癫痫是一种常见的反复发作的慢性神经系统疾病.据世界卫生组织(WHO)报告,全球约有5000万癫痫患者,而我国的癫痫患者约达900多万,并以每年40万的速度增长.目前癫痫的治疗主要以药物治疗和手术治疗为主,在过去的30多年中已有超过15种第三代抗癫痫药物问世,但目前仍有20％-30％的患者无法通过药物来控制癫痫的发作[1],而通过外科手术切除癫痫灶的缓解率也只能达到40％-60％左右[2-3].而且并不是所有患者都适合外科手术治疗,尤其是具有多个癫痫灶或癫痫灶定位在功能皮质区的患者不适合手术切除治疗.经颅直流电刺激(transcranial direct cur-rent stimulation,tDCS)作为一种新兴的、非侵人性神经调节技术[4],通过调节大脑皮层的兴奋性继而改善癫痫的发作[5],适用性好、可操作性强,近年来已成为神经康复领域研究的热点.本文旨在tDCS治疗癫痫的临床研究、影响因素、机制三方面进行综述.

目的 系统评价肌内效贴对脑卒中后肩痛的疗效.方法计算机检索PubMed、EMbase、TheCochrane Library、Web of Science、PEDro、CNKI和WanFang Data数据库,搜集有关肌内效贴对脑卒中后肩痛治疗效果的随机对照试验(RCT),检索时限均为建库至2018年11月.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果共纳8个RCT,包括525例患者.Meta分析结果显示:与对照组相比,肌内效贴干预4周可降低脑卒中后的肩关节疼痛(VAS评分)[SMD=-0.81,95％CI(-0.58,-0.04),P=0.04]、提高肩前屈活动度[SMD=0.59,95％CI (0.17,1.01),P=0.006]及外展活动度[SMD=0.67,95％CI (0.24,1.09),P=0.002]、改善Fugl-Meyer上肢功能[SMD=1.00,95％CI (0.25,1.76),P=0.009],两组差异均有统计学意义.结论当前证据表明,肌内效贴干预4周后能有效改善脑卒中后肩痛.受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证.

目的 评价中国康复临床实践指南的方法学质量.方法计算机检索CBM、VIP、CNKI、WanFangData和医脉通数据库,搜集国内发表的康复医学指南,检索时限为1979年1月至2018年5月.由4名评价者独立采用AGREEⅡ工具对纳入指南进行质量评价.结果共纳入11篇指南,包括神经系统康复5篇,骨关节系统康复1篇,儿科康复、内科系统康复、烧伤康复、地震康复和康复诊疗规范各1篇.AGREEⅡ评分显示:纳入11篇指南在6个领域(范围和目的、参与人员、制订严谨性、清晰性、应用性、独立性)的平均得分分别为:65.3％、28.0％、9.3％、42.1％、6.3％和4.0％.A级(推荐)0篇,B级(修改完善后推荐)2篇,C级(不推荐)9篇.结论现有中国康复临床实践指南数量较少,且方法学质量较低,与国际公认的临床实践指南制定和报告规范差距较大.在未来我国康复指南的制订过程中,要重视指南的报告规范和指南制订的方法学,包括指南开发过程的严谨性、报告的清晰性、应用性和独立性,提升临床实践指南的质量和应用性,从而指导和规范中国康复医学临床实践.

目的 系统评价脑卒中幸存者家庭远程康复的治疗效果.方法 计算机检索PubMed、EMbase、Web of Science、Joanna Briggs Institute Library、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集有关家庭远程康复治疗脑卒中患者疗效的随机对照试验(RCT),检索时限均从建库至2019年1月1日.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 共纳入11个RCT,包括793例患者.Meta分析结果显示:家庭远程康复干预1～2年内的BI评分明显高于传统康复[MD=20.22,95％CI (17.10,23.35),P＜0.000 01].在干预2个月内ARAT评分[SMD=0.16,95％CI(-0.14,0.45),P=0.30]、3个月内MBI评分[SMD=0.98,95％CI(-0.33,2.29),P=0.14]及FMA评分[SMD=0.57,95％CI(-0.08,1.23),P=0.09]、6个月内CSI评分[MD=-1.48,95％CI(-3.90,0.94),P=0.23]及BBS评分[MD=1.33,95％CI(-1.15,3.81),P=0.29]等方面,两组差异均无统计学意义.描述性分析结果提示,干预6个月时两组在生命质量方面差异无统计学意义,但在干预2年后,家庭远程康复优于传统康复.结论 当前证据显示,家庭远程康复与传统康复疗效相当,但长期(1～2年)家庭远程康复在改善日常生活能力及生命质量的效果可能更好.受纳入研究数量和质量的限制,上述结论尚待开展更多高质量研究予以验证.

目的 评价肌内效贴对膝骨关节炎(KOA)的治疗效果.方法 检索Cochrane Library、PubMed、CNKI、Web of Science和PEDro中关于肌内效贴对KOA治疗的临床随机对照试验,检索时限截止2018年11月.由2名研究者按照纳入标准和排除标准独立文献筛选、提取数据、质量评价,采用RevMan5.3进行Meta分析.结果 共纳6个研究.干预组与对照组相比视觉模拟评分有显著性差异(WMD=-1.28,95％CI-2.36～-0.20,P=0.02),而对西安大略及麦克马斯特大学骨关节炎指数评分、关节活动度以及股四头肌、腘绳肌肌力的改善无显著性差异(P>0.05),其余临床结局采用描述性分析.结论 肌内效贴对KOA的治疗效果尚不确定.

Objectives To systematically review the efficacy of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation of unilateral neglect in stroke patients.Methods PubMed,The Cochrane Library,PEDro,EMbase,CNKI,WanFang Data and VIP databases were searched online for randomized controlled trials (RCTs) of rTMS on rehabilitation of unilateral neglect in stroke patients from inception to March 2017.Two reviewers independently screened literature,extracted data and assessed the quality of included studies.Meta-analysis was then performed by using RevMan 5.3 software.Results A total of 12 RCTs involving 303 patients were included.The results of meta-analysis showed that:the stimulate group was superior to the control group in line bisection test (MD=-5.54,95％CI-6.79 to -4.29,P＜0.000 01),line cancellation test (MD=-3.75,95％CI-4.60 to-2.90,P＜0.000 1) and star cancellation test (MD=-22.94,95％CI-26.52 to-19.35,P＜0.000 01).However,there was no significant difference in the score of the modified Barthel index between two groups (MD=3.91,95％CI-9.52 to 17.34,P=0.57).Conclusions rTMS appears to improve the symptoms of unilateral neglect in stroke patients.Due to limited quality and quantity of the included studies,more high quality studies are needed to verify above condusions.

Objective To systematically review respiratory muscle training (RMT) on respiratory functions of patients with spinal cord injury (SCI).Methods PubMed,EMbase and The Cochrane Library were electronically searched to collect the randomized controlled trials (RCTs) about RMT on pulmonary functions in patients with SCI from inception to April,2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies,then,meta-analysis was performed by using RevMan 5.3 software.Results A total of 11 RCTs involving 263 patients were included.The results of meta-analysis showed that,compared with conventional rehabilitation group,RMT effectively improved vital capacity (MD=0.41,95％CI 0.12 to 0.69,P=0.005),inspiratory capacity (MD=0.35,95％CI 0.05 to 0.65,P=0.02),maximal inspiratory pressure (MD=7.75,95％CI 0.11 to 15.39,P=0.05) and maximal voluntary ventilation (MD=17.52,95％CI 8.11 to 26.93,P=0.000 3).There were significant differences between two groups.Conclusion Current evidence shows that RMT can effectively improve the respiratory function of Due patients with SCI.to limited quality and quantity of the included studies,more high quality studies are needed to verify above conclusion.

目的 系统评价太极拳训练对精神分裂症患者阴性症状和活动参与的效果,并探究太极拳训练对精神分裂症患者的安全性.方法 计算机检索PubMed、EMbase、CBM、The Cochrane Library (2016年3期)、CNKI、VIP、WanFang Data,搜集太极拳训练与精神分裂症患者相关的随机对照试验(RCT)和半随机对照试验(quasi-RCT),检索时限为建库到2016年4月1日.由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析.结果 共纳入3个RCT和2个quasi-RCT,共计520例患者.Meta分析结果显示:太极拳组与对照组在阳性与阴性症状量表(PANSS)阴性症状得分[MD=-0.95,95％CI(-3.78,-1.89),P=0.51]和阳性症状得分[MD=-0.02,95％ CI(-0.50,0.46),P=0.94]方面均无统计学差异,但太极拳组在改善患者阴性症状量表(SANS)的注意力缺陷[MD=-2.83,95％CI(-3.36,-2.31),P＜0.000 01]、意志缺乏[MD=-2.12,95％CI(-2.54,-1.70),P＜0.000 01]、社交障碍[MD=-3.79,95％CI (-4.31,-3.26),P＜0.000 01]、情感淡漠[MD=-1.88,95％CI(-2.43,-1.33),P＜0.000 01]和思维贫乏[MD=-3.89,95％CI (-4.60,-3.18),P＜0.000 01]方面优于对照组.此外,太极拳对于精神分裂症患者日常生活活动和工具性日常生活活动的参与无明显改善作用.结论 现有证据显示,太极拳训练对精神分裂症患者多种阴性症状可能存在积极作用,但是否能影响活动参与尚不明确.受纳入研究数量和质量限制,上述结论尚需开展更多高质量研究予以验证.

干细胞增殖与分化的过程受多种内在机制和微环境的影响[1].脉冲电磁场(pulsed electromagnetic fields,PEMFs)作为一种非侵入性的物理干预方法,在临床上多用于治疗骨质疏松及骨不连[2].美国乔治亚理工学院、台湾中原大学、韩国国民大学、意大利菲拉市大学以及国内武汉华中同济大学和四川大学等诸多国内外科研机构和学者对PEMFs的生物学效应进行了深入研究.本文对PEMFs如何调控骨髓间充质干细胞、表皮干细胞、前软骨干细胞、神经干细胞及脂肪干细胞等的增殖与分化进行阐述;对其相关机制进行探讨,发现PEMFs可能通过影响细胞膜电位、细胞间信息传递、第二信使、基因调控以及氧化应激反应等调控干细胞的增殖与分化.因此,可以推断PEMFs通过直接或协同干预的方式发挥其生物学效应,调控干细胞的增殖与分化,在康复医学、组织工程学和再生医学等领域中具有广泛的应用前景.

BACKGROUND:Whole body vibration training, a recently developed method of neuromuscular training, is a useful method to improve muscle strength and postural control in the elderly. Recently, researchers attempt to explore whether whole body vibration training can reduce motor dysfunction for stroke patients. <br> OBJECTIVE:To summarize clinical progress in whole body vibration treatment on stroke patients with limb motor dysfunction, including muscle strength of the affected limbs, muscle tension, balance and gait. <br> METHODPubMed, EBSCO, Medline database were searched for articles relate to whole body vibration training intervention for stroke patients with motor dysfunction published from January 2002 to June 2014. Final y, 34 articles were included in result analysis. <br> RESULTS AND CONCLUSION:Whole body vibration training is feasible and safe for stroke patients has the feasibility and safety. For therapeutic efficacy, we focus on the muscle strength, muscle tone, balance, posture control ability, but there is no sufficient evidence to support that the whole body vibration training can improve the motor dysfunction. There is also no recognized standard on specific intervention protocols, such as vibration type, treatment frequency, treatment amplitude, treatment time. Many researchers aim to observe the clinical curative effect at present, but rarely explore the intervention mechanism of the whole body vibration. Further large-sample, multi-center randomized control ed experiments are required to test the validity.

目的 系统评价重复经颅磁刺激(rTMS)对脑卒中患者失语症的效果.方法 计算机检索PubMed、EMbase、The Cochrane Library(2014年第6期)、CBM、CNKI、VIP和WanFang Data,查找有关rTMS治疗脑卒中患者失语症的随机对照试验(RCT),检索时限均为从建库到2014年6月.由2位评价员独立按照纳入与排除标准筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.3软件进行Meta分析.结果 最终纳入9个RCT,共计130例患者.Meta分析结果显示:与对照组相比,rTMS治疗能够改善脑卒中患者的言语功能[WMD=14.36,95％CI (6.93,21.79),P=0.000 2].描述性分析结果显示:刺激右侧Broadmann 45区(频率为1 Hz、强度为90％RMT、持续2或3周、间歇2天、每次20或30分钟)的治疗方案可能对卒中后失语患者有积极作用,且有远期效应.结论 rTMS对脑卒中患者言语功能可能有积极作用.受纳入研究数量和质量限制,上述结论尚有赖于进一步开展更多大样本、多中心、高质量的RCT加以验证.

上肢痉挛是脑卒中患者常见并发症之一.痉挛可造成上肢功能受限,出现肘屈曲、腕掌屈、前臂旋前、手指屈曲等异常模式,致使日常生活活动(activities of daily living,ADL)能力下降,如穿衣困难,姿势不美观,出现痉挛性肢体疼痛和关节挛缩等问题.脑卒中患者偏瘫肢体在恢复过程中出现的肌张力增高或痉挛状态是影响肢体功能恢复的重要因素[1].课题组根据针对康复治疗中较为常见的上肢屈曲痉挛,自行研发的抗痉挛三角架并应用于上肢屈曲痉挛患者,取得了较好效果.报道如下.

Objective This study focuses on systematic evaluation of the safety and the curative effect of intravenous vernakalant for rapid conversion of atrial fibrillation(AF).Methods Retrieve the related literature from Pub Med,Cochrane Central Register of Controlled Trials,The ISI Web of Knowledge Databases,EMBASE,www.clinicaltrials.gov,CBMdisc,CHKD,the time is ranging from the database′s initial construction to November 30,2011.In all the clinical trials for the vernakalant therapy of AF,three researchers will evaluate its quality and extract its information according to the The Grading of Recommendations Assessment,Development and Evaluation(GRADE) and then Meta analysis will be conducted on the results which meet the quality standard.Results Six randomized controlled trials(RCTs)(1 325 patients) met inclusion criteria and were included into this system. According to the outcomes of GRADE system,three are of high quality: the success rate of rapid conversion of paroxysmal AF,the success rate of rapid conversion of paroxysmal recent-onset AF,and the mortality;two of them were of moderate quality: the successrate of rapid conversion of persistent AF and the incidence of drug SAEs(serious adverse events).The following were the results of Meta analysis: ①Rapid conversion of paroxysmal AF: within 60 or 90 min,success rate of vernakalant group was superior to control group[50.15% vs 6.22%,OR 12.47, 95% CI(6.73,23.14),P<0.00001].②Rapid conversion rate of recent-onset AF:success rate of vernakalant group was superior to control group[57.02% vs 5.08%,OR 23.57,95% CI(11.86,46.85),P<0.00001] ③Rapid conversion rate of persistent AF: compared to control,vernakalant showed a higher rate of success,but there were no statistical difference between both groups [10.19% vs 1.30%,OR 6.31,95% CI(1.06,37.70),P=0.04].④Incidence of SAEs: there was no statistical difference between both groups [8.36% vs 9.26%,OR 0.95,95% CI(0.67,1.35),P=0.78]. ⑤Mortality rate:among the entire deaths one patient in the deaths was confirmed as vernakalant.Conclusion Vernakalant is effective and well-tolerated in the rapid conversion of recent-onset AF and paroxysmal AF,and will not increase the mortality rate and SAEs.

Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation(rTMS) in treating stroke patients with motor dysfunction.Methods?The Cochrane Library,MEDLINE,EMbase,CBM,CNKI and WanFang Data were searched from inception to January 2012,and the references of the included studies were also retrieved to collect the randomized controlled trials(RCTs) on rTMS in treating stroke patients with motor dysfunction.Two reviewers independently screened articles according to the inclusion and exclusion criteria,extracted data and evaluated the quality of the included studies.Then meta-analysis was performed using RevMan 5.0.2 software,and evidence quality and recommendation level were assessed using the GRADE system.Results A total of 11 RCTs involving 376 patients were included.The results of meta-analysis(including 3 RCTs,low quality) showed that,compared with the routine rehabilitation treatment,2 to 4 weeks of rTMS was much beneficial to stroke patients with motor dysfunction,with significant differences(WMD=11.02,95%CI 2.56 to 19.47).The other 8 studies only adopted descriptive analysis accordingly.Conclusion It is still uncertain of the effectiveness of rTMS in improving motor dysfunction of stroke patients,so rTMS should be applied with caution in clinic.

This paper is aimed to introduce the definition and application of Population Impact Measures (PIMs). The PIMs use Number Need to Treat (NNT) for reference and generalize the variables of clinical research to interest population, which then can be used to measure the effectiveness of interventions and the harmfulness of risk factors, so as to provide evidence for making public health policy. Of the PIMs, the variables used for measuring the effectiveness of interventions include Disease Impact Number (DIN), Population Impact Number (PIN) and Number of Events Prevented in your Population (NEPP); Te variables used for measuring the harmfulness of risk factors include Exposure Impact Number (EIN), Exposed Cases Impact Number (ECIN), Population Impact Number (PIN), Case Impact Number (CIN) and Population Impact Number of Eliminating a Risk factor (PIN-ER-t). © 2012 Editorial Board of Chin J Evid-based Med.

Objective To evaluate Mental Imagery on rehabilitation of functions in patients with stroke.Methods Cochrane Central Register of Controlled Trials(CENTRAL),MEDLINE,EMbase,PEDro(www.pedro.org.au),OpenSIGLE,National Technical Information Service(NTIS),CNKI,VIP,Wanfang Data,and CBM were searched for the Randomized controlled trials(RCTs) of Mental Imagery on rehabilitation of functions in patients with stroke from the date of establishment of the databases to October 2010.The bibliographies of the included studies were searched,too.Three independent researchers evaluated the included studies using GRADE.The extracted data were analyzed by RevMan 5.0.25 and GRAEDprofiler 3.2.2.Results A total 16 trials were discovered.Meta-analyses showed that at the end of 4th,6th,and 8th,compared with conventional rehabilitation,the mental practice increased the score measured by FMA(WMD=7.81,95%CI 1.96 to 13.65;WMD=13.89,95%CI 4.53 to 23.25;and WMD=9.45,95%CI 3.67 to 15.23,respectively) and ARAT(WMD=5.70,95%CI 3.17 to 8.22,P=0.30).The 4 outcomes were all of low quality in the GRADE system.Conclusion The current evidence shows mental practice could improve the upper limb function in patients after stroke,and the side effects of mental practice are not found in meta-analyses.Compared with other rehabilitative therapies,it is simper,of lower input costs,and of low operating costs.The clinicians should recommend it.Due to the limitations of the included studies,more large-sample,high-quality RCTs are required.

Evidence is the core of Evidence-Based Medcine;the Grades of Recommendations Assessment,Development and Evaluation(GRADE System) is a milestone in the history of evidence development.is paper outlines the GRADE System and GRADEpro 3.2 so ware,and briefly explores the right and wrong application which was published in the Chinese Journal of Evidence-Based Medicine.The GRADEpro 3.2 so ware is easy to operate,but for evaluating the reasons of upgrade and downgrade,and the importance of the parameters of outcomes,it needs to comprehensively and systematically understand the knowledge of relevant background,and to construct a solid foundation in clinical epidemi-ology and systematic review.In view of this paper based on the current GRADE System,there may be some discrepancy to the later content with the GRADE System constant improvement.Therefore,it is strongly recommended that readers should keep constant learning and improving.

Objective To systematically review the efficacy of low-frequency repetitive transcranial magnetic stimulation(rTMS) compared with sham therapy for the treatment of major depressive disorder.Methods The Cochrane Library,Medline,EMbase,CBMdisk,CNKI and VIP were searched through computer from 1985 to 2011.The review included RCTs comparing the treatment efficacy of low-frequency rTMS located on right dorsolateral prefrontal cortex(DLPFC) with sham stimulation in the patients suffering major depressive disorder.The quality of the included RCTs was strictly evaluated and the data were extracted by two reviewers independently.The extracted data were analyzed by RevMan 4.2.Results Among seven double-blinded RCTs involving 234 patients included,1 was A level in quality,5 were B level,and 1 was C level according to the outcomes of quality evaluation.The results of Meta-analysis indicated that low frequency rTMS was superior to sham stimulation in remission rates after two weeks' treatment(RR=3.11,95%CI 1.56 to 6.19).Additionally,low frequency rTMS was lower than the sham stimulation in the scores of HDRS and MADRS(WMD= –6.41,95%CI –9.32 to –3.50,and WMD= –5.27,95%CI –9.08 to –1.46,respectively).But no significant difference in response rates between the low prequency rTMS group and the sham group was found(RR=1.72,95%CI 0.74 to 4.01).There were no severe and intolerable side effects reported in these seven studies.Conclusion The low frequency rTMS as a non-invasive and safe technique may appear to be effective for the treatment of major depressive disorder according to the positive results but the conclusion is not definite because of negative results.This review suggests that parameters could be sited as frequency: 1 Hz,intensity: 90%-110% motor threshold(MT),location: right DLPFC and duration: 2 weeks.Nevertheless,further multicenter and high quality studies are needed before it is used as a first-line treatment for major depressive disorder.

Objective To evaluate the effectivenes of continous passive motion(CPM) on limb function in patients after total knee arthroplasty.MethodsThe Cochrane Database of Systematic Reviews,MEDLINE,EMBASE,PEDro,CNKI and VIP were retrieved from the date of establishment of the databases to July,2010 to collect randomized controlled trials(RCTs).The quality of RCTs was critically appraised and data were extracted by 4 reviewers independently.Meta-analysis was conducted for the eligible RCTs.Results26 RCTs were included.The result of Meta-analysis showed that CPM improved the range of motion(ROM) in active knee flexion and passive knee flexion,eliminate swelling in short term(6 weeks) and alleviate pain in short and medium term(less than 6 months).CPM showed no significant difference in improving the ROM in active and passive knee extention and quadriceps strength,and shortening hospital stay.ConclusionThe patients carried out CPM training after total knee arthroplasty can effectively improve limb flexion function,eliminate joint swelling,and relieve pain in the short term.But more high-quality and large-scale RCTs are needed.

Objective To evaluate the effectiveness of repetitive transcranial magnetic stimulation(rTMS) for treating dysfunction in patients with Parkinsonˉs disease(PD).Methods We searched the Cochrane Library(Issue 1,2010),MEDLINE,EMbase,CBMdisc,and CNKI from the date of the database establishment to April 2010.Randomized controlled trials(RCTs) of rTMS for patients with PD were collected.The quality of the included RCTs was critically appraised and data were extracted by two reviewers independently.Meta-analyses were conducted for the eligible RCTs.Re-sults Eight RCTs were included.The pooled results of the rst 2 RCTs showed that,there was no signi cant difference compared with control group about treating PD patients with clinical motor dysfunction by high-frequency rTMS 10 days later(WMD= ¨C4.75,95%CI ¨C13.73 to 4.23).The pooled analysis of another 3 studies showed that,no signi cant difference were found about improving symptoms with treatment of low-frequency rTMS for 1 month compared with control group(WDM= ¨C8.51,95%CI ¨C18.48 to 1.46).The pooled analysis of last 3 studies showed that,patient with treatment of low-frequency rTMS for 3 months,had been signi cantly improved in clinical symptoms such as neurological,behavior and emotional state,clinical motor function,and activities of daily living(WDM= ¨C5.79,95%CI ¨C8.44 to ¨C1.13).The frontal or motor cortex rTMS manifested as low frequency(u1Hz),high intensity(Y90% RMT),multi-frequency(Y3 times) and long time(Y3 months) had a positive effect on the clinical symptoms of patients with PD and also had a long-term effect.Conclusions rTMS can improve clinical symptoms and dysfunction of the patients with PD.