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Objective:To explore any effect of supplementing low-frequency repeated transcranial magnetic stimulation (rTMS) with intermittent resistance training on muscle tone and the recovery of motor function among persons with Parkinson′s disease (PD).Methods:A total of 104 PD patients were randomly divided into an observation group and a control group, each of 52. Both groups were treated with conventional drugs and low-frequency rTMS, while the observation group was additionally provided with intermittent resistance training for 8 weeks. Before and after the intervention, the motor functioning of both groups was evaluated using unified Parkinson′s disease rating scale-III (UPDRS-III) and the Berg Balance Scale (BBS). Limb muscle tension was quantified using the modified Ashworth scale (MAS). The subjects′ psychological states were quantified using the exercise self-efficacy scale (ESE), and the modified Barthel index (MBI) was applied to evaluate their ability in the activities of daily living. A 3D motion processing system collected and analyzed data describing each subject′s gait kinematics.Results:After the intervention, significantly greater average improvement was observed in all of the outcome measures among the observation group compared with the control group.Conclusion:Combining intermittent resistance training with low-frequency rTMS can significantly reduce muscle tone and improve the motor functioning of PD patients. The combination is more effective than low-frequency rTMS alone.
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Objective:To observe any effect of repeated transcranial magnetic stimulation (rTMS) in the treatment of diabetic peripheral neuropathic pain (DPNP).Methods:Eighty-six persons with type 2 diabetes mellitus and DPNP were randomly divided into an observation group and a control group, each of 43. Both groups were given basic treatment to control plasma glucose and blood pressure, while the observation group was additionally provided with daily 10Hz rTMS of the primary motor cortex (M1 area) of the non-dominant hand 5 days a week for 4 weeks. Before and after the treatment, pain in both groups was evaluated using a visual analog scale (VAS) and the Patient′s Global Impression Change scale (PGIC). The motor conduction velocity (MCV) and sensory conduction velocity of the median and the common peroneal nerves were also tested.Results:After treatment, the average VAS pain rating and PGIC score of the observation group were significantly lower than the control group′s averages and those before treatment. The observation group′s treatment effectiveness rate (79.07%) was then much better than that of the control group (23.26%). After the treatment, the average MCV of the median and common peroneal nerves of the observation group (47.65±1.94 m/s and 46.98±3.26 m/s, respectively) were significantly faster than before treatment, and those of the control group.Conclusions:rTMS based on routine intervention can significantly relieve DPNP and promote the recovery of injured nerves, bettering diabetics′ physical condition and life quality.
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Objective To investigate the diagnostic value and safety of thoracoscopy routine pleural biopsy combined with frozen biopsy for pleural effusion. Methods A retrospective analysis was made on the pathological diagnosis rate of pleural effusion. Results 120 cases in thoracoscopy, 103 cases were confirmed with routine biopsy specimens (85.8%), 16 cases found in the lesions with conventional clamp not satisfactory tissue specimens, combined with frozen cut obtained satisfactory specimens, the diagnostic accuracy rate of 16 cases of cryobiopsy was 100.0%, and the total diagnostic accuracy rate of medical thoracoscopy combined with pleural biopsy and cryobiopsy was 95.0%. There was significant difference between conventional biopsy and cryobiopsy (P < 0.05). Conclusion Medical thoracoscopy combined with pleural biopsy and cryobiopsy can achieve a higher rate of pathological diagnosis, and the complications are mild, so it is worthy of clinical promoting.
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Objective To discuss combined detection of pleural biopsy under medical thoracoscopy and pulmonary serum tumor markers in diagnosis of pleural effusion with unknown reason.Methods 76 patients with pleural effusion caused by unknown reason from January 2014 to March 2016 were retrospectively analyzed. Pleural biopsy was conducted under medical thoracoscopy and sent for pathological examination, and 10 ml venous blood was collected from these patients upon admission for testing serum tumor markers (CEA, SCC-AG, ProGRP and CYFRA21-1).Results Among the 76 patients, there were 32 cases with benign lesions (14 with pulmonary tuberculosis, 9 with inlfammatory lesions, 6 with granulomatous inlfammation, 2 with empyema and 1 with hamartoma) and 44 cases with malignant lesions (18 with adenocarcinoma, 13 with squamous carcinoma, 6 with small cell lung cancer, 3 with adeno-squamous carcinoma, 2 with mesothelioma, 1 with large cell carcinoma and 1 with thymoma). The detection of serum tumor markers showed statistically significant differences in the levels of CEA, SCC-AG, ProGRP and CYFRA21-1 in serum between the malignant pleural effusion group and benign pleural effusion group (P = 0.021,P = 0.006,P = 0.003 andP = 0.010). The levels of various serum tumor markers in the malignant pleural effusion group were obviously higher than those in the benign pleural effusion group. According to the pathological results, patients with pleural effusions not caused by lung cancer (2 with mesothelioma and 1 with thymoma) were eliminated from 44 patients with malignant pleural effusions. The rest 41 patients with pleural effusions caused by lung cancer were divided into non-small cell lung cancer and small cell lung cancer according to the pathological types. The results showed that there were statistically signiifcant differences in the levels of CEA, ProGRP and CYFRA21-1 between non-small cell lung cancer and small cell lung cancer (P = 0.036,P = 0.005 andP = 0.008), while there was no statistically signiifcant difference in the level of SCC-AG (P = 0.811).Conclusions Due to high detection rate and high accuracy in detecting pleural effusions caused by unknown reason, medical thoracoscopy is of great signiifcance, especially for the diagnosis of malignant pleural effusions of pleural metastases. However, serum indicators may provide important reference values for us before the pathological results are available. Thus, it is an important means of diagnosing malignant pleural effusions caused by lung cancer and should be promoted in clinic.
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Objective To observe the therapeutic effect of surface functional electrical stimulation combined with electroacupuncture on neurogenic bladder after the spinal cord injury.Methods Forty cases of neurogenic bladder after the spinal cord injury were randomly divided into a control group (n =20) and a combination group (n =20).The combination group was treated with surface functional electrical stimulation combined with electroacupuncture on the basis of internal urethral catheterization,while the control group was treated with surface functional electrical stimulation on the basis of internal urethral catheterization.The bladder urination was tested using urodynamic study before and after two months of treatment.Results There was no significant difference between the 2 groups in the average maximum bladder capacity,detrusor pressure at filling time,maximal urethral closure pressure,maximum urine flow rate and residual urine volume before the treatment.After the treatment,however,the average maximum bladder capacity,maximal urethral closure pressure and maximum urine flow rate in the combination group were significantly higher than those of the control group,while the average detrusor pressure at filling time and the residual urine volume of the combination group were significantly lower than the control group.Conclusion Surface functional electrical stimulation combined with electroacupuncture could remarkably improve bladder function of patients with the neurogenic bladder after the spinal cord injury.
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Objective To identify the risk factors for deep vein thrombosis(DVT) in the lower extremities during hospitalization for acute spinal cord injury(SCI).Methods Retrospective data analyses were performed for 49 SCI patients admitted within a week after they were diagnosed.The patients were divided into a DVT-free(n =40) group and a DVT group(n =9) according to their lower limbs' color Doppler ultrasound results.And the subjects' gender,age,chronic diseases (diabetes,hypertension and hyperlipidemia,etc.),complications (pulmonary infection,urinary tract infections and pressure sores,etc.),the history of cancer,smoking history and lower extremity fractures were recorded.Intermittent pneumatic compression treatment,the early rehabilitation intervention,antithrombotic therapy,history of venous catheterization,operative intervention,blood transfusion history,muscle strength of lower extremity and time from onset to being transfered to rehabilitation department were also recorded Single factor analysis,was conducted,followed by Binary logistic regression to pick out the risk factors for DVT.Results The result of the binary logistic regression analysis showed that gender (OR 6.87 ; 95％ CI 1.09-43.22 ;P ＜ 0.05) and intermittent pneumatic compression treatment (OR 12.47 ; 95％ CI 1.09-142.36 ; P ＜ 0.05) were significant predictors of DVT.Conclusion Gender and intermittent pneumatic compression treatment are related with DVT risk for patients with acute SCI.
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Objective To investigate the effects of 20 Hz repetitive transcranial magnetic stimulation (rTMS) with different intensities on neurobehavior and expression of glial fibrillary acidic protein (GFAP) in ischemic penumbra of rats with cerebral infarction,so as to explore the probable mechanism. Methods Forty-three rats were randomly divided into a blank control group( n =7 ),a model control group( n =7),a sham stimulation control group(n =8) and a rTMS group (n =21) ; the rTMS group was further subdivided into 3 subgroups:80％ MT subgroup,100％ MT subgroup and 120％ MT subgroup,with 7 rats in each subgroup.The cerebral infarction model was established by right middle cerebral artery occlusion (MCAO) in each group except the blank control group.The 3 rTMS subgroups were given 14 successive blocks of 20 Hz rTMS with corresponding intensity.The sham stimulation control group received sham treatment (without any output).The model control group was given no stimulation,and the blank control group did not receive any special treatment.Functional assessments were performed at 3 different time points.After 14-day treatment,the expression of GFAP proteins in ischemic penumbra were detected by immunohistochemistry technique. Results Functional outcome reflected from 3 behavioral tests in 100％ MT subgroup after 14-day stimulation was better than 1 day after operation,while in the other rTMS subgroups functional outcomes were just better in 2 behavioral tests.The expressions of GFAP in 3 rTMS subgroups were all less than that in model control group. Conclusions The 20 Hz rTMS with 80％ MT and 100％ MT might be safe and effective to improve the functional outcome in rats with acute cerebral infarction,especially 100％ MT.Decrease of expression of GFAP in ischemic penumbra might be one of the mechanisms of beneficial effects of rTMS in ischemia brain injury.
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The good cooperation between the operating room nurses and anesthesiologists is benefitial to improving working efficiency and can make the patients uneventful during operating period.As an anesthesiologist,the author taught the basic anesthesia knowledge such as the commonly used anesthesia methods,the prevention and treatment of complications and gave advice to the nurses of the nursing trainning group.The cooperations before anesthesia,during anesthesia,after anesthesia were analyzed and the significance of nursing cooperation with anesthesiologist was discussed.
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Objective To investigate the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) at different intensities on the ultrastructure of an ischemic brain penumbra and the expression of brainderived neurotrophic factor (BDNF) using rats with permanent middle cerebral artery occlusion (MCAO).Methods Forty-two rats were randomly divided into a blank control group,an MCAO model control group,a sham stimulation control group and an rTMS group.The rTMS group was divided further into 3 subgroups:an 80％ of motor threshold (MT) subgroup,a 100％ of MT subgroup and a 120％ of MT subgroup.The cerebral infarction model was established by right MCAO.rTMS treatment was given 24 hours after the MCAO model was successfully established.The rTMS group and sham stimulation control group were given 20 Hz rTMS with the planned intensities.The MCAO model control group was not given any stimulation.After 14 days of treatment,transmission electron microscopy,immunohistochemical and Western blotting ( WB ) methods were used to investigate the ultrastructure of the ischemic penumbra and the expression of BDNF.Results Damage reflected in the ultrastructure in the 3 rTMS subgroups was less than in the model control group and the sham stimulation control group.Expression of BDNF protein increased significantly in 100％ of the MT group and blank control group rats as compared with that in the sham stimulation control group,while the blank control group and the 3 rTMS subgroups had no statistically significant difference in comparison with the MCAO model control group.The expression of BDNF protein had no statistically significant difference between any of the groups.Conclusion 20 Hz rTMS might,especially at 100％ of the MT,promote the recovery of the ultrastructure of neural tissues in the ischemic penumbra after acute cerebral infarction and enhance the expression of BDNF in the ipsilesional hemisphere.This may be one of the important mechanisms of rTMS's effectiveness in the treatment of ischemic stroke.