 88 patients from out-patient and in-patient services at our hospital were randomly assigned to an early exercise group(E-EG), a late exercise group(L-EG), and a control group(CG)using a randomized delayed-start design.Patients in the E-EG carried out a rigorous, formal group exercise program, one hour per session, twice per week, for 18 months(May 2018-November 2019). Patients in the L-EG took part in the exercise program in the final 6-12 months of the study.We assessed outcomes using the Unified Parkinson's Disease Rating Scale(UPDRS), Parkinson's disease questionnaire-39(PDQ-39 Q), trail-making test part A & B, nine-hole peg test(9-HPT), 30 second sit to stand test(30s SST), 10 m walk test(10 m W), mini-balance evaluation systems test(Mini-BEST), Fullerton Advanced Balance(FAB)Scale and time up and go(TUG)test.Results:Compared with pre-exercise levels, patients with PD in the E-EG had lower performance in UPDRS(17.5±8.3 vs.20.0±8.6, t=-2.2, P=0.02)and lower performance in PDQ-39(27.2±2.1 vs.29.0±9.8, t=-2.6, P=0.001)after exercise.Moreover, compared with pre-exercise levels, patients with PD in the E-EG showed decreased post-exercise performance in trail-making test part B(114.2±25.5 vs.129.8±28.4, t=-2.3, P=0.02)and in 9-HPT(33.7±7.3 vs.39.6±9.3, t=-2.6, P=0.001). Conclusions:The practice of group-based rehabilitation exercise can improve movement abilities and quality of life in PD patients, especially if implemented early.Targeted rehabilitation exercise should be taken as part of the treatment strategy for PD patients as early as possible to deliver the best benefits.
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Objective:To investigate the clinical efficacy of gastrojejunal bypass surgery combined with radical gastrectomy following conversion therapy for gastric cancer with outlet obstruction.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 10 initially unresectable gastric cancer patients with outlet obstruction who were admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2019 to July 2020 were collected. There were 8 males and 2 females, aged from 41 to 59 years, with a median age of 53 years. Patients underwent 'sandwich therapy' of gastrojejunal bypass surgery combined with gastrectomy following conversion therapy. Observation indicators: (1) gastrojejunal bypass surgery and postoperative situations; (2) conversion therapy and complications; (3) radical gastrectomy and postoperative situations; (4) follow-up. Follow-up using outpatient examinations or telephone interview was conducted to detect postoperative complications, progress-free survival, tumor recurrence and metastasis up to March 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Gastrojejunal bypass surgery and postoperative situations: 10 patients received modified gastrojejunal bypass surgery combined with No.4sb lymph node dissection, without intraoperative serious complications, conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to liquid diet intake were 73 minutes(range, 60-87 minutes), 33 mL(range,20-110 mL), 3 days(range, 2-6 days), 4 days(range, 4-9 days). One patient had post-operative Clavien-Dindo grade Ⅱ complication of anastomotic bleeding, and was improved after transfusion of blood products. (2) Conversion therapy and complications: of 10 patients, 9 cases received 4 cycles of FLOT regimen. One of the 9 cases was suspended chemotherapy due to Clavien-Dindo grade Ⅱ anastomotic edema after 2 cycles of FLOT regimen. Of 10 patients, there were 6 cases with partial response and 4 cases with stable disease. Of 6 patients with partial response, 4 cases with preoperative cT4b stage were down stage to T4a stage, showing the relationship of tumor with transverse mesentery and pancreatic capsule clearer than the first exploration, 2 cases with preoperative lymph nodes fusion had shrank obviously. Of 4 patients with stable disease, 3 cases were negative for lymph nodes shranking, and the rest 1 case with tumor peritoneal metastasis diagnosed by initial laparoscopy can not be evaluated by imaging examination after chemotherapy. Two of 10 patients had Clavien-Dindo grade I complication of elevated blood glucose during the chemotherapy, which were improved after insulin therapy. (3) Radical gastrectomy and post-operative situations: 10 patients underwent radical resection after conversion therapy. Of 4 cases with stable disease, 3 cases with preoperative lymph nodes fusion showed obvious space between lymph nodes and surrounding tissues at resurgical exploration and received radical resection, 1 case with peritoneal metastasis showed abdominal wall nodelus and omental tuberosity as fibrous scars at resurgical exploration and received radical resection. The operation time, volume of intra-operative blood loss, time to postoperative first flatus, time to initial liquid diet intake, duration of total hospital stay, duration of postoperative hospital stay of 10 patients were 148 minutes(range, 95-195 minutes), 108 mL(range, 100-180 mL), 3 days(range, 2-7 days), 4 days(range, 3-9 days), 11 days(range, 10-21 days), 8 days(range, 7-16 days). Two of 10 patients had perioperative complications. Results of pathological examination of 10 patients showed the number of dissected lymph nodes as 25±6. There were 1 case of stage T1, 5 cases of stage T3, 4 cases of stage T4a. There were 1 case of stage N0, 2 cases of stage N1, 3 cases of stage N2, 4 cases of stage N3. There were 3 cases of tumor regression grade 1a, 1 case of grade 1b, 4 cases of grade 2, 2 cases of grade 3. (4) Follow-up: 10 patients were followed up for 3.9-13.0 months, with a median follow-up time of 6.0 months. The median progression-free survival time of 10 patients was 6.0 months. During the follow-up, 1 case underwent postoperative Clavien-Dindo grade Ⅱ complication of delayed gastric emptying and was improved after symptomatic treatment.Conclusion:The gastrojejunal bypass surgery combined with gastrectomy following conversion therapy for gastric cancer with outlet obstruction is safe and effective.
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Objective:To explore the curative effect of surgical treatment for Crohn′s disease (CD), to investigate the timing of surgical intervention and the choice of surgical methods.Methods:From January 1, 2016 to August 31, 2020, at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, the clinical data of 123 patients with CD and receiving surgical treatment were retrospectively analyzed, which included the type of lesion, the location of lesion, clinical manifestation, surgical method, preoperative inflammatory and nutritional indicators, postoperative recovery of digestive tract function, and the development and treatment of postoperative complications. CD was diagnosed according to Consensus opinion on diagnosis and treatment of inflammatory bowel disease ( Beijing 2018). Patient was classitied according to the Montreal Classification. Postoperative complications were graded according to the Clavien-Dindo Criteria. Mann-Whitney U test was used for statistical analysis. Results:Among 123 patients, according to the Montreal classification, two cases (1.6%) were diagnosed at ≤16 years old (type A1), 66 cases (53.7%) were diagnosed at 17 to 40 years old (type A2), and 55 cases (44.7%) were diagnosed at >40 years old (type A3). The lesions were 52 cases (42.3%) of terminal ileum (L1) type, 20 cases (16.3%) of colon (L2) type, and 51 cases (41.5%) of ileocolon (L3) type. Four cases (3.2%) were non-stenosis and non-penetrating (B1) type, 87 cases (70.7%) were stenosis (B2) type, and 32 cases (26.0%) were penetrating (B3) type. Eighteen patients (14.6%) underwent emergency surgery due to complete intestinal obstruction (10 cases), gastrointestinal perforation (five cases), gastrointestinal bleeding (two cases), and rectovesical fistula complicated with septic shock (one case). One hundred and five patients (85.4%) received selective surgery due to poor conservative treatment effects. 51 cases (41.5%) underwent traditional open surgery and 72 cases (58.5%) underwent laparoscopic surgery. Nineteen patients (15.4%) received temporary or permanent ostomy. The preoperative C reactive protein level of patients with emergency surgery was higher than that of patients undergoing selective surgery ((39.23±24.13) mg/L vs. (11.48±2.68) mg/L), while the levels of plasma albumin (ALB) and pre-ALB were lower than those of patients receiving selective surgery ((29.90±10.60) g/L vs. (38.38±8.30) g/L, (146.00±125.49) mg/L vs. (209.06±61.19) mg/L), and the differences were statistically significant ( Z=9.603, 8.754 and 7.111, all P<0.01). During the follow-up, a total of 23 cases (18.7%) developed postoperative complications, including one case of postoperative intra-abdominal hemorrhage and underwent re-operation (Clavien-Dindo grade Ⅲ complication); four cases of anastomotic leakage after operation; six cases of postoperative paralytic ileus; 11 cases of surgical site infection, all of which were Clavien-Dindo grade Ⅱ complications, and one case of deep venous thrombosis of lower extremity. No patient with severe intraoperative complication was observed, and no patients died during the operation or hospitalization. The postoperative exhaust time of patients was (3.2±1.4) d, the time of open fluid diet was (5.8±0.8) d, the length of hospital stay was (18.0±14.1) d, and the length of postoperative hospital stay was (11.2±8.8) d. Conclusions:The concept of multidisciplinary collaboration should be emphasized in the treatment of CD. Surgical treatment can effectively control the complications and improve the quality of life of patients, but the timing of operation and the choice of surgical methods should be decided prudently after perioperative treatment, multi-disciplinary participated and regulation of the internal environment. The standardized and targeted treatments for the surgical difficulties of inflammatory bowel disease should be conducted.
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" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.
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As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.
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Objective To calculate the standardized cesarean delivery rate by considering the individual characteristics of puerprae, and to evaluate the medical quality of obstetrics in the hospital. Methods Medical records of 69 406 puerprae from January to December in 2016 were collected from 33 tertiary general hospitals in Shanxi province. A logistic regression model was used to construct a maternal risk adjustment model of cesarean delivery, with the area under the ROC curve (AUC) used to evaluate the goodness of fit of the model. Results Of the 69 406 puerprae, 30 881 used caesarean delivery, accounting to 44. 37% . The cesarean section rate difference was statistically significant among those of different age, nationality, conditions upon admission, whether to participate in a clinical pathway, fetus number, birth weight and maternal gestational age, as well as the severity of complications (P< 0. 001). According to the logistic model, those of older age, history of cesarean delivery, twins or triplet births, neonatal overweight, malposition, placenta previa, and those with various pregnancy complications tend to use maternal cesarean section surgery, with a goodness-of-fit of 0. 82. With risk adjusted, the ranking of actual cesarean section rate and standardized cesarean section rate varies among the hospitals. Conclusions With the factor of puerprae factor adjusted, the standardized cesarean delivery rate can eliminate risk factors of the puerprae, it is feasible to scientifically evaluate the cesarean delivery rate of the hospital′s obstetric department.
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@#Objective To determine the value of accommodation quotient (AQ) on dysphagia evaluation in the elderly. Methods 40 old cases with dysphagia were assessed with AQ, Kubota Water Swallow Test (WST) and Swallowing Evaluation (SE) before and after 3 weeks of treatment. The patients were divided into 2 groups based on the first AQ assessment: mild group (AQ=1.5~2.5) and serious group (AQ< 1.5). Results There was not significant difference in scores of WST between both groups (P>0.05) but SE (P<0.05). The AQ before treatment moderately correlated with the scores of WST and SE before treatment and improvement (P<0.001), and SE after treatment (P<0.001), but did not correlate with the score of WST after treatment (P>0.05). Conclusion The AQ may indicate the function of swallowing in the elderly, and predict the outcome of dysphagia.
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@#Objective To study the effects neuromuscular electrotherapy and kinesitherapy on brachial plexus palsy. Methods 20 patients with brachial plexus palsy accepted neuromuscular electrical stimulation on involved muscles, and were followed up for 18～58 months. Other 17 patients accepted neurolysis alone were as control. Results The function of shoulder and elbow in electric stimulation group was significantly superior to that of control (P<0.01). Conclusion Neuromuscular electrotherapy combined with kinestherapy is effective on the brachial plexus palsy.
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@#Objective To observe the changes of neural blood flow when oppressed with different pressures and at different sites in rat's sciatic nerve.MethodsThe sciatic nerve compression model of rat with pressure and time controlled simultaneously was established.The changes of neural blood flow were observed by oppressing the sciatic nerve with five grades pressures using Gasbag.The rats were randomly divided into the distal compression group and proximal compression group,and the changes of neural blood flow were observed in each group.ResultsThe neural blood flow changed significantly(P<0.05) when the sciatic nerve was oppressed with different pressures and it had the decreasing tendency with the pressures increasing.The neural blood flow of each group decreased obviously(P<0.01).The effect of oppressing distal nerve on neural blood flow was more obvious than that of oppressing proximal nerve(P<0.01).ConclusionMechanical compression can influence the neural blood flow obviously.The distal vessels of sciatic nerve are the major sources of nerve blood supply.
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@#Objective To observe the changes of neural blood flow when oppressed with different pressures and at different sites in rat's sciatic nerve.MethodsThe sciatic nerve compression model of rat with pressure and time controlled simultaneously was established.The changes of neural blood flow were observed by oppressing the sciatic nerve with five grades pressures using Gasbag.The rats were randomly divided into the distal compression group and proximal compression group,and the changes of neural blood flow were observed in each group.ResultsThe neural blood flow changed significantly(P<0.05) when the sciatic nerve was oppressed with different pressures and it had the decreasing tendency with the pressures increasing.The neural blood flow of each group decreased obviously(P<0.01).The effect of oppressing distal nerve on neural blood flow was more obvious than that of oppressing proximal nerve(P<0.01).ConclusionMechanical compression can influence the neural blood flow obviously.The distal vessels of sciatic nerve are the major sources of nerve blood supply.
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@#Objective To explore the effects of rehabilitation on radial nerve injury.Methods 20 patients with radial nerve injury were included.The involved muscles were stimulated with NMR-muscular restorer for 10～15 min per muscle combined with kinesitherapy for 20～30 min.The patients were followed up for 12～30 months.Results 15 cases with no-operation recovered to 16 marks,which means excellent,3.5～18 months after rehabilitation.3 case after nerve exploration recovered to 16 marks in 1 case and 15 marks in 2 cases.1 case after neuro-anastomosis recovered to 6 marks,which means improved,6 months after rehabilitation.1 case after radial nerve graft recovered to 4 marks,which means no-improved after 12 months follow-up.Conclusion Neuromuscular electrotherapy combined with kinesitherapy is effective on radial nerve injury.
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@#ObjectiveTo explore the effect of left move and twists of I/t curve on predicting prognosis of facial paralysis.Methods181 cases with 171 Bell's palsy and 10 Hunt's syndrome were examined with I/t curve of frontal muscle and upper orbicularis. The assessing criterion of diseases course was determined according to the recovery time of frontal muscle evaluated by raising eyebrow, the recovery time of orbicularis ascertained by House-Brackmann Ⅰ, Ⅱ grades and stable phase in partial moderate and severe facial paralysis.ResultsThe recovery time of frontal muscle and orbicularis between twist and non-twist in I/t curve and in sex was not significant. The left move of I/t curve was confined to slight, moderate and severe arranges; the recovery time was not significant also. Twist rate in I/t curve was highest in moderate facial paralysis and then second in orbicularis of slight paralysis. The left move of I/t curve had a very significant relationship with recovery time of frontal muscle and orbicualris.ConclusionThe left move of I/t curve plays a very important role in determining nerve injury degrees and predicting prognosis of facial paralysis.
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@#ObjectiveTo measure cortical areas involved ankle dorsiflexion and planter flexion.MethodsSix-health subjects performed ankle dorsiflexion and planter flexion. While, functional MRI at 1.5 T was made.ResultsWhen ankle dorsiflexion, the excited cortical areas included bilateral primary motor cortex (MⅠ) and primary somatosensory cortex (SⅠ), but area on contralateral side bigger than that on ipsilateral side, as well as chief visual cortexes and vermis of cerebellum. Inhibited areas included area 19, area 20 and area 39. When ankle planter flexion, the excited areas included contralateral secondary motor area (MⅡ) and striate body, ipsilateral supplementary motor area (SMA) and limbic system. Inhibited areas included bilateral upper middle precentral gyrus and postcentral gyrus, superior parietal lobule, inferior parietal lobule and prefrontal cortex.ConclusionThere is a great difference in the brain function images respectively in ankle dorsiflexion and planter flexion.
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Objective To evaluate the usefulness of functional magnetic resonance imaging (fMRI) as a noninvasive method in recording the activities of the human brain as excited by low frequency current(LFC) stimulator. Methods The right common peroneal nerves of 6 healthy volunteers were stimulated with LFC (NMR-II stimulator). The activities of the brain were then recorded and evaluated during the scanning by the fMRI technique. Data obtained during the study were dealt with with the software SPM99. Results In both cerebral hemispheres, the area where the postcentral and superior temporal gyrus, inferior parietal lobule met were excited, and so were the operculum at both sides. Postcentral gyrus, superior parietal and paracentral lobule, and the precuneus in the left cerebral hemisphere, as well as the superior occipital gyrus and the superior parietal lobule in the right hemisphere,were involved as the excited areas. Conclusion fMRI is a useful tool for recording and evaluating the brain activities excited by LFC.
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@#ObjectiveTo identify the effect of Xianlinggubao Tablet on the osteoporosis bone pain and bone density in a population of 50 cases at age of 50 and above. MethodsIn a prospective study, the changes of the clinic bone pain and bone density were observed before and after 4—8 weeks treatment. Results & ConclusionsThe bone pain in 36 of 50 was relieved, but no significant difference was observed in bone density. Therefore, Xianligubao Tablet can relieve the osteoporosis bone pain, which may change the space structure of bone trabecula.