Correlation study between motor rehabilitation level and psychological state in patients with limb movement disorders after stroke

BACKGROUND The psychological state of patients with post stroke limb movement disorders undergoes a series of changes that affect rehabilitation training and recovery of limb motor function.AIM To determine the correlation between motor rehabilitation and the psychological state of patients with limb movement disorders after stroke.METHODS Eighty patients with upper and lower limb dysfunction post stroke were retrospectively enrolled in our study.Based on Hospital Anxiety and Depression Scale(HADS)scores measured before rehabilitation,patients with HADS scores≥8 were divided into the psychological group;otherwise,the patients were included in the normal group.Motor function and daily living abilities were compared between the normal and psychological groups.Correlations between the motor function and psychological status of patients,and between daily living ability and psychological status of patients were analyzed.RESULTS After 1,2,and 3 wk of rehabilitation,both the Fugl-Meyer assessment and Barthel index scores improved compared to their respective baseline scores(P<0.05).A greater degree of improvement was observed in the normal group compared to the psychological group(P<0.05).There was a negative correlation between negative emotions and limb rehabilitation(-0.592≤r≤-0.233,P<0.05),and between negative emotions and daily living ability(-0.395≤r≤-0.199,P<0.05).CONCLUSION There is a strong correlation between motor rehabilitation and the psychological state of patients with post stroke limb movement disorders.The higher the negative emotions,the worse the rehabilitation effect.

Associations between meeting 24-hour movement guidelines and quality of life among children and adolescents with autism spectrum disorder

Background:The Canadian 24-hour movement behavior(24-HMB)guidelines suggest that a limited amount of screen time use,an adequate level of physical activity(PA),and sufficient sleep duration are beneficial for ensuring and optimizing the health and quality of life(QoL)of children and adolescents.However,this topic has yet to be examined for children and adolescents with autism spectrum disorder(ASD)specifically.The aim of this cross-sectional observational study was to examine the associations between meeting 24-HMB guidelines and several QoLrelated indicators among a national sample of American children and adolescents with ASD.Methods:Data were taken from the 2020 U.S.National Survey of Children’s Health dataset.Participants(n=956)aged 617 years and currently diagnosed with ASD were included.The exposure of interest was adherence to the 24-HMB guidelines.Outcomes were QoL indicators,including learning interest/curiosity,repeating grades,adaptive ability,victimization by bullying,and behavioral problems.Categorical variables were described with unweighted sample counts and weighted percentages.Age,sex,race,preterm birth status,medication,behavioral treatment,household poverty level,and the educational level of the primary caregivers were included as covariates.Odds ratio(OR)and 95%confidence interval(95%CI)were used to present the strength of association between adherence to 24-HMB guidelines and QoL-related indicators.Results:Overall,452 participants(45.34%)met 1 of the 3 recommendations,216(22.65%)met 2 recommendations,whereas only 39 participants(5.04%)met all 3 recommendations.Compared with meeting none of the recommendations,meeting both sleep duration and PA recommendations(OR=3.92,95%CI:1.639.48,p<0.001)or all 3 recommendations(OR=2.11,95%CI:1.034.35,p=0.04)was associated with higher odds of showing learning interest/curiosity.Meeting both screen time and PA recommendations(OR=0.15,95%CI:0.040.61,p<0.05)or both sleep duration and PA recommendations(OR=0.24,95%CI:0.070.87,p<0.05)was associated with lower odds of repeating any grades.With respect to adaptive ability,participants who met only the PA recommendation of the 24-HMB were less likely to have difficulties dressing or bathing(OR=0.11,95%CI:0.020.66,p<0.05)than those who did not.For participants who met all 3 recommendations(OR=0.38,95%CI:0.150.99,p=0.05),the odds of being victimized by bullying was lower.Participants who adhered to both sleep duration and PA recommendations were less likely to present with severe behavioral problems(OR=0.17,95%CI:0.040.71,p<0.05)than those who did not meet those guidelines.Conclusion:Significant associations were found between adhering to 24-HMB guidelines and selected QoL indicators.These findings highlight the importance of maintaining a healthy lifestyle as a key factor in promoting and preserving the QoL of children with ASD.

CLINICAL APPLICATION OF BOTULINUM TOXIN TYPE B IN MOVEMENT DISORDERS AND AUTONOMIC SYMPTOMS

Objective To evaluate efficacy and safety of botulinum toxin type B (BTX-B) in treatment of movement disorders including blepharospasm, oromandibular dystonia, hemifacial spasm, tremor, tics, and hypersecretory disorders such as sia-lorrhea and hyperhidrosis. Methods A retrospective study of BTX-B injections in treatment of 58 patients with various neurological disorders was performed. The mean follow-up time was 0.9 ± 0.8 years. Results of the first and last treatment of patients with at least 3 injection sessions were compared. Results The response of 58 patients to a total of 157 BTX-B treatment sessions was analyzed. Of the 157 treatment sessions, 120 sessions (76.4%) resulted in moderate or marked improvement while 17 sessions (10.8%) had no response. The clinical benefits after BTX-B treatment lasted an average of 14 weeks. Of the 41 patients with at least 3 injection ses-sions (mean 10 ± 8.6), most patients needed increased dosage upon the last session compared to the first session. Nineteen patients (32.8%) with 27 sessions (17.2%) reported adverse effects with BTX-B treatment. Conclusions Though most patients require increased dosage to maintain effective response after repeated injections, BTX-B is an effective and safe treatment drug for a variety of movement disorders, as well as drooling and hyperhidrosis.

Molecular imaging of movement disorders

Positron emission tomography measures the activity of radioactively labeled compounds which distribute and accumulate in central nervous system regions in proportion to their metabolic rate or blood flow. Specific circuits such as the dopaminergic nigrostriatal projection can be studied with ligands that bind to the pre-synaptic dopamine transporter or post-synaptic dopamine receptors (D1 and D2). Single photon emission computerized tomography (SPECT) measures the activity of similar tracers labeled with heavy radioactive species such as technetium and iodine. In essential tremor, there is cerebellar hypermetabolism and abnormal GABAergic function in premotor cortices, dentate nuclei and ventral thalami, without significant abnormalities in dopaminergic transmission. In Huntington&#x02019;s disease, there is hypometabolism in the striatum, frontal and temporal cortices. Disease progression is accompanied by reduction in striatal D1 and D2 binding that correlates with trinucleotide repeat length, disease duration and severity. In dystonia, there is hypermetabolism in the basal ganglia, supplementary motor areas and cerebellum at rest. Thalamic and cerebellar hypermetabolism is seen during dystonic movements, which can be modulated by globus pallidus deep brain stimulation (DBS). Additionally, GABA-A receptor activity is reduced in motor, premotor and somatosensory cortices. In Tourette&#x02019;s syndrome, there is hypermetabolism in premotor and sensorimotor cortices, as well as hypometabolism in the striatum, thalamus and limbic regions at rest. During tics, multiple areas related to cognitive, sensory and motor functions become hypermetabolic. Also, there is abnormal serotoninergic transmission in prefrontal cortices and bilateral thalami, as well as hyperactivity in the striatal dopaminergic system which can be modulated with thalamic DBS. In Parkinson&#x02019;s disease (PD), there is asymmetric progressive decline in striatal dopaminergic tracer accumulation, which follows a caudal-to-rostral direction. Uptake declines prior to symptom presentation and progresses from contralateral to the most symptomatic side to bilateral, correlating with symptom severity. In progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), striatal activity is symmetrically and diffusely decreased. The caudal-to-rostral pattern is lost in PSP, but could be present in MSA. In corticobasal degeneration (CBD), there is asymmetric, diffuse reduction of striatal activity, contralateral to the most symptomatic side. Additionally, there is hypometabolism in contralateral parieto-occipital and frontal cortices in PD; bilateral putamen and cerebellum in MSA; caudate, thalamus, midbrain, mesial frontal and prefrontal cortices in PSP; and contralateral cortices in CBD. Finally, cardiac sympathetic SPECT signal is decreased in PD. The capacity of molecular imaging to provide in vivo time courses of gene expression, protein synthesis, receptor and transporter binding, could facilitate the development and evaluation of novel medical, surgical and genetic therapies in movement disorders.

Sleep-associated movement disorders and the risk of cardiovascular disease: A systematic review and metaanalysis

AIM:To investigate whether an association exists between sleep-associated movement disorders and cardiovascular disease(CVD).METHODS:Several studies have observed the relationship of sleep-associated movement disorders such as restless legs syndrome(RLS)and periodic limb movements during sleep with CVD,but the results were still contradictory.We performed an extensive literature search on Pub Med,Medline and Web of Science published from inception to December 2014.Additional studies were manually searched from bibliographies of retrieved studies.Meta-analyses were conducted with Stata version 12.0(Stata Corp,College Station,Texas).Pooled odds ratios(ORs)and 95%CIs were calculated to assess the strength of association using the random effects model.Sensitivity and subgroup analyses were performed to explore the underlying sources of heterogeneity.The publication bias was detected using Egger’s test and Begg’s test.RESULTS:A total of 781 unique citations were indentified from electronic databases and 13 articles in English were finally selected.Among these studies,nine are cohort studies;two are case-control studies;and two are cross-sectional studies.The results showed that the summary OR of CVD associated with sleepassociated movement was 1.51(95%CI:1.29-1.77)in a random-effects model.There was significant heterogeneity between individual studies(P for heterogeneity=0.005,I2=57.6%).Further analysis revealed that a large-scale cohort study may account for this heterogeneity.A significant association was also found between RLS and CVD(OR=1.54,95%CI:1.24-1.92).In a fixed-effects model,we determined a significant relationship between sleep-associatedmovement disorders and coronary artery disease(CAD)(OR=1.34,95%CI:1.16-1.54;P for heterogeneity=0.210;I2=30.0%).Our meta-analysis suggests that sleep-associated movement disorders are associated with prevalence of CVD and CAD.CONCLUSION:This finding indicates that sleep-associated movement disorders may prove to be predictive of underlying CVD.

Racial Demographics in an Urban Movement Disorders Clinic

Objective: To assess the prevalence of Parkinson’s disease (PD) among African- Americans compared to non-Hispanic Whites in a tertiary urban Movement Disorders center. Background: Contributing factors in the prevalence of Parkinson’s disease (PD) based on race may improve health disparities in the United States. According to the largest study analyzing prevalence and incidence of PD among Medicare beneficiaries, the ratio of African-Americans (AA) to Caucasians in the general Medicare population is 9%, while the prevalence ratio of PD among AA compared to Caucasians is approximately 5%. Methods: We performed a retrospective analysis of African-American patients with PD in the movement disorders database at Boston Medical Center, which is the largest safety net hospital in New England. The demographics of the patients seen in the general neurology clinic are 30.57% AA and 38.06% non-Hispanic Caucasian. Results: The Movement disorders database included 488 patients, 327 of whom had PD. Of these, 287 were Caucasians and 18 were of African descent. Based on our clinic population the expected PD case ratio among AA compared to Caucasians was approximately 49%. The actual race ratio in patients of African descent compared to Caucasian was 6%, which was substantially lower than expected at Boston Medical Center. Conclusion: The demographics of the PD patients in our movement disorders clinic do not reflect the population at Boston Medical Center, or the demographics of our neurology clinic as a whole.

Role of a wireless surface electromyography in dystonic gait in functional movement disorders: A case report

BACKGROUND Dystonic gait(DG) is one of clinical symptoms associated with functional dystonia in the functional movement disorders(FMDs). Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. There is no report for DG in FMDs caused by an abnormal pattern in the ankle muscle recruitment strategy during gait.CASE SUMMARY A 52-year-old male patient presented with persistent limping gait. When we requested him to do dorsiflexion and plantar flexion of his ankle in the standing and seating positions, we didn’t see any abnormality. However, we could see the DG during the gait. There were no evidences of common peroneal neuropathy and L5 radiculopathy in the electrodiagnostic study. Magnetic resonance imaging of the lumbar spine, lower leg, and brain had no definite finding. No specific finding was seen in the neurologic examination. For further evaluation, a wireless surface electromyography(EMG) was performed. During the gait, EMG amplitude of left medial and lateral gastrocnemius(GCM) muscles was larger than right medial and lateral GCM muscles. When we analyzed EMG signals for each muscle, there were EMG bursts of double-contraction in the left medial and lateral GCM muscles, while EMG analysis of right medial and lateral GCM muscles noted regular bursts of single contraction. We could find a cause of DG in FMDs.CONCLUSION We report an importance of a wireless surface EMG, in which other examination didn’t reveal the cause of DG in FMDs.

Common Movement Disorders in Children: Diagnosis, Pathogenesis and Management

Movement disorders in childhood are a heterogeneous group of diseases with presentations that vary according to etiopathogenesis and age of onset. While sharing certain characteristics with the conditions that affect adults, they also have unique features that are determined by the metabolic, physiological and environmental distinctiveness of the developing brain. This context makes the nervous system of children vulnerable to various insults such as birth trauma, infections and toxicity. Some inborn errors of metabolism and genetic conditions selectively affect the young brain and psychological adaptation may also contribute to the occurrence and severity of certain conditions at this age group. The present review outlines the pathophysiology, clinical presentation and course, diagnosis and therapy of movement disorders in children. We also emphasize, when available, preventive and prophylactic measures and conclude by suggesting several avenues for future research in aspects that are currently not well understood.

Sleep disorders in Alzheimer’s disease:the predictive roles and potential mechanisms

Sleep disorders are common in patients with Alzheimer’s disease,and can even occur in patients with amnestic mild cognitive impairment,which appears before Alzheimer’s disease.Sleep disorders further impair cognitive function and accelerate the accumulation of amyloid-βand tau in patients with Alzheimer’s disease.At present,sleep disorders are considered as a risk factor for,and may be a predictor of,Alzheimer’s disease development.Given that sleep disorders are encountered in other types of dementia and psychiatric conditions,sleep-related biomarkers to predict Alzheimer’s disease need to have high specificity and sensitivity.Here,we summarize the major Alzheimer’s disease-specific sleep changes,including abnormal non-rapid eye movement sleep,sleep fragmentation,and sleep-disordered breathing,and describe their ability to predict the onset of Alzheimer’s disease at its earliest stages.Understanding the mechanisms underlying these sleep changes is also crucial if we are to clarify the role of sleep in Alzheimer’s disease.This paper therefore explores some potential mechanisms that may contribute to sleep disorders,including dysregulation of the orexinergic,glutamatergic,andγ-aminobutyric acid systems and the circadian rhythm,together with amyloid-βaccumulation.This review could provide a theoretical basis for the development of drugs to treat Alzheimer’s disease based on sleep disorders in future work.

Assessing gray matter volume in patients with idiopathic rapid eye movement sleep behavior disorder

Idiopathic rapid eye movement sleep behavior disorder(iRBD) is often a precursor to neurodegenerative disease. However, voxel-based morphological studies evaluating structural abnormalities in the brains of iRBD patients are relatively rare. This study aimed to explore cerebral structural alterations using magnetic resonance imaging and to determine their association with clinical parameters in iRBD patients. Brain structural T1-weighted MRI scans were acquired from 19 polysomnogram-confirmed iRBD patients(male:female 16:3; mean age 66.6 ± 7.0 years) and 20 age-matched healthy controls(male:female 5:15; mean age 63.7 ± 5.9 years). Gray matter volume(GMV) data were analyzed based on Statistical Parametric Mapping 8, using a voxel-based morphometry method and two-sample t-test and multiple regression analysis. Compared with controls, iRBD patients had increased GMV in the middle temporal gyrus and cerebellar posterior lobe, but decreased GMV in the Rolandic operculum, postcentral gyrus, insular lobe, cingulate gyrus, precuneus, rectus gyrus, and superior frontal gyrus. iRBD duration was positively correlated with GMV in the precuneus, cuneus, superior parietal gyrus, postcentral gyrus, posterior cingulate gyrus, hippocampus, lingual gyrus, middle occipital gyrus, middle temporal gyrus, and cerebellum posterior lobe. Furthermore, phasic chin electromyographic activity was positively correlated with GMV in the hippocampus, precuneus, fusiform gyrus, precentral gyrus, superior frontal gyrus, cuneus, inferior parietal lobule, angular gyrus, superior parietal gyrus, paracentral lobule, and cerebellar posterior lobe. There were no significant negative correlations of brain GMV with disease duration or electromyographic activity in iRBD patients. These findings expand the spectrum of known gray matter modifications in iRBD patients and provide evidence of a correlation between brain dysfunction and clinical manifestations in such patients. The protocol was approved by the Ethics Committee of Huashan Hospital(approval No. KY2013-336) on January 6, 2014. This trial was registered in the ISRCTN registry(ISRCTN18238599).

Upper extremity disorders in heavy industry workers in Greece

AIM To investigate the disability due to musculoskeletal disorders of the upper extremities in heavy industry workers.METHODS The population under study consisted of 802 employees, both white-and blue-collar, working in a shipyard industry in Athens, Greece. Data were collected through the distribution of questionnaires and the recording of individual and job-related characteristics during the period 2006-2009. The questionnaires used were the Quick Disabilities of the Arm, Shoulder and Hand(QD) Outcome Measure, the Work Ability Index(WAI) and the ShortForm-36(SF-36) Health Survey. The QD was divided into three parameters-movement restrictions in everyday activities, work and sports/music activities-and the SF-36 into two items, physical and emotional. Multiple linear regression analysis was performed by means of the SPSS v.22 for Windows Statistical Package.RESULTS The answers given by the participants for the QD did not reveal great discomfort regarding the execution of manual tasks, with the majority of the participants scoring under 5%, meaning no disability. After conducting multiple linear regression, age revealed a positive association with the parameter of restrictions in everyday activities(b = 0.64, P = 0.000). Basic education showed a statistically significant association regarding restrictions during leisure activities, with b = 2.140(P = 0.029) for compulsory education graduates. WAI's final score displayed negative charging in the regression analysis of all three parameters, with b =-0.142(P = 0.0), b =-0.099(P = 0.055) and b =-0.376(P = 0.001) respectively, while the physical and emotional components of SF-36 associated with movement restrictions only in daily activities and work. The participants' specialty made no statistically significant associations with any of the three parameters of the QD.CONCLUSION Increased musculoskeletal disorders of the upper extremity are associated with older age, lower basic education and physical and mental/emotional health and reduced working ability.

Chemogenetic activation of sublaterodorsal tegmental glutamatergic neurons alleviates rapid eye movement sleep behavior disorder symptoms in a chronic rat model of Parkinson disease

Rapid eye movement(REM)sleep behavior disorder(RBD)is a parasomnia that is featured by elevated motor behaviors and dream enactments during REM sleep.Clinical observations show that RBD bears significant relevance with several synucleinopathies such as Lewy body dementia and Parkinson disease(PD),and often develops prior to their diagnosis.Being a potential biomarker of PD,investigating the relationship of RBD symptoms and their emergence in developing PD would provide insight intoits pathogenesis.Here,in a chronic model of PD,rats with daily rotenone treatment exhibited key RBD features,including elevated sleep muscle tone,sleep fragmentation and EEG slowing at different time points.Based on detectedearly alpha synuclein aggregation and neural apoptosis in the sublaterodorsal tegmental nucleus(SLD),an area known to promote REM sleep and maintain sleep muscle atonia,the possible involvement of SLD glutamatergic neurons was interrogated.Via chemogenetic activation of SLD glutamatergic neurons,key RBD symptoms and EEG slowing in REM sleep were alleviated.These results are consistent with a progressive degeneration in REM sleep promoting pathways.Our findings provide a foundation for further studies into RBD and its relationship to neurodegenerative diseases.

Gender Differences in Rapid Eye Movement-Related Sleep Disordered Breathing

Sleep disordered breathing (SDB) is an independent risk factor for cardiovascular disease. It is known to be associated more frequently with men than women, particularly in the premenopausal age range. The goal of this study is to evaluate gender differences among Korean patients diagnosed with SBD. This study included 309 patients who visited our Sleep Clinic due to sleep-related symptoms and were diagnosed with SDB by overnight polysomnography (PSG). We analyzed age, gender, body mass index, various PSG indices including sleep stages, apnea-hypopnea index (AHI) and AHI ratio in rapid eye movement (REM) versus non-REM (NREM) sleep stages (R:N ratio). Of those 309 patients diagnosed with obstructive sleep apnea, 217 (70.2%) were men (mean age 51.05 ± 12.64 years) and 92 (29.8%) were women (mean age 64.53 ± 10.43 years). The mean AHI during total sleep time was 30.34 ± 21.17 in men and 21.47 ± 17.14 in women (P P P = 0.402). REM SDB with R:N ratio higher than 2.0 was more frequently observed in women than in men, 34.8% (32/92) of women, compared with 11.9% (26/217) in men (P 60 years old. These findings suggest the possibility of different pathophysiologic mechanisms of SDB between genders and also between NREM versus REM sleep, which can be partly explained by the influence of female sex hormones.

Transient involuntary movement disorder after spinal anesthesia: A case report

BACKGROUND Spinal anesthesia is commonly used for various surgeries.While many complications occur after induction of spinal anesthesia,involuntary movement is an extremely rare complication.CASE SUMMARY Herein,we report the case of a 54-year-old healthy male patient who experienced involuntary movements after intrathecal injection of local anesthetics.This patient had undergone metal implant removal surgery in both the lower extremities;7 h after intrathecal hyperbaric bupivacaine administration,involuntary raising of the left leg began to occur every 2 min.When the movement disorder appeared,the patient was conscious and cooperative.No other specific symptoms were noted in the physical examination conducted immediately after the involuntary leg raising started;moreover,the patient's motor and sensory assessments were normal.The symptom gradually subsided.Twelve hours after the symptom first occurred,its frequency decreased to approximately once every three hours.Two days postoperatively,the symptoms had completely disappeared without intervention.CONCLUSION Anesthesiologists should be aware that movement disorders can occur after spinal anesthesia and be able to identify the cause,such as electrolyte imbalance or epilepsy,since immediate action may be required for treatment.Furthermore,it is crucial to know that involuntary movement that develop following spinal anesthesia is mostly self-limiting and may not require additional costly examinations.

Botulinum Toxin Type A Satisfaction in Different Neurological Disorders

Background: The botulinum toxin type A (BoNT-A) is used in a wide range of neurological diseases. We aimed to study the overall patients/caregivers’ satisfaction with BoNT-A treatment in different neurological conditions. Methods: Prospective study included patients who had received at least two BoNT-A treatment sessions. They were asked to rate overall treatment satisfaction at the peak of treatment effect on a 1 to 10 scale (1 = not at all satisfied;10 = fully satisfied). Subjects with a rating of 1to3 were classified as not at all satisfied, those with a rating of 4 to7 as somewhat satisfied, and those with a rating of 8 to10 as very satisfied. Treatment satisfaction questionnaire for medicine (TSQM) was assessed at the end of observational period. Quality of life QOL was assessed before BoNT-A treatment and at the last visit. Results: The study was conducted from first April 2014 to August 2021. 548 patients were identified with mean age 43.66 ± 14.50. Most of participants 389 (71%) were female. At the end of observational period, the mean satisfaction was 7.28 ± 1.78. There was a highly significant difference (P P P = 0.001). Conclusion: Satisfaction with BoNT-A therapy for different neurological disorders is overall good. The highest patient satisfaction was observed with primary focal HH, and the least satisfaction was observed in writer’s cramp. BoNT-A therapy improved QOL.

气机升降理论内涵及不寐病辨证分型探讨

气机升降理论是“汉派李氏脑病流派”辨治不寐病的核心理论思想,基于气机升降理论将不寐病分为升降太过和升降不及两大类,根据气机运行的部位、气的多少、气机升降出入的不同形式将不寐病分为营卫不和型、脏腑气机失调型、阴阳不交型三大类型;每一类型又有各自不同亚型,共有卫阳虚不敛营阴证、卫气盛夜不入营阴证、卫气入于阴而日不得出于阳证、肝胆气机疏泄失调证、心肾气机上下相济失调证、脾升胃降枢机失调证、阳不入阴证、阳盛阴虚证、阴不潜阳证九种亚型,并表现出各自独有的临床特征。基于气机升降理论的辨证分型法补充完善了现阶段不寐病辨证分型类别,为临床诊治不寐病开拓了新思路。

基于视频库的翻转课堂在运动障碍疾病教学中的应用

目的探讨基于视频库的翻转课堂在运动障碍疾病教学中的效果。方法建立运动障碍疾病标准化诊断视频库。将2020年6—12月在浙江大学医学院附属第二医院神经内科实习的本科阶段医学生分为对照组和教改组。对照组采用常规教学方法,教改组采用翻转课堂法。课后2组学生进行国际帕金森和运动障碍协会统一帕金森病评分量表第3部分(unified parkinson’s disease rating scale,UPDRS-3)评估,统计与标准分的差距。2组互换教学模式,再次评估MDS-UPDRS-3量表。最后,进行2组间教学满意度的评价比较。结果第一阶段结束,对照组与标准分差值Δ_(A1)为(7.43±2.60)分、教改组与标准分差值Δ_(B1)为(4.90±2.62)分,教改组小于对照组(P<0.05)。第二阶段结束,2组学生评分与标准分差值Δ_(A2)和Δ_(B2)的差异无统计学意义(P>0.05)。教改组的教学满意度高于对照组(P<0.01)。结论与传统的教学方式相比,基于视频学习的翻转课堂可以使学生更快、更好地掌握帕金森病的诊断思路和查体方法。同时在学生满意度方面也有很大的优势,体现了这种方法在运动障碍疾病教学中的良好效果。

川芎祛瘀汤对关节镜下肩袖修补术后患者活动障碍和疼痛的影响

目的观察川芎祛瘀汤对关节镜下肩袖修补术后患者活动障碍和疼痛的影响。方法选取2020年1月—2023年1月期间安阳市中医院收治的90例肩袖损伤行关节镜下肩袖修补术患者,采用随机数字表法分为对照组和观察组,每组各45例。术后对照组予常规治疗及护理,观察组加用川芎祛瘀汤治疗。连续治疗4周。观察比较两组患者术前后疼痛、肩关节功能、肩关节活动情况、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)及血管内皮生长因子(Vascular endothelial growth factor,VEGF)表达。结果术后2、4周两组患者VAS评分均较术前降低,差异有统计学意义(P<0.05);且观察组术后2、4周VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。术后4、8周两组患者UCLA评分及Constant-Murley评分均较术前明显下降,差异有统计学意义(P<0.05);且观察组术后4、8周UCLA评分及Constant-Murley评分均明显低于对照组,差异有统计学意义(P<0.05)。术后8周两组患者肩关节活动度均较术前明显升高,差异有统计学意义(P<0.05);且观察组肩关节活动度明显高于对照组,差异有统计学意义(P<0.05)。术后4周两组患者IL-6、TNF-α表达均较术前明显降低,VEGF表达均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组IL-6、TNF-α含量均明显低于对照组,VEGF明显高于对照组,差异有统计学意义(P<0.05)。结论川芎祛瘀汤能有效缓解关节镜下肩袖修补术后患者疼痛,促进术后患者肩关节功能恢复,改善其关节活动,有效抑制炎症反应,促进血管再生,改善局部微循环。

以运动障碍专科医生为主导、社区医生为中心的帕金森病管理模式效果研究

背景帕金森病(PD)的发病率逐年增高,增加了医保的疾病负担,目前的慢性病管理模式在PD患者的社区管理中没有发挥作用。目的探讨以运动障碍专科医生为主导、社区医生为中心的PD管理模式的效果,以期提高社区医生的PD综合管理能力,提高PD患者的生活质量。方法选取2022年1月—2023年5月在内蒙古科技大学包头医学院第二附属医院神经内科接受诊治的102例PD患者为研究对象,采用随机数字表法分为对照组和主动干预组各51例。对照组患者接受常规社区管理,主动管理组患者接受以PD为亚专业的社区医生的主动管理,管理内容包括用药调整、运动康复、饮食营养、认知功能障碍和精神功能障碍管理等。分别于患者回归社区的1周内(管理前)和6个月时(管理后)对患者开展评价,评价内容包括单日左旋多巴等效剂量、统一帕金森病评定量表第三部分(UPDRS-Ⅲ)、统一帕金森病评定量表第四部分(UPDRS-Ⅳ)、Hoehn-Yahr(H-Y)分期、39项帕金森病生活质量调查问卷(PDQ-39)。结果管理6个月时,主动管理组患者的左旋多巴等效剂量高于管理前,UPDRS-Ⅲ评分、UPDRS-Ⅳ的其他并发症维度得分、PDQ-39得分低于管理前(P<0.05)。Spearman秩相关分析结果显示,主动管理组患者管理前后的PDQ-39得分差值与其精神健康、屈辱感、认知、社会支持、交流、身体不适维度得分差值呈正相关(rs值为0.651~0.893,P<0.05),与UPDRD-Ⅳ得分差值呈正相关(rs=0.338,P<0.05),而与UPDRS-Ⅲ得分差值不相关(P>0.05)。单因素Logistic回归分析结果显示,与对照组相比,主动管理组患者PDQ-39降低的可能性是对照组患者的11.769倍(95%CI=4.340~31.918,P<0.001)。结论以运动障碍专科医生为主导、社区医生为中心的PD管理模式可以提高患者的生活质量,这为PD社区管理提供了参考。