BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes i...BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.展开更多
Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10...Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.展开更多
BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear wheth...BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear whether intracoronary pressure differs between the two spasm types.AIM To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with VSA.METHODS Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent SPT.During the SPT,a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery,and the ratio of the intracoronary pressure to the aortic pressure(Pd/Pa)was continuously monitored.An SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of>90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG changes.Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as>90%spasm with two or more segments.RESULTS Among 87 patients,the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group(n=33)than in the diffuse spasm group(n=54,P<0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,respectively.The Pd/Pa at baseline was similar in both groups(diffuse:0.96±0.05,focal:0.95±0.05,P=0.35);however,the Pd/Pa during coronary spasm was lower in focal spastic vessels(0.66±0.20)than in diffuse spastic vessels(0.76±0.11,P<0.01),and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels(-0.29±0.20)than in diffuse spastic vessels(-0.18±0.11,P<0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the intracoronary pressure during coronary spasm.展开更多
BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case...BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.展开更多
AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospectiv...AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally,due to prolonged screen use SNR and AS may become more frequent in the future.展开更多
Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought t...Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought to investigate the effectiveness and safety of guiding catheter crossing over spasmodic radial or (and) brachial artery segments by the aid of PCI wire and balloon compared with traditional anti-spasmodic approach. Methods: The clinical data of 168 patients with coronary artery disease (CAD) (group A), whose PCI was performed via radial artery access with radial or (and) brachial artery spasm or (and) dissection and guiding catheter passing through spasmodic segments successfully by the aid of PCI guiding wire and balloon were analyzed retrospectively, simultaneously, the other 73 patients (group B) who used conventional approach to cross over the spasmodic radial or (and) brachial artery segments were treated as the control. The success rate, the time consumption and the complication were compared between the two groups. Findings: There was no significant difference in the spasmodic site between the two groups (all p value > 0.05). The success rate in group A was significantly higher than that in group B (168(100%) vs 28 (38.4%), p (4.2%) vs 14 (19.2%), p Conclusions: It is more effective and safer for guiding catheter crossing over spasmodic or (and) dissected radial or (and) brachial artery segments by the aid of PCI guiding wire and balloon than using the routine approach of administration of anti-spasm drugs for trans-radial PCI.展开更多
Vasospasm is a thorny problem often encountered in microvascular surgery.This investigation is dedicated to establishing a model of vasospasm and to evaluating the antispasmodic efficacy of 10 pharmacologic agents und...Vasospasm is a thorny problem often encountered in microvascular surgery.This investigation is dedicated to establishing a model of vasospasm and to evaluating the antispasmodic efficacy of 10 pharmacologic agents under direct monitoring of laser speckle contrast imaging(LSCI).80 SD rats were used.A pair of microsurgical forceps were used to trigger vasospasm of the femoral vessels by blunt dissection.Five minutes later,10 pharmacological agents were dripped to the femoral vessels,after which LSCI was used to collect perfusion images,acquiring the perfusion intensity and the inner caliber of the femoral vessels at multiple time points.展开更多
We report a case of essential thrombocythemia(ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction(AMI) without significant obstructive coronary artery disease.Right coronar...We report a case of essential thrombocythemia(ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction(AMI) without significant obstructive coronary artery disease.Right coronary vasospasm was observed after intra-coronary methylergonovine administration and she received verapamil 120 mg/d thereafter and hydroxyurea 1500 mg/d for thrombocythemia.After discontinuation of the hydroxyurea for 9 mo based on the impression of coronary spasm-related instead of coronary thrombosis-related AMI,her platelet count rose but no chest pain was observed.It is suggested that coronary spasm potentially plays a role in patients with ET,AMI and no significant coronary artery stenosis.展开更多
Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainst...Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.展开更多
We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission h...We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia,he was admitted to our institution for coronary angiography(CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery(LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm,which was relieved after the intracoronary infusion of nitroglycerin. Finally,a CAG showed myocardial bridging(MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77,which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus,coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.展开更多
Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle ...Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle response (AMR) which was characteristic of Hemifacial Spasm.The animal models of Hemifacial Spasm in New Zealand white rabbits were established by compressing the main trunk of artificial demyelinated facial nerve with the temporal superficial artery. At 6 weeks after surgery, the facial nerves were taken from the experimental group and control one, the immunohistochemistry for CGRP using polyclonal antibody with ABC kit was performed in the facial nerves; at the same time, the observation for the facial nerves of light and transmission electron microscope was performed. Results The facial nerve demyelinated and the axons retrogressively changed, CGRP immunoreactive positive fibers were significantly detected in experimental groups; whereas this phenomenon was not found in control group. Conclusion CGRP can nutrien the injured facial nerve and plays an important role in the pathogenesis of Hemifacial Spasm.展开更多
Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis ...Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis which was not properly treated.展开更多
BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinici...BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.展开更多
BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessiv...BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.展开更多
Distal esophageal spasm(DES)is a rare major motility disorder in the Chicago classification of esophageal motility disorders(CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal s...Distal esophageal spasm(DES)is a rare major motility disorder in the Chicago classification of esophageal motility disorders(CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal sphincter(LES)relaxation on high-resolution manometry(HRM)in the latest version of CCv3.0.This feature differentiates it from achalasia type 3,which has an elevated LES relaxation pressure.Like other spastic esophageal disorders,DES has been linked to conditions such as gastroesophageal reflux disease,psychiatric conditions,and narcotic use.In addition to HRM,ancillary tests such as endoscopy and barium esophagram can provide supplemental information to differentiate DES from other conditions.Functional lumen imaging probe(FLIP),a new cutting-edge diagnostic tool,is able to recognize abnormal LES dysfunction that can be missed by HRM and can further guide LES targeted treatment when esophagogastric junction outflow obstruction is diagnosed on FLIP.Medical treatment in DES mostly targets symptomatic relief and often fails.Botulinum toxin injection during endoscopy may provide a temporary therapy that wears off over time.Myotomy through peroral endoscopic myotomy or via surgical Heller myotomy can provide long term relief in cases with persistent symptoms.展开更多
A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographicall...A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause.展开更多
The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowled...The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.展开更多
BACKGROUND:The main aim of rehabilitation is to ameliorate motor function and use the damaged limbs in the activities of daily living.Several factors are needed in the self-recovery of the patients,and the most import...BACKGROUND:The main aim of rehabilitation is to ameliorate motor function and use the damaged limbs in the activities of daily living.Several factors are needed in the self-recovery of the patients,and the most important one is to reduce spasm.Some mechanical repetitive movements can affect and change the excitability of motor neurons.OBJECTIVE:To observe the effect of repetitive training on ameliorating spasm of upper limbs of hemiplegic patients.DESIGN:A self-controlled observation before and after training.SETTING:Department of Rehabilitation,Xuanwu Hospital of Capital Medical University.PARTICI PANTS: Seven hemiplegic patients induced by brain injury were selected from the Department of Rehabilitation,Xuanwu Hospital,Capital Medical University from March to June in 2005.Inclusive criteria:①Agreed and able to participate in the 30-minute training of hand function; ②Without disturbance of understanding.The patients with aphasia or apraxia,manifestation of shoulder pain,and severe neurological or mental defects.For the 7 patients,the Rivermead motor assessment(RMA)scores ranged 0-10 points,the Rivermead mobility index(RMI)ranged 1-3,and modified Ashworth scale(MAS)was grade 2-4.Their horizontal extension of shoulder joint was 0°-30°,anteflextion was 0°-50°,internal rotation was 50°-90°,external rotation was 0°-10°:and the elbow joint could extend for 15°-135°.METHODS:The viva 2 serial MOTOmed exerciser(Reck Company,Germany)was used.There were three phases of A-B-A.①The phase A lasted for 1 week.The patient sat on a chair facting to the MOTOmed screen.and did the circumduction of upper limbs forwardly,30 minutes a day and 5 days a week.②The phase B lasted for 3 weeks.The training consisted of forward circumduction of upper limbs for 15 minutes.followed by backward ones for 15 minutes and 5-minute rest.③The training in the phase A was performed again for 2 weeks.The extensions of upper limbs were recorded at phase A,the extension and flexion of elbow joints were recorded at phase B,and the extensions were recorded at the second A phase.All the patients were evaluated by the same therapeutist.①RMA was used to evaluate the motor function completely,including the motor control of both upper and lower limbs,but only the data of upper limbs were recommended to be used. Tne flexibility and concordance of upper limbs were described by detecting the ability of hand to move objects with 15 items,2 grades for each item:0 for could not complete and 1 for could complete.②RMI was used to measure the flexion and extension of elbow joint and shoulder joint,the scores ranged from 0(no movement and no obvious muscle contraction)to 5(close to normal movement).③MAS was used to evaluate the muscle tension in clinic.Grade 1 for without abnormal increase of muscle tension,and grade 5 for muscle rigidity.and it was unable for passive movement.④Ranges of motion of elbow joint and should joint were measured using protractor.MAIN OUTCOME MEASURES:①The strength of each limb to persist for 40 s recorded by two hand pedals;②Changes of muscle tensions detected by the two hand pedals;③Changes of muscle contraction at the flexion and extension of ipsilateral limb recorded by EMG;④Minimal moment of iplateral end foot;⑤RMA;⑥RMI;⑦MAS;⑧Ranges of motion of elbow joints and shoulder joints.RESULTS:The functions were evaluated at 6 weeks after training.①The strength of each limb to persist for 40 s was recorded.and the strength of the ipsilateral limb changed obviously from 20%-40%to 50%-70%.②The muscle tensions detected by the two hand pedals changed from 2.2-4.0 N·m to 0.2-1.0 N·m.③EMG displayed that along with the enhancement of fast movements.the strength curve increased(the EMG for the extension of elbow joints were obvious).④The minimal moment of iplateral end foot was 5.0 N·m.⑤The RMA scores ranged 15-30 points.⑥The RMI ranged 4-5.⑦MAS were grades 0-2.⑧For shoulder joints,the ranges of motion were 90°-180°for external extension,90°for anteflexion,90°for internal rotation and 50°-75°for external rotation;For elbow joints,the extension of active movements was close to 0°.CONCLUSION:After repetitive movements,the strength of upper limb increased,the range of motion enlarged,and spasm reduced.展开更多
Gastrointestinal spasm is manifested asabdominal pain in a soft belly that feels com-fort with warmth and pressure.We treated97 cases of the disease with moxibustion.The curative effect was good in comparisonwith a co...Gastrointestinal spasm is manifested asabdominal pain in a soft belly that feels com-fort with warmth and pressure.We treated97 cases of the disease with moxibustion.The curative effect was good in comparisonwith a control group.展开更多
文摘BACKGROUND Although the spasm provocation test(SPT)can diagnose coronary spasms,it would be helpful if it could also predict their occurrence.AIM To investigate whether coronary spasms can be predicted using changes in intracoronary artery pressure measured using a pressure wire during the SPT.METHODS Seventy patients underwent SPTs with pressure-wire measurement of intracoronary artery pressure.During each SPT,the pressure wire was advanced into the distal portion of the right coronary artery(RCA)and left anterior descending coronary artery,and the ratio of intracoronary pressure to aortic pressure(Pd/Pa)was monitored.Coronary spasm was defined as an arterial narrowing of>90%in response to the administration of acetylcholine(ACh),with chest symptoms and/or ischemic electrocardiographic changes.ACh was administered to the RCA at low,moderate,or high doses of 20,50,or 80μg,respectively,and to the left coronary artery(LCA)at low,moderate,or high doses of 50,100,or 200μg,respectively.Coronary arteries with coronary spasms at low doses of ACh were defined as group L,and those with coronary spasms at moderate or high doses were defined as group MH.Those who did not occur coronary spasms at any ACh dose were designated as group N.RESULTS Among the 132 coronary arteries assessed using a pressure wire,there were 49 in group N,25 in group L,and 58 in group MH.Baseline Pd/Pa was the lowest in group L(P=0.001).The decrease in the Pd/Pa between baseline to low doses of ACh was lower in group MH than in group N(P<0.001).A receiver-operating characteristics analysis showed that the cutoff baseline Pd/Pa value for predicting group L was 0.95,with a sensitivity of 0.600(15/25)and a specificity of 0.713(76/107)and that the cutoff value of Pd/Pa from baseline to low doses of ACh for predicting group MH was−0.04,with a sensitivity of 0.741(43/58)and a specificity of 0.694(34/49).CONCLUSION These findings suggest that indices of intracoronary pressure during SPT may be useful means for predicting the occurrence of coronary spasms.
基金the National Key R&D Program of China(Grant No.2019YFC1709900)National Natural Science Foundation of China(Grant No.71804022)+1 种基金Natural Science Foundation of Henan province(Grant No.232300420256)Medical technologies R&D Program of Henan province(Grant No.LHGJ20220348).
文摘Background:To investigate the effects of acupuncture on post-stroke limb spasm model rats and the underlying mechanism.Methods:A total of 50 Sprague-Dawley rats were randomly divided into three groups,Control group(10),Model group(20)and Zhishen Tiaoxing(ZSTX)acupuncture group(20).Middle cerebral artery occlusion was conducted in SD rats to establish post-stroke limb spasm rats,which were treated with ZSTX acupuncture.Behavioral assays were determined by the Narrow ally test,the limb muscle tension was detected by the BL-420S test system,and infarct volume was assessed after the cerebral infarction by 2,3,5-triphenyltetrazolium chloride staining.Heterogeneous neurotransmitterγ-aminobutyric acid(GABA)and its receptors GABAA and GABAB in the cerebral cortex of the infarct area were determined by immunofluorescence assay.The release of Trkb and K-Cl cotransporter isoform 2 was detected by an immunofluorescence double labeling study.Western Blot was utilized to measure the expression of BDNF and Trkb.Results:The results showed that the behavioral assays in post-stroke limb spasm rats were significantly improved by the treatment of ZSTX acupuncture.14 days of ZSTX acupuncture can effectively inhibit muscle tone and decrease Infarct volume,which was measured with BL-420S biological function experiment system and triphenyltetrazolium chloride.Meanwhile,the results of Double-Label Immunofluorescence Assays showed that ZSTX acupuncture improved the expression of GABA,GABAA,GABAB,BDNF,and K-Cl cotransporter isoform 2.Double-Label Immunofluorescence Assays and WB results showed that 14 days ZSTX acupuncture declined the expression of Trkb.Conclusions:Our results suggest that 14 days of ZSTX acupuncture can significantly improve post-stroke limb spasm.Meanwhile,the pathogenesis of post-stroke limb spasm and the efficacy of ZSTX acupuncture involve metabolic pathways of neurotransmitters,and electro-acupuncture can treat post-stroke limb spasm by regulating BDNF/Trkb-KCC2 signaling pathway.
文摘BACKGROUND Several reports show that two types of coronary vasospasm(diffuse and focal spasm)are associated with the severity or prognosis of coronary spasm in patients with vasospastic angina(VSA).It is unclear whether intracoronary pressure differs between the two spasm types.AIM To investigate such relationships using a pressure wire during the spasm provocation test(SPT)in patients with VSA.METHODS Eighty-seven patients with VSA(average age:67 years;50 men,37 women)underwent SPT.During the SPT,a pressure wire was advanced into the distal portion of the right coronary artery and left anterior descending coronary artery,and the ratio of the intracoronary pressure to the aortic pressure(Pd/Pa)was continuously monitored.An SPT was performed using acetylcholine(ACh),and the presence of coronary spasm was defined as the presence of>90%arterial narrowing in response to an ACh infusion,with the usual chest symptoms and/or ischemic ECG changes.Focal spasm was defined as total or subtotal spasm within one segment of the AHA classification,while diffuse spasm was defined as>90%spasm with two or more segments.RESULTS Among 87 patients,the frequencies of metabolic syndrome and having coronary atherosclerosis were higher in the focal group(n=33)than in the diffuse spasm group(n=54,P<0.05).In the vessel analyses,in these 134 spastic segments,diffuse and focal spasms were detected in 100 and 34 vessels,respectively.The Pd/Pa at baseline was similar in both groups(diffuse:0.96±0.05,focal:0.95±0.05,P=0.35);however,the Pd/Pa during coronary spasm was lower in focal spastic vessels(0.66±0.20)than in diffuse spastic vessels(0.76±0.11,P<0.01),and the reduction in Pd/Pa during an SPT was also lower in focal spastic vessels(-0.29±0.20)than in diffuse spastic vessels(-0.18±0.11,P<0.01).The presence of focal spasm was a significant factor responsible for reduction in Pd/Pa during SPT.CONCLUSION These findings suggest that focal spasm may be more severe than diffuse spasm,judging from the intracoronary pressure during coronary spasm.
文摘BACKGROUND Coronary artery spasm(CAS)is a rare but critical condition during surgery.Clinical manifestations can vary from only subtle electrocardiography change to sudden death.In this case report,we present the case of a patient with myasthenia gravis(MG)who developed refractory CAS-related cardiogenic shock during thymoma surgery.CASE SUMMARY A 61-year-old man had a history of cigarette smoking and coronary artery disease with a bare metal stent placed.Three months ago,he suffered from coronary spasms,with three vessels involved,after surgery for cervical spine injury.He started having progressive dysphagia 4 wk prior and was diagnosed with MG via serologic tests,and computed tomography declared a thymoma in the anterior mediastinum.After the symptoms of MG subsided,he was referred for thy-mectomy.The operation was uneventful until the closing of the sternal wound.Electrocardiography showed sudden onset ST elevation,followed by ventricular tachycardia and severe hypotension.Cardiopulmonary cerebral resuscitation was initiated immediately with electrical defibrillation,extracorporeal membrane oxygenation was performed due to refractory cardiogenic shock,and the patient was transferred to an angiography room.Angiography showed diffuse CAS with three vessels involved.Intracoronary isosorbide dinitrate and adenosine were administered,and then the patient was transferred to the intensive care unit.CONCLUSION Our case highlights the importance of being prepared for clinical situations such as the one described here and suggests the necessity of developing an appropriate anesthesia plan that includes proactive analgesia and preemptive coronary vaso-dilators.
文摘AIM:To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex(SNR),in order to present common investigation strategies and diagnostic pitfalls.METHODS:Retrospective case series of twenty-two patients,mainly children,with SNR or accommodation spasm(AS).AS was diagnosed on the basis of blurred vision and a difference of>2 dioptres between manifest and cycloplegic retinoscopy.If esotropia and miosis were present,the patients were diagnosed with SNR.All patients underwent visual acuity testing,orthoptic evaluation,assessment of refraction before and after cycloplegia,and dilated fundoscopy.Additional diagnostic investigations,such as neuroimaging,lumbar puncture(LP),electrophysiology and blood tests,were also recorded.Screen use among children was assessed in hours per day.RESULTS:There were 19 female and 3 male patients(age range 7-33 y,median=10 y).Seventeen patients had AS and 5 patients had SNR,with episodic blurry vision and headaches being the most common symptoms.Brain neuroimaging was performed in six patients(27%),although only one had a history of brain trauma.Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy.The majority of patients(90%)reported prolonged daily screen time(>2 h/d),and in 55%of cases there were concurrent social problems or psychological triggers.Treatment consisted of careful explanation of the condition,atropine1%eye drops and full cycloplegic correction by means of bifocal glasses.CONCLUSION:The diagnosis of SNR and AS may be challenging,because symptoms are usually intermittent and nonspecific,and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment,that may exaggerate the underlying psychological disorder.Hence,detailed clinical testing and assessment of psychosocial profile is necessary,in order to avoid unnecessary investigations.Neuroimaging should be performed only in selected cases.Finally,due to prolonged screen use SNR and AS may become more frequent in the future.
文摘Objective: Percutaneous coronary intervention (PCI) via the radial artery access has more advantages than that of femoral artery access, while radial or (and) brachial artery have tendency to be spasmodic. We sought to investigate the effectiveness and safety of guiding catheter crossing over spasmodic radial or (and) brachial artery segments by the aid of PCI wire and balloon compared with traditional anti-spasmodic approach. Methods: The clinical data of 168 patients with coronary artery disease (CAD) (group A), whose PCI was performed via radial artery access with radial or (and) brachial artery spasm or (and) dissection and guiding catheter passing through spasmodic segments successfully by the aid of PCI guiding wire and balloon were analyzed retrospectively, simultaneously, the other 73 patients (group B) who used conventional approach to cross over the spasmodic radial or (and) brachial artery segments were treated as the control. The success rate, the time consumption and the complication were compared between the two groups. Findings: There was no significant difference in the spasmodic site between the two groups (all p value > 0.05). The success rate in group A was significantly higher than that in group B (168(100%) vs 28 (38.4%), p (4.2%) vs 14 (19.2%), p Conclusions: It is more effective and safer for guiding catheter crossing over spasmodic or (and) dissected radial or (and) brachial artery segments by the aid of PCI guiding wire and balloon than using the routine approach of administration of anti-spasm drugs for trans-radial PCI.
文摘Vasospasm is a thorny problem often encountered in microvascular surgery.This investigation is dedicated to establishing a model of vasospasm and to evaluating the antispasmodic efficacy of 10 pharmacologic agents under direct monitoring of laser speckle contrast imaging(LSCI).80 SD rats were used.A pair of microsurgical forceps were used to trigger vasospasm of the femoral vessels by blunt dissection.Five minutes later,10 pharmacological agents were dripped to the femoral vessels,after which LSCI was used to collect perfusion images,acquiring the perfusion intensity and the inner caliber of the femoral vessels at multiple time points.
文摘We report a case of essential thrombocythemia(ET) in a 30-year-old female who exhibited inferior wall ST-elevation acute myocardial infarction(AMI) without significant obstructive coronary artery disease.Right coronary vasospasm was observed after intra-coronary methylergonovine administration and she received verapamil 120 mg/d thereafter and hydroxyurea 1500 mg/d for thrombocythemia.After discontinuation of the hydroxyurea for 9 mo based on the impression of coronary spasm-related instead of coronary thrombosis-related AMI,her platelet count rose but no chest pain was observed.It is suggested that coronary spasm potentially plays a role in patients with ET,AMI and no significant coronary artery stenosis.
文摘Primary hemifacial spasm(HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone(REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression(MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD(such as lateral spread response,brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.
文摘We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia,he was admitted to our institution for coronary angiography(CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery(LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm,which was relieved after the intracoronary infusion of nitroglycerin. Finally,a CAG showed myocardial bridging(MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77,which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus,coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.
文摘Objective To study the immunoreactivity of Calcitonin gene-related peptide (CGRP) in the facial nerve when Hemifacial Spasm is occurring. Methods The electrophysiological technique was used to explore abnormal muscle response (AMR) which was characteristic of Hemifacial Spasm.The animal models of Hemifacial Spasm in New Zealand white rabbits were established by compressing the main trunk of artificial demyelinated facial nerve with the temporal superficial artery. At 6 weeks after surgery, the facial nerves were taken from the experimental group and control one, the immunohistochemistry for CGRP using polyclonal antibody with ABC kit was performed in the facial nerves; at the same time, the observation for the facial nerves of light and transmission electron microscope was performed. Results The facial nerve demyelinated and the axons retrogressively changed, CGRP immunoreactive positive fibers were significantly detected in experimental groups; whereas this phenomenon was not found in control group. Conclusion CGRP can nutrien the injured facial nerve and plays an important role in the pathogenesis of Hemifacial Spasm.
文摘Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis which was not properly treated.
文摘BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.
基金Supported by the National Natural Science Foundation of China,No. 82000252
文摘BACKGROUND Acute stent thrombosis(AST)is a serious complication of percutaneous coronary intervention(PCI).The causes of AST include the use of stents of inappropriate diameters,multiple overlapping stents,or excessively long stents;incomplete stent expansion;poor stent adhesion;incomplete coverage of dissection;formation of thrombosis or intramural hematomas;vascular injury secondary to intraoperative mechanical manipulation;insufficient dose administration of postoperative antiplatelet medications;and resistance to antiplatelet drugs.Cases of AST secondary to coronary artery spasms are rare,with only a few reports in the literature.CASE SUMMARY A 55-year-old man was admitted to the hospital with a chief complaint of back pain for 2 d.He was diagnosed with coronary heart disease and acute myocardial infarction(AMI)based on electrocardiography results and creatinine kinase myocardial band,troponin I,and troponin T levels.A 2.5 mm×33.0 mm drugeluting stent was inserted into the occluded portion of the right coronary artery.Aspirin,clopidogrel,and atorvastatin were started.Six days later,the patient developed AST after taking a bath in the morning.Repeat coronary angiography showed occlusion of the proximal stent,and intravascular ultrasound showed severe coronary artery spasms.The patient’s AST was thought to be caused by coronary artery spasms and treated with percutaneous transluminal coronary angioplasty.Postoperatively,he was administered diltiazem to inhibit coronary artery spasms and prevent future episodes of AST.He survived and reported no discomfort at the 2-mo follow-up after the operation and initiation of drug treatment.CONCLUSION Coronary spasms can cause both AMI and AST.For patients who exhibit coronary spasms during PCI,diltiazem administration could reduce spasms and prevent future AST.
文摘Distal esophageal spasm(DES)is a rare major motility disorder in the Chicago classification of esophageal motility disorders(CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal sphincter(LES)relaxation on high-resolution manometry(HRM)in the latest version of CCv3.0.This feature differentiates it from achalasia type 3,which has an elevated LES relaxation pressure.Like other spastic esophageal disorders,DES has been linked to conditions such as gastroesophageal reflux disease,psychiatric conditions,and narcotic use.In addition to HRM,ancillary tests such as endoscopy and barium esophagram can provide supplemental information to differentiate DES from other conditions.Functional lumen imaging probe(FLIP),a new cutting-edge diagnostic tool,is able to recognize abnormal LES dysfunction that can be missed by HRM and can further guide LES targeted treatment when esophagogastric junction outflow obstruction is diagnosed on FLIP.Medical treatment in DES mostly targets symptomatic relief and often fails.Botulinum toxin injection during endoscopy may provide a temporary therapy that wears off over time.Myotomy through peroral endoscopic myotomy or via surgical Heller myotomy can provide long term relief in cases with persistent symptoms.
文摘A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause.
基金support of this research by the Mount Sinai Health System and the THANC Foundation
文摘The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.
文摘BACKGROUND:The main aim of rehabilitation is to ameliorate motor function and use the damaged limbs in the activities of daily living.Several factors are needed in the self-recovery of the patients,and the most important one is to reduce spasm.Some mechanical repetitive movements can affect and change the excitability of motor neurons.OBJECTIVE:To observe the effect of repetitive training on ameliorating spasm of upper limbs of hemiplegic patients.DESIGN:A self-controlled observation before and after training.SETTING:Department of Rehabilitation,Xuanwu Hospital of Capital Medical University.PARTICI PANTS: Seven hemiplegic patients induced by brain injury were selected from the Department of Rehabilitation,Xuanwu Hospital,Capital Medical University from March to June in 2005.Inclusive criteria:①Agreed and able to participate in the 30-minute training of hand function; ②Without disturbance of understanding.The patients with aphasia or apraxia,manifestation of shoulder pain,and severe neurological or mental defects.For the 7 patients,the Rivermead motor assessment(RMA)scores ranged 0-10 points,the Rivermead mobility index(RMI)ranged 1-3,and modified Ashworth scale(MAS)was grade 2-4.Their horizontal extension of shoulder joint was 0°-30°,anteflextion was 0°-50°,internal rotation was 50°-90°,external rotation was 0°-10°:and the elbow joint could extend for 15°-135°.METHODS:The viva 2 serial MOTOmed exerciser(Reck Company,Germany)was used.There were three phases of A-B-A.①The phase A lasted for 1 week.The patient sat on a chair facting to the MOTOmed screen.and did the circumduction of upper limbs forwardly,30 minutes a day and 5 days a week.②The phase B lasted for 3 weeks.The training consisted of forward circumduction of upper limbs for 15 minutes.followed by backward ones for 15 minutes and 5-minute rest.③The training in the phase A was performed again for 2 weeks.The extensions of upper limbs were recorded at phase A,the extension and flexion of elbow joints were recorded at phase B,and the extensions were recorded at the second A phase.All the patients were evaluated by the same therapeutist.①RMA was used to evaluate the motor function completely,including the motor control of both upper and lower limbs,but only the data of upper limbs were recommended to be used. Tne flexibility and concordance of upper limbs were described by detecting the ability of hand to move objects with 15 items,2 grades for each item:0 for could not complete and 1 for could complete.②RMI was used to measure the flexion and extension of elbow joint and shoulder joint,the scores ranged from 0(no movement and no obvious muscle contraction)to 5(close to normal movement).③MAS was used to evaluate the muscle tension in clinic.Grade 1 for without abnormal increase of muscle tension,and grade 5 for muscle rigidity.and it was unable for passive movement.④Ranges of motion of elbow joint and should joint were measured using protractor.MAIN OUTCOME MEASURES:①The strength of each limb to persist for 40 s recorded by two hand pedals;②Changes of muscle tensions detected by the two hand pedals;③Changes of muscle contraction at the flexion and extension of ipsilateral limb recorded by EMG;④Minimal moment of iplateral end foot;⑤RMA;⑥RMI;⑦MAS;⑧Ranges of motion of elbow joints and shoulder joints.RESULTS:The functions were evaluated at 6 weeks after training.①The strength of each limb to persist for 40 s was recorded.and the strength of the ipsilateral limb changed obviously from 20%-40%to 50%-70%.②The muscle tensions detected by the two hand pedals changed from 2.2-4.0 N·m to 0.2-1.0 N·m.③EMG displayed that along with the enhancement of fast movements.the strength curve increased(the EMG for the extension of elbow joints were obvious).④The minimal moment of iplateral end foot was 5.0 N·m.⑤The RMA scores ranged 15-30 points.⑥The RMI ranged 4-5.⑦MAS were grades 0-2.⑧For shoulder joints,the ranges of motion were 90°-180°for external extension,90°for anteflexion,90°for internal rotation and 50°-75°for external rotation;For elbow joints,the extension of active movements was close to 0°.CONCLUSION:After repetitive movements,the strength of upper limb increased,the range of motion enlarged,and spasm reduced.
文摘Gastrointestinal spasm is manifested asabdominal pain in a soft belly that feels com-fort with warmth and pressure.We treated97 cases of the disease with moxibustion.The curative effect was good in comparisonwith a control group.
