Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke （59.6%） was the primary stroke type found in the young group, while ischemic stroke （60.0%） was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction （such as friendship） improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

Drug utilization evaluation of medications used in the management of neurological disorders

Background and object:The burden of neurological disorders in India is expected to increase due to the rapid demographic and epidemiological transition,with irrational drug use,which is also a global concern.Thus,drug utilization evaluation is designed to ensure appropriate medicine use within the healthcare settings.The aim of the study was to assess the rate and pattern of drug utilization in the management of neurological disorders.Materials and methods:A hospital-based cross-sectional drug utilization evaluation study on neurological drugs was carried out at the Department of Neurology over a span of six months.All legible prescriptions consisting neurological medications irrespective of patient's gender,aged≥18 years were included for the study.The World Health Organization(WHO)core drug use indicators were used to assess the drug prescribing and utilization patterns.Results:A total of 310 prescriptions were reviewed,where male predominance was found to be 56.45%.Out of 310 prescriptions,drugs belonging to 26 neurological classes were prescribed for the management of various neurological disorders.The majority of patients were diagnosed with epilepsy and the most prescribed drugs per patient were phenytoin(14.8%)and valproic acid(6.45%).By following the WHO core drug prescribing indicators,65.47%of drugs prescribed from the India National List of Essential Medicines,2022,followed by 29.83%of drugs prescribed in generic name and 10.86%of prescriptions including injections.Conclusion:The study findings showed that the prescribing pattern in the Department of Neurology was in accordance with the WHO core prescribing indicators.But,the extent of polypharmacy prescriptions was very high.Therefore,interventions are very necessary to promote rational drug prescribing patterns and thus clinical pharmacists can contribute to assess and review the drug utilization pattern to optimize the drug therapy and improvement in patient safety.

Expressions of ICAM-1 and its mRNA in sera and tissues of patients with hepatocellular carcinoma

INTRODUCTIONThe increased expression of ICAM-1 on a widerange of cells and in the sera of patients withmalignancies, chronic liver diseases andinflammation diseases has been described since thelate 1980s[1-22]. Recently rapid progress in studieson expression of ICAM-1 in patients withhepatocellular carcinoma ( HCC ) have beenachieved, including clinical and experimentalresearches[23-31].

The Popularization and Application of Cold Storage Red Blood Cells or Whole Blood at -80 ℃ of the Rh(D) Negative Patients in Surgical Operation

Summary: The efficiency of cold storage red blood cells (CSRBC) or whole blood at -80 ℃ used in 27 Rh(D) negative patients during surgical operation was reported. The Rh(D) negative patients received the transfusion of CSRBC or whole blood stored at -80 ℃ for 180 to 360 days. The changes in the indexes, such as blood TB, DB, K +, Na +, BUN, Cr, urine protein (URPO), UOB, Hb, HCT, serum total protein, relative to hemolytic reaction and blood volume before and after transfusion were observed. The results showed that after transfusion of CSRBC or whole blood 27 cases were negative for urine protein and UOB, and the levels of BUN and Cr were normal (P>0.05). Blood TB, DB, Hb, and HCT were increased, while pH, blood K + and blood Na + was normal with the difference being not significant before and after operation (P>0.05). Plasma protein was decreased, but there was no significant difference before and after operation (P>0.05). It was suggested that CSRBC or whole blood at -80 ℃ could be safely infused to the Rh(D) negative patients without side effects during the surgical operation.

Tacrolimus-induced posterior reversible encephalopathy syndrome following liver transplantation

In this editorial,we talk about a compelling case focusing on posterior reversible encephalopathy syndrome(PRES)as a complication in patients undergoing liver transplantation and treated with Tacrolimus.Tacrolimus(FK 506),derived from Streptomyces tsukubaensis,is a potent immunosuppressive macrolide.It inhibits Tcell transcription by binding to FK-binding protein,and is able to amplify glucocorticoid and progesterone effects.Tacrolimus effectively prevents allograft rejection in transplant patients but has adverse effects such as Tacrolimus-related PRES.PRES presents with various neurological symptoms alongside elevated blood pressure,and is primarily characterized by vasogenic edema on neuroimaging.While computed tomography detects initial lesions,magnetic resonance imaging,especially the Fluid-Attenuated Inversion Recovery sequence,is superior for diagnosing cortical and subcortical edema.Our discussion centers on the incidence of PRES in solid organ transplant recipients,which ranges between 0.5 to 5+ACU-,with varying presentations,from seizures to visual disturbances.The case of a 66-year-old male status post liver transplantation highlights the diagnostic and management challenges associated with Tacrolimus-related PRES.Radiographically evident in the parietal and occipital lobes,PRES underlines the need for heightened vigilance among healthcare providers.This editorial emphasizes the importance of early recognition,accurate diagnosis,and effective management of PRES to optimize outcomes in liver transplant patients.The case further explores the balance between the efficacy of immunosuppression with Tacrolimus and its potential neurological risks,underlining the necessity for careful monitoring and intervention strategies in this patient population.

High levels of Zinc-α-2-Glycoprotein among Omani AIDS patients on combined antiretroviral therapy

Objective:To investigate the levels of zinc-α-2-glycoprotein(ZAG) among Omani AIDS patients receiving combined antiretroviral therapy(cART).Methods:A total of 80 Omani AIDS patients(45 males and 33 females),average age of 36 vears.who were receiving cART at the Saltan Qaboos University Hospital(SQUH).Muscat,Oman,were tested for the levels of ZAG.In addition,SO healthy blood donors(46 males and 34 females),average age of 26 years,attending the SOUH Blood Bank,were tested in parallel as a control group.Measurement of the ZAG levels was performed using a competitive enzyme—linked immunosorbent assay and in accordance with the manufacturer's instructions.Results:The ZAG levels were found to he significantly higher among AIDS patients compared to the healthy individuals(P=0.033).A total of 56(70%) of the AIDS patients were found to have higher levels of ZAG and 16(20%) AIDS patients were found to have high ZAG levels,which are significantly(P>0.031) associated with weight loss.Conclusions:ZAG levels are high among Omani AIDS patients on cART and this necessitales the measurement of ZAG on routine basis,as it is associated with weight loss.

血浆BNP和D-二聚体与老年脑梗死患者神经功能缺损评分及预后的关系

目的探讨血浆B型钠尿肽(BNP)和D-二聚体(D-D)与老年脑梗死(CI)患者神经功能缺损评分及预后的关系。方法选取2018年12月—2021年12月西部战区总医院收治的118例老年CI患者为CI组,另选择同期健康体检者118例为对照组。测定两组血浆BNP、D-D、血脂等生化指标水平。行美国国立卫生研究院卒中量表(NIHSS)评分,将CI组分为轻度组(n=34)、中度组(n=49)和重度组(n=35);并根据随访30 d改良Rankin量表(mRS)评分将其分为预后不良组(n=83)和预后良好组(n=35),比较不同神经损伤程度和预后时血浆BNP、D-D及血脂水平的变化,绘制受试者工作特征(ROC)曲线分析BNP、D-D对老年CI患者预后不良的预测价值。结果CI组吸烟比例、血浆BNP、D-D及LDL-C水平高于对照组(P<0.05);多因素Logistic回归分析显示吸烟、BNP、D-D与CI密切相关(P<0.05);血浆BNP、D-D水平中度组高于轻度组,重度组高于中度组,预后不良组高于预后良好组(均P<0.05);血浆BNP预测老年CI患者预后不良的曲线下面积(AUC)值为0.868,敏感度、特异度分别为70.24%、85.29%,血浆D-D预测老年CI患者预后不良的AUC值为0.809,敏感度、特异度分别为86.90%、70.59%(均P<0.001)。结论BNP、D-D在老年CI患者血浆中呈异常表达,并且与神经功能缺损相关,可用于预测患者预后。

住培医师作为标准化病人的PBL教学法在神经内科教学中的应用

目的探讨住培医师作为标准化病人的以问题为导向的教学法(problem-based learning,PBL)在神经内科临床教学中的应用效果。方法采用随机数字表法,将2020年6月—2021年10月苏州大学附属第二医院62名正在培训的神经内科住培医师随机分成对照组(31名,传统教学法)和观察组(31名,住培医师作为标准化病人的PBL教学法)进行临床住培。从神经内科轮转期6个月以上住培学员中选取标准化病人培训对象。比较2组住培医师培训之后的理论知识、实践能力及综合素质评分。结果观察组住培医师的理论知识及实践操作成绩均高于对照组,差异有统计学意义(P<0.05);观察组住培医师的综合素质评分均高于对照组,差异有统计学意义(P<0.05)。结论住培医师作为标准化病人的PBL教学法在神经科临床培训教学中的应用效果显著。

护患沟通交流模式在儿童神经内科护理中的应用

目的 探讨护患沟通交流模式在儿童神经内科护理中的应用。方法 选取2022年5月至2023年5月烟台市烟台山医院接诊的70例神经内科患儿,根据随机数字表法分为对照组与观察组,每组各35例。对照组予以传统护理模式,观察组予以护患沟通交流模式。比较两组不良情绪、护理依从性及家属满意度。结果 干预后,观察组儿童抑郁量表和儿童青少年多维度焦虑量表评分均低于对照组(P <0.05)。观察组护理总依从率高于对照组(P <0.05)。观察组家属总满意率高于对照组(P <0.05)。结论 护患沟通交流模式在儿童神经内科护理中的应用可有效改善患儿的不良情绪,提高护理依从性及家属满意度,值得推广应用。

The effect of fluoxetine combined with repetitive transcranial magnetic stimulation on the psychological emotions and cognitive and neurological functions of acute post-stroke depression patients

Objective This research was designed to probe into the effects of fluoxetine combined with repetitive transcranial magnetic stimulation (rTMS) on the psychological emotions and the cognitive and neurological functions of acute post-stroke depression patients.Methods This experiment recruited 115 acute post-stroke depression patients who were treated in our hospital from February 2018 to April 2020 as the study cohort. 55 of the patients were treated with fluoxetine, and 60 were treated with fluoxetine combined with rTMS. Both groups were treated for 2 months. The self-rating anxiety scale (SAS), the self-rating depression scale (SDS), the National Institutes of Health stroke scale (NIHSS), the mini mental state scale (MMSE), the Barthel index, and the quality of life scale (SF-36) scores were observed.Results Compared with the control group (CG), the SAS, SDS, and NIHSS scores in the research group (RG) decreased, while the MMSE and Barthel index scores increased (P<0.05). After the treatment, the SF-36 scores in the RG were higher than they were in the CG (P<0.05).Conclusions Fluoxetine combined with rTMS can effectively improve the psychological emotions and the cognitive and neurological functions of acute post-stroke depression patients, so it is worthy of clinical promotion.

专科护士参与的住院患者脑卒中风险筛查及随访管理

目的探讨专科护士参与的住院患者脑卒中风险筛查及随访管理效果,为全面落实脑卒中一级预防提供借鉴。方法构建住院患者脑卒中风险筛查模式,对内外科≥40岁的住院患者进行脑卒中风险筛查。由病区责任护士对患者进行初筛、专科护士对高危风险患者进行卒中一级预防管理,进行1年的随访。结果2021年9月从内外科36个病区中筛查出脑卒中风险患者3416例,其中高危513例(15.02%),中危1926例(56.38%),低危977例(28.60%);对3类患者实施分级管理,其中高危患者由神经内科进一步诊疗;完成1年随访的197例高危患者,随访后血压、血脂、运动等达标率显著高于随访前(均P<0.05),健康自我管理能力得分显著提高(均P<0.05)。结论专科护士参与的住院患者脑卒中风险筛查模式有利于早期发现脑卒中风险患者,落实一级预防,从而降低脑卒中发生率。

学生标准化病人教学方法在神经内科临床实践教学中的应用

目的探讨将学生标准化病人应用于神经内科临床实践教学中的应用效果。方法将80名临床医学本科大四学生随机分成为传统临床带教对照组和学生标准化病人(student as standardized patients,SSP)组。对照组以传统临床带教的方式进行临床实践教学,SSP组采用学生标准化病人进行临床实践教学。临床实践结束后所有学生接受客观结构化临床考试(objective structured clinical examination,OSCE)及完成满意度问卷调查。结果SSP组在OSCE考试中病史采集、神经系统查体得分方面优于对照组,差异有统计学意义(P<0.05)。调查问卷结果显示,SSP组在临床思维提升、激发学习兴趣、沟通能力提升方面得分均高于对照组,差异有统计学意义(P<0.05)。结论学生标准化病人应用于神经内科的临床实践过程中有助于提高临床医学生的病史采集及神经系统体格检查技能,取得更好的教学效果。

优质护理提升老年性脑梗死护理质量价值分析

目的 探讨优质护理提升老年性脑梗死护理质量价值。方法 选取本院收治的老年性脑梗死80例患者,按照收治的先后顺序,分为传统参照组和优质服务组。传统参照组患者采用常规护理,优质服务组患者采取优质护理。比较两组的护理质量评分、住院时间、住院费用、生活质量评分、不良情绪评分、神经功能缺损评分、并发症发生率、护理满意度。结果 优质服务组护理质量评分高于传统参照组,住院时间短于传统参照组,住院费用少于传统参照组(均P <0.05);优质服务组物质生活、躯体功能、心理功能、社会功能等生活质量评分与护理满意度均高于传统参照组(均P <0.05);优质服务组焦虑、抑郁等不良情绪评分与神经功能缺损评分,以及并发症发生率均低于传统参照组(均P <0.05)。结论 优质护理在老年性脑梗死中的临床疗效确切,可提高护理质量,改善患者不良情绪和神经功能,改善患者生活质量,提高护理满意度,缩短住院时间,减少并发症的发生。

神经重症患者下肢深静脉血栓危险因素分析及血栓前状态分子标志物的预测价值

目的:分析神经重症患者下肢深静脉血栓危险因素及血栓前状态分子标志物的预测价值。方法:回顾性分析2021年2月—2023年2月于德化县医院收治的80例患者的病历资料。以术后3 d是否形成血栓将患者分为血栓组(n=39)和非血栓组(n=41),比较两组病历资料及术前血栓前状态分子标志物水平[组织型纤溶酶原激活剂-纤溶酶原激活剂抑制剂-1复合物(t-PAIC)、凝血酶-抗凝血酶复合物(TAT)、纤溶酶-2α纤溶酶抑制物复合物(PIC)、血栓调节蛋白(TM)],采用单因素和多因素logistic回归分析神经重症患者下肢深静脉血栓形成的危险因素,通过绘制受试者工作特征(ROC)曲线分析t-PAIC、TAT、PIC、TM对神经重症患者下肢深静脉血栓的预测价值。结果:两组年龄、右下肢肌力、卧床时间、下肢深静脉穿刺、下肢制动、白细胞(WBC)、纤维蛋白原(FIB)、D-二聚体(D-D)、t-PAIC、TAT、PIC、TM、急性生理与慢性健康评分系统(APACHEⅡ)评分、Caprini评分比较,差异有统计学意义(P<0.05);多因素logistic分析结果显示,年龄≥65岁、下肢制动、D-D升高、t-PAIC、TAT、PIC、TM、Caprini评分是神经重症患者下肢深静脉血栓形成的独立危险因素(P<0.05);ROC曲线显示,TM、TAT、PIC、t-PAIC、联合预测ROC曲线下面积(AUC)分别为0.672、0.837、0.789、0.633、0.887。结论:血栓前t-PAIC、TAT、PIC、TM水平是影响神经重症患者下肢深静脉血栓的独立危险因素,联合检测能早期识别神经重症患者下肢深静脉血栓高危患者。

Factors associated with early neurological deterioration after intravenous thrombolysis with alteplase in patients with acute ischemic stroke

Objective To investigate the risk factors of early neurological deterioration(END)after intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS).Methods We screened consecutive AIS patients from January 2006 to May 2015 in Tangshan Gongren Hospital.In this study,all patients were treated with in-

丁苯酞对脑梗死再灌注患者血清s-100β蛋白、NSE及神经功能缺损的影响

探讨丁苯酞对脑梗死再灌注患者血清s-100β蛋白、NES及神经功能缺陷的影响。选取106例脑梗死再灌注患者,因治疗方案的不同,将其分为常规治疗组与丁苯酞治疗组,每组各53例。常规治疗组采用常规治疗方法,丁苯酞治疗组采用丁苯酞进行治疗,比较两组患者的临床疗效。结果表明,经治疗干预后,丁苯酞治疗组的血清s-100β蛋白与NSE水平显著低于常规治疗组,丁苯酞治疗组的NIHSS评分显著低于常规治疗组(P<0.05)。结论:应用丁苯酞能够有效降低脑梗死再灌注患者的血清s-100β蛋白与NSE水平,恢复脑梗死再灌注患者的神经功能。

Risk factors and prognosis of neurological complications in patients with infective endocarditis

Objective To identify risk factors of neurological complications(NC)in left-sided infective endocarditis(IE)and to assess its impact on the outcome and cardiac surgery.Methods Clinical data,NC,treatment and outcome of patients with definite left-sided IE admitted to our hospital during 2001—2012 were retrospectively ana-

神经科住院医师医患沟通能力评估初探

目的沟通技能是神经科住院医师必须掌握的核心能力之一。本研究旨在了解神经科住院医师医患沟通技能现况,并初步探讨可能的提升方式。方法选择北京协和医院神经科25名住院医师为研究对象,在进行年度客观结构化临床考试(objective structured clinical examination,OSCE)考核时,同期采用医患沟通技能评价(set elicit give understand end,SEGUE)量表评估其医患沟通能力,SEGUE量表包括5个维度,分别是“问诊准备”“信息收集”“信息给予”“理解患者”及“结束问诊”,共计25分。分析神经科住院医师医患沟通能力的常见薄弱环节、表现方式,并初步探讨可能的提升措施。结果25名住院医师均接受了医患沟通能力评估,平均分为(20.78±3.85)分,不同性别住院医师之间的差异无统计学意义[(20.81±3.68)分vs.(20.50±4.29)分,P=0.86]。各评估维度平均分由高到低依次为“问诊准备”“理解患者”“信息收集”“信息给予”及“结束问诊”。其中,“进一步说明下一步诊疗方案”单项得分最低,“询问患者是否还有其他问题需要探讨”和“解释诊断性操作的理论依据”两项得分也较低。按照住院医师入职年限进行亚组分析,结果显示住院医师的医患沟通能力虽然随着入职年限增加而升高,但组间差异不具有统计学意义,且各组间不足之处相仿。结论神经科住院医师医患沟通能力存在欠缺,且这种不足并未随着临床实践的积累得到显著提高。提高神经科住院医师的医患沟通能力,不仅需要持续提升专业技术能力,还要积极倡导开设系统、专业的医患沟通培训课程,从医疗技术和沟通技术两方面提高医患沟通的效果。

神经重症患者分级身体约束的实践研究

目的探讨神经重症患者分级身体约束的应用效果,为临床护理提供参考。方法将神经重症患者209例按入院院区分为对照组(101例)和观察组(98例)。对照组采用常规身体约束方案,观察组采用分级身体约束方案。比较两组身体约束率、身体约束时间、非计划拔管率、谵妄发生率、患者家属满意度。同时选择实施观察组、对照组患者护理的护士各38人为调查对象,比较两组护士在相关培训前后的身体约束知识、身体约束行为。结果两组身体约束率、身体约束时间、谵妄发生率、患者家属满意度比较,差异有统计学意义(均P<0.05);两组非计划拔管率比较,差异无统计学意义(P>0.05)。培训后观察组护士身体约束知识和行为显著高于对照组(均P<0.05)。结论分级身体约束方案可降低神经重症患者身体约束率,缩短约束时间,减少谵妄发生率,有利于提高护士身体约束知识水平及身体约束行为能力,提高患者家属满意度,保障患者约束安全与舒适。

Pender健康促进理论在老年缺血性脑梗死患者恢复中的应用价值

目的探讨Pender健康促进理论在老年缺血性脑梗死患者恢复中的应用价值。方法将2021年12月至2022年12月我院收治的98例老年缺血性脑梗死患者随机分为两组各49例。对照组实施常规护理,观察组在对照组基础上采用Pender健康促进理论。比较两组神经功能、日常活动能力、自护能力及护理满意度。结果护理后,观察组NIHSS评分低于对照组,BI、自护概念、自护技能、责任、健康认知评分高于对照组(P<0.05)。观察组护理满意度为89.8%,高于对照组的73.5%(P<0.05)。结论Pender健康促进理论应用于老年缺血性脑梗死患者可改善其神经功能,提高日常活动能力、自护能力及护理满意度。