目的:探讨镜像视觉反馈训练在合并认知障碍的脑卒中吞咽障碍患者吞咽功能康复中的临床效果.方法 :选取经蒙特利尔认知评估量表(MoCA)筛选合并认知障碍的脑卒中吞咽障碍患者40例,随机分成镜像组和对照组各20例.对照组接受常规吞咽康复训练,镜像组在此基础上给予镜像视觉反馈训练.比较治疗前后临床吞咽功能与认知水平.结果 :治疗2周后,2组的标准吞咽功能评价量表(SSA)评分较治疗前明显降低(P＜0.05),MoCA评分较治疗前明显提高(P＜0.05),且镜像组明显高于对照组(P＜0.05);2组简单反应时均较治疗前明显缩短(均P＜0.05),且镜像组明显快于对照组(P＜0.05).结论 :镜像视觉反馈训练能改善脑卒中后认知障碍合并吞咽困难患者的吞咽功能和注意力、执行力.

目的 运用表面肌电图(sEMG)仪评估腰椎间盘突出症腰痛患者双侧肌肉失衡问题,为临床悬吊治疗提供指导.方法 选取老年腰椎间盘突出症腰痛患者28例作为研究对象.运用sEMG分别记录悬吊治疗前后竖脊肌胸段、竖脊肌腰段、多裂肌、臀中肌、臀大肌的平均振幅(AEMG)肌电信号.结果 治疗前健侧与患侧竖脊肌胸段、竖脊肌腰段、多裂肌、臀臀大肌AEMG比较差异无统计学意义(P>0.05),臀中肌患侧明显低于健侧,差异有统计学意义(P<0.05);治疗后健患侧竖脊肌胸段、竖脊肌腰段、多裂肌、臀大肌AEMG比较差异无统计学意义(P>0.05),臀中肌患侧仍明显;治疗后患侧臀大肌AEMG明显高于治疗前,差异有统计学意义(P<0.05).结论 老年慢性腰椎间盘突出症腰痛患者患侧臀中肌功能下降,骨盆不稳,经过2 w5次的悬吊训练,时间稍短,虽未能恢复正常,但患者临床症状已明显缓解.

BACKGROUND:Myofascial trigger points have been widely applied in clinical rehabilitation and tissue pain field in the United States and Europe countries, and they have been recognized as the common cause of clinical musculoskeletal pain, joint function limitation, tissue injuries and muscle fatigue by many physiotherapists abroad. However, in China, many experts stil have some mistaken ideas and limitations to understand the pathological mechanism and to diagnosis and treat myofascial trigger points. OBJECTIVE:From the aspects of the etiology, pathological mechanism, diagnosis and positioning, treatments, to elaborate the method issues and the clinical experience of treatments of myofascial trigger points. METHODS:PubMed, ScienceDirect, EBSCO and CNKI databases were searched by the keywords of “myofascial trigger points, myofascial pain syndrome” in Chinese and English, respectively, in the titles and abstract to retrieve relevant articles published from the time of database construction to August 2014. RESULTS AND CONCLUSION:It is concluded that a child has myofascial trigger points in some skeletal muscles after age of 4 years. The main causes of myofascial trigger points include issue trauma, the wrong posture, bone and joint degeneration, nutrition deficiency, mental stress, chronic infection and so on. The pathological mechanism of myofascial trigger points remains unknown, but what has been widely accepted is the integrated trigger point&nbsp;hypothesis introduced by Simons. And how to find and position myofascial trigger points is the key point to treat this disease successfuly. The application of myofascial trigger points techniques is important for the rehabilitation of clinical tissue pain and the occurrence and spread of bone and joint injuries, myofascitis, muscle pain, muscle fatigue and so on.

OBJECTIVE:Analyze the immunophenotype of the different cells in the various subtypes of giant cell tumor of tendon sheath (GCTS) and investigate the value of clusterin in pathological diagnosis and histogenesis of giant cell tumor of tendon sheath.METHODS:A total of 104 cases of GCTS from the surgical pathology files of Shanghai Jiaotong university affiliated the sixth people's hospital were identified. Immunohistochemistry (IHC) for clusterin, desmin, CD163, CD68, p63, p53, Ki-67 and CD35 was performed on all cases, using EnVision technique.RESULTS:All cases of GCTS were researched, including 44 cases of localized type (L-GCTS), 32 cases of diffused type (D-GCTS), 26 cases of pigmented villonodular synovitis (PVNS) and 2 cases of malignant type. There was a slight female predominance in all these subtypes, and the male to female ratio was about 38:66. L-GCTS usually occured within the small joints (90.9%, 40/44), while D-GCTS, PVNS and M-GCTS commonly occured within the large weight-bearing joints [68.8% (22/32), 100% (26/26) and 2/2 respectively]. Of 74 cases with follow-up, the recurrence rates of L-GCTS, D-GCTS, PVNS and M-GCTS respectively were 30.3% (10/33), 30.4% (7/23), 18.8% (3/16) and 2/2. The different subtypes of GCTS had the same cell components, including the large synovial-like mononuclear cells, the small histiocytoid cells, foamy histiocytes cells, inflammatory cells, fibroblasts and the osteoclast-like multinucleated giant cells. There were obvious differences among immunophenotype of the various cell components in GCTS: the large synovial-like mononuclear cells were strong positive for clusterin, partly positive for desmin and Ki-67, and negative for CD163. The small histiocytoid cells were strong positive for CD163 but negative for clusterin and desmin. The osteoclast-like multinucleated giant cells were strong positive for CD68 but negative for clusterin, CD163 and desmin. Normal synoviocytes were strong positive for clusterin, partly positive for desmin. The number of the large synovial-like mononuclear cells that were positive for clusterin in D-GCTS were more than that in L-GCTS (P < 0.01) and PVNS (P < 0.05).CONCLUSIONS:GCTS was synovial tumors, not belonged to the category of fibrohistiocytic lesions. The true tumor cells may be the large synovial-like mononuclear cells, and the number of the cells in the D-GCTS was obviously more than that in L-GCTS and PVNS. This may be the reason that the biological behavior of D-GCTS was more aggressive, destructive and recurrent. Clusterin was an useful marker in pathological differential diagnosis of GCTS.

腱鞘巨细胞瘤(giant cell tumor of tendon sheath,GCTS)是一种起源于滑膜的肿瘤,发生于关节、滑囊和腱鞘滑膜,可分为3种类型,即局限型腱鞘巨细胞瘤(localized type tenosy-novial giant cell tumor,L-GCTS)、弥漫型腱鞘巨细胞瘤(dif-fuse type tenosynovial giant cell tumor,D-GCTS)和色素绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)。但这3种类型肿瘤的临床特征、生物学行为和预后有一定差异,在病理诊断时容易和骨、软组织的其他各种富于巨细胞的病变混淆,本文通过对GCTS的临床及影像学特征、病理学特征、预后、病因及病变性质和分子生物学改变等方面的文献复习,并加以综述,提高对GCTS的认识。

Purpose To investigate the clinicopathologic features,immunohistochemical features and differential diagnosis of malignant giant cell tumor of tendon sheath(MGCTS).Methods Pathological examination and immunohistochemical study(EnVision method) were performed on 2 cases of MGCTS.The results were compared with sixty-three cases of diffused type(DGCTS) and literature was reviewed.Results MGCTS tumors tended to affect older patients than their diffuse-type counterpart.The lesions commonly occurred within the large weight-bearing joints.Recurrence was common and often multiple.Radiographic images of MGCTS tumors showed obviously malignant,ill-defined extra-articular soft tissue masses adjacent to the large joint and pathological fractures.MRI findings showed circumscribed nodular lesions with decreased signal intensity in both T1-and T2-weighted images,which indicating intratumoral hemorrhage of varying degrees.Both two cases of MGCTS showed metachronous sarcomatous histology several years after diagnosis of previously DGCTS.Histologically,MGCTS still remained the same cell components of DGCTS with proliferative large synovial-like mononuclear cells in inflammatory background.The large synovial-like mononuclear cells were rounded mononuclear cells with eosinophilic cytoplasm,slightly atypical,arranging loosely,and strong positive for clusterin.The tumor infiltrated into soft tissue and bone tissue with necrosis,and lots of intravascular tumor emboli could be indentified.The index of Ki-67 was a little higher than DGCTS.Conclusions MGCTS is an unusual synovial malignant tumor with concurrent or previous benign DGCTS/PVNS,poses challenges to diagnosis and prognostication.The true neoplastic cells may be the malignant transformation of large synovial-like mononuclear cells,stained for clusterin,which is an useful biological marker in pathological differential diagnosis.MRI findings show circumscribed nodular lesions with decreased signal intensity in both T1-and T2-weighted images,which indicating intratumoral hemorrhage of varying degrees,and maybe representing an important distinguishing feature.The pathological differential diagnosis of MGCTS should be based on many diagnosis features,including anaplastic cells,and large tumor size,large necrosis,more aggressive and destructive.