Serious motor dysfunction is the leading cause of disability in individuals with stroke. Rehabilitation is the most effective intervention. Taking “stroke” “cerebrovascular accident” “rehabilitation” “motor dysfunction” and other key words, the relevant studies published from January 2015 to January 2020 were searched in Web of Science database to explore the advance in rehabilitation of motor dysfunction in individuals with stroke based on basic and clinical researches. Basic researches mainly focused on the mechanism of neural plasticity, neural loop and various intervention measures, and clinical researches mainly focused on novel rehabilitation intervention technologies for motor dysfunction in individuals with stroke. In addition, mechanism and rehabilitation are still two hotpots in the field of the disease. This paper reviews the search results in order to provide reference for subsequent relevant clinical work and scientific research.
Objective To investigate an evaluation method of medical literature applicability to clinical work， and provide a convenient way for physicians to search for the best evidence. Methods Delphi method was used to choose appropriate evaluating indexes， analytic hierarchy process was performed to determine the weighing of each index， and the formula to calculate medical literature applicability was formed. The practicability of this formula was evaluated by consistency checking between the formula’s results and experts’ opinions on literature applicability. Results Five evaluating indexes were determined， including literature’s publishing year （X1）， whether the target questions were covered （X2）, sample size （X3）， trial category （X4）， and journal level （X5）. The formula to calculate medical literature applicability was Y=3.93 X1＋11.78 X2＋14.83 X3＋44.53 X4＋24.93 X5. The result of consistency checking showed that the formula’s results were highly consistent with experts’ opinions （Kappa=0.75， P＜0.001）. Conclusion The applicability formula is a valuable tool to evaluate medical literature applicability.
Abstract： Objective To investigate prognosis factors of primary small cell carcinoma of the esophagus （PSCCE）, and to optimize the treatment strategy of PSCCE. Method We retrospectively analyzed clinical data of 15 patients （13 males and 2 females with an age of 57.7±2.3 years） with middle thoracic PSCCE in West China Hospital from June 2005 to February 2010. We searched ISI and MEDLINE from April 2001 to February 2010 to extract clinical data of 139 PSCCE patients with 94 males and 45 females with an age of 63.3±10.7 years. We analyzed prognosis factors of the 139 patients including gender, age, tumor location, pathological type, lesions stage and treatment strategy by Kaplan-Meier. Difference in survival curves between limited disease patients and extended disease patients was tested by log-rank test. Results Among the 15 patients, 14 patients had limited disease, and 1 patient had extended disease. Their data were not included in survival analysis because the follow-up was incomplete. Among the 139 patients, 88 patients had limited disease with their 2-year survival rate of 31.8% （28/88）. Fifty-one patients had extended disease with their 2-year survival rate of 7.8% （4/51）. The 2-year survival rate between limited-disease patients and extended-disease patients was statistically different（P＜0.05）. Radiation therapy in combination with chemotherapy had significant influence on the survival rate of patients with either local lesions or advanced lesions（P＜ 0.05）, while other factors such as gender, age and tumor location had no significant influence on their survival rate（P＞0.05）. Conclusion Chemotherapy is the fundamental treatment of PSCCE, which plays an important role in reducing PSCCE preoperative staging and restraining PSCCE postoperative recurrence and metastasis. Surgery and radiation therapy are effective for patients with local lesions. Local treatment in combination with chemotherapy is effective for patients with limited disease. Radiation therapy in combination with chemotherapy is the standard therapy for patients with extended lesions,
Objective To explore the influencing factors of hepatoduodenal ligament lymph node (HDLN), and to analyze the prognostic significance of HDLN metastasis for gastric cancer patients undergone radical gastrectomy. Methods The records and pathological data of gastric cancer patients treated in our hospital from Jan. 2010 to Jun. 2015 were retrospectively analyzed. Results The total number of patients included in this study was 273, of which 96 had lymph node metastasis of the HDLN. Results of unconditional logistic regression analysis showed that age, T staging, M staging, and pathological staging were influencing factors for HDLN metastasis (P<0.05). Results of log-rank test showed that, pathological staging and HDLN status were influencing factors for prognosis of patients undergone radical gastrectomy (P<0.05). For Ⅳ pathological staging patients, the overall survival situation was better in Ⅰ–Ⅲ pathological staging+positive-HDLN group and Ⅰ–Ⅲ pathological staging+negative-HDLN group (P<0.05). For patients in Ⅰ, Ⅱ, and Ⅲ pathological staging, patients in positive-HDLN group had bad survival situation than those of negative-HDLN group in the same pathological staging (P<0.001), and patients in Ⅲ pathological staging+positive-HDLN had the worst prognosis (P=0.001). Conclusion The status of HDLN can be used as an independent prognostic factor for prognosis of gastric cancer.
“Problem - based learning” has become a teaching model widely used in medical undergraduate classroom teaching. In this model, the answers to questions, relevant facts or concepts are not presented directly by the lecturer. The complex questions raised by students are used as a tool to help students learn relevant concepts and principles. This paper discusses the teaching model based on “problem-based learning”, including “problem-based learning” combined with new technologies (new media, three-dimensional printing technology, wisdom teaching), and other teaching mode (case-based learning, lecture-based learning, etc.), as well as the progress in the application of these patterns in clinical teaching of undergraduate course, and analyzes its advantages and disadvantages, hoping to provide a reference for medical undergraduate teaching mode.
Along with the illness progresses of maintenance hemodialysis (MHD) patients, their functional limitations such as decreased cardiopulmonary endurance, muscle loss, dysfunction of arteriovenous fistula, fatigue, and sleep disorders are increasingly prominent and urgently need to be resolved. Modern physiotherapy as a non-invasive and non-pharmacological therapy which can reduce the functional limitations of MHD patients, improves the patients’ exercise capacity and quality of life. Physical therapy techniques suitable for MHD patients include active and passive exercise therapy such as aerobic exercise, resistance exercise, breathing training, and muscle stretching, as well as physical agents therapy such as neuromuscular electrical stimulation, infrared, and low-frequency pulsed electromagnetic field. Choosing appropriate physical agents and exercise prescription can reduce the treatment risk and improve the efficacy.
Pusher syndrome (PS) is a postural control disorder that occurs after stroke, which is mainly manifested as a balance dysfunction that is difficult to correct, leading to a significant decline in activity safety of stroke patients and hindering the process of rehabilitation treatment. Proper interventions are needed as soon as possible. Based on the research results of PS both domestic and foreign, this paper firstly summarizes the foundations of the mechanism of PS occurrence, and elaborates the existing disputes. Secondly, this paper systematically introduces the current mainstream assessment and treatment methods of PS, summarizes the problems in relevant clinical practice, and on this basis, gives some suggestions on the possible research directions in the future. The purpose is to provide reference for clinical application and future research directions.
ObjectiveTo explore and verify the effectiveness of task-oriented circuit therapy (TOCT) in rehabilitation training for stroke patients’ walking ability.MethodsSixty patients with stroke were selected from the Department of Neurology and Department of Rehabilitation Medicine of West China Hospital of Sichuan University from September 2019 to December 2020. By envelope method, the patients were randomly divided into the trial group and the control group, with 30 cases in each group. Both groups received routine rehabilitation treatment. The patients in the control group received conventional one-to-one rehabilitation therapy, and the patients in the trial group received TOCT training. The training lasted for 4 weeks. The patients were followed up 3 months after the training. Motor Assessment Scale (MAS) and Functional Ambulation Category Scale (FAC) were used to evaluate the walking ability of the patients before training, at the end of 4 weeks of training (after training) and at the follow-up. SF-36 health survey short form was used to evaluate the quality of life of patients before training and during follow-up.ResultsBefore training, there was no significant difference in gender, age, course of disease, stroke location, walking ability score or SF-36 score between the two groups (P>0.05). After training and at follow-up, the walking ability related scores of the two groups were improved. The trial group was better than the control group (MAS: Z=−3.220, P=0.001; Z=−4.703, P<0.001. FAC: Z=−2.447, P=0.014; Z=−3.249, P=0.001). SF-36 scores of the two groups were improved after 3 months of follow-up. The trial group was better than the control group (Z=−6.674, P<0.001). During the study period, there were no complications or adverse reactions related to rehabilitation training.ConclusionsTOCT has a significant effect on rehabilitation training of lower limb function of stroke patients. It has more advantages than conventional rehabilitation training in improving the walking ability and the quality of life of patients.
【摘要】 目的 探讨康复宣教与训练等干预手段对股骨干骨折患者围手术期的影响。 方法 2010年6月－2011年3月收治股骨干骨折患者90例，其中男48例，女42例；年龄17~58岁，平均38岁。开放性骨折28例，闭合性骨折62例。股骨骨折部位:上1/3骨折33例，中1/3骨折35例，下1/3骨折20例，多段骨折2例。横形骨折20例，斜形骨折30例，粉碎性骨折40例。将90例患者随机分为康复组（46例）和对照组（44例）。对照组采用骨科术前常规处理，康复组采用骨科术前常规处理加康复宣教与训练。 结果 康复组住院时间为（5.35±1.27） d，对照组为（7.67±1.85） d，两组比较差异有统计学意义（Plt;0.05）。 康复组治疗后发生并发症7例，对照组16例，康复组并发症发生率（15.2%）明显低于对照组（36.4%），差异有统计学意义（Plt;0.05）。治疗后5 d，康复组疗效获优35例，良6例，可3例，差2例，优良率89.1%；对照组获优25例，良5例，可12例，差2例，优良率68.2%；两组疗效比较差异有统计学意义（Plt;0.05）。 结论 康复宣教与训练能预防与改善股骨干骨折围手术期卧床引起的并发症，减轻患者腿部疼痛及肿胀，缩短围手术期时间，使患者能尽早手术，加快住院床位周转，提高患者生活质量。【Abstract】 Objective To explore the effects of rehabilitation education and training interventions on perioperative patients with femoral shaft fractures. Methods A total of 90 patients with femoral shaft fractures were selected from June 2010 to March 2011, including 48 males and 42 females aged from 17 to 58 years (mean 38 years). In these 90 patients, open fracture was in 28 and closed fracture was in 62. Fracture site: upper 1/3 fracture was in 33, middle 1/3 fracture was in 35, lower 1/3 fracture was in 20 and multiple fractures was in 2. There were transverse fractures in 20 patients, oblique fractures in 30 patients and comminuted fractures in 40 patients. All of the patients were randomly divided into experimental group (46 patients) and control group (44 patients). The patients in the control group underwent the routine treatment before the orthopedic surgery; besides the routine treatment, the patients in the experimental group were given the rehabilitation education and training before the orthopedic surgery. Results The hospital duration in the rehabilitation group was (5.35±1.27) days while in the control group was (7.67±1.85) days, the difference was statistically significant (Plt;0.05). There were 7 cases who had complications in rehabilitation group compared with 16 patients in the control group; the incidence of the complications in the rehabilitation group (15.2%) was significantly lower than that in the control group (36.4%) (Plt;0.05). After the treatment for 5 days, the therapeutic effect in rehabilitation group were excellent in 35 cases, good in 6 cases, middle in 3 cases and poor in 2 cases (with the good rate of 89.1%); while in the control group were excellent in 25 cases, good in 5 cases, middle in 12 cases and poor in 2 cases (with the good rate of 68.2%); the difference was significant between the two groups (Plt;0.05). Conclusion Rehabilitation education and training could prevent the perioperative complications in patients with femoral shaft fracture, decrease the pain and edema, speed up the turnover of hospital beds, and improve the patients’ quality of life.
Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA ) on the selection of operative procedures in lower rectal cancer.MethodsProspectively enrolled 130 patients diagnosed definitely as lower rectal cancer (distance of tumor to the dentate line ≤7 cm) at West China Hospital of Sichuan University from July 2007 to September 2008 were randomly assigned into two groups with 65 participants, respectively. In one group named MSCT+SAAgroup, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only the preoperative MSCT was made. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation program, respectively.ResultsAccording to the criteria, 119 patients with colorectal cancer were actually included into MSCT+SAA group (n=58) and MSCT group (n=61). The baselines characteristics of two groups were basically identical. For MSCT+SAAgroup, the accuracies of preoperative staging T, N, M and TNM were 89.66%, 79.31%, 100% and 77.59%, respectively; For MSCT group, the corresponding rates were 86.89%, 70.49%, 100% and 65.57%, respectively. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (93.10% vs. 80.33%, P=0.041). The clinical staging (P=0.001), preoperative T staging (P=0.000), M staging (P=0.016), TNM staging (P=0.013) and serum level of SAA (P=0.029) were related to the selection of operative procedures when analyzing the relationship between the operative procedures and multiple clinicopathologic factors in lower rectal cancer. ConclusionCombinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, thus provide higher predictive coincidence rate to operative procedures for surgeon.