OBJECTIVE: To compare the clinical efficacy of jingjin needling combined with rehabilitation training and conventional acupuncture combined with rehabilitation training for post-stroke spastic paralysis. METHODS: A total of 60 patients with post-stroke spastic paralysis were randomly divided into an observation group and a control group, 30 cases in each one. Both groups received conventional rehabilitation training. In the observation group, jingjin needling was applied at tendon blockage points of the shoulder, elbow, wrist, hip, knee, and ankle. In the control group, conventional acupuncture was applied at Jianyu (LI15), Quchi (LI11), Hegu (LI4), Biguan (ST31), Fengshi (GB31), Taichong (LR3), etc. on the affected side. Treatment was given once daily, 5 days a week for 4 weeks in both groups. The scores of clinical spasticity index (CSI), modified Ashworth scale, modified Barthel index (MBI), and Fugl-Meyer assessment scale (FMA) were evaluated before and after treatment, and the onset time was compared between the two groups. RESULTS: After treatment, the scores of CSI and modified Ashworth scale were decreased compared with those before treatment (P<0.001), while the scores of MBI and FMA were increased compared with those before treatment (P<0.001) in the two groups. After treatment, the scores of CSI and modified Ashworth scale in the observation group were lower than those in the control group (P<0.05), the MBI score in the observation group was higher than that in the control group (P<0.05). There was no statistically significant difference in FMA scores between the two groups (P>0.05). The onset time of the observation group was earlier than that in the control group (P<0.05). CONCLUSION Both jingjin needling combined with rehabilitation training and conventional acupuncture combined with rehabilitation training can effectively treat post-stroke spastic paralysis, jingjin needling combined with rehabilitation training exhibits better therapeutic effect and rapider onset.
Humans ; Acupuncture Therapy ; Male ; Female ; Middle Aged ; Aged ; Stroke/complications* ; Adult ; Acupuncture Points ; Muscle Spasticity/etiology* ; Treatment Outcome ; Stroke Rehabilitation ; Paralysis/therapy* ; Combined Modality Therapy

OBJECTIVE: To analyze the factors influencing the occurrence of C5 nerve root palsy after posterior approach cervical single-door enlargement kyphoplasty and construct a Nomogram-related prediction model. METHODS: A total of 255 patients with cervical spondylotic myelopathy who underwent posterior cervical single-door laminoplasty between May 2019 and February 2023 were selected as the research subjects. They were divided into the occurrence group (45 patients) and the non-occurrence group (210 patients) based on whether C₅ nerve root palsy occurred after the operation. The general data of patients in the two groups were compared. The predictive value of statistically significant continuous variables was analyzed using receiver operating characteristic (ROC) curve analysis. The factors influencing patients' postoperative C₅ nerve root palsy were analyzed using Logistic regression analysis. And the clinical efficacy of Nomogram model was assessed using decision curve analysis. RESULTS: Compared with the non-occurrence group, the patients in the occurrence group had a shorter disease duration, higher preoperative cervical curvature and spinal cord posterior displacement distance, and higher percentage of positive pathological reflexes, foraminal stenosis, and ossification of the posterior longitudinal ligament.The difference was statistically significant P<0.05. The area under the curve (AUC) for cervical curvature and posterior displacement of the spinal cord prior to surgery were 0.699 and 0.697, respectively. The optimal cutoff values were determined to be 21° and 3 mm, with statistically significant differences (P<0.05). Logistic regression analysis showed that abnormal electromyography OR=6.693, 95%CI(2.754, 16.264), P<0.001;preoperative cervical curvature OR=2.254, 95%CI(1.215, 2.920), P=0.003;foraminal stenosis OR=3.049, 95%CI(1.234, 7.530), P=0.016;ossification of the posterior longitudinal ligament OR=2.646, 95% CI(1.015, 6.899), P=0.047;and the distance of spinal cord posterior displacement OR=0.298, 95% CI(0.173, 0.513), P<0.001;which were all related factors influencing postoperative C₅ nerve root palsy in patients with this disease. The C-index of the Nomogram model for predicting the risk of postoperative C₅ nerve root palsy in patients was 0.861, with a 95% confidence interval of (0.795, 0.927). The risk threshold of this model was determined to be greater than 0.17. CONCLUSION Abnormal electromyography, preoperative cervical curvature, intervertebral foramen stenosis, ossification of the posterior longitudinal ligament, and the degree of posterior displacement of the spinal cord are all significant contributing factors to C₅ nerve root palsy following posterior cervical single-door laminoplasty. A prediction model developed based on these factors demonstrates enhanced accuracy and substantial clinical application value.
Humans ; Female ; Nomograms ; Male ; Middle Aged ; Aged ; Kyphoplasty/adverse effects* ; Cervical Vertebrae/surgery* ; Spinal Nerve Roots ; Adult ; Postoperative Complications/etiology* ; Paralysis/etiology*

Objective:To explore the clinical characteristics and treatment methods of middle ear cholesteatoma with intracranial and extracranial complications as the first diagnosis. Methods:A total of 244 patients were initially diagnosed with intracranial and/or extracranial complications associated with middle ear cholesteatoma at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2022, and medical records were collected and retrospectively analyzed. Results:Among 244 patients with intracranial and extracranial complications of middle ear cholesteatoma, 203 cases had one complication, 34 cases had 2 complications, and 7 cases had 3 or more complications. One hundred and eighty-six cases presented labyrinthitis, 41 cases had peripheral facial paralysis, 27 cases had periauricular abscess, 12 cases had meningitis, 10 cases had brain abscess, 7 cases had sigmoid sinus lesions, 6 cases had epidural abscess, and 4 cases demonstrated hydrocephalus. Conclusion:The destructive nature of middle ear cholesteatoma can lead to intracranial and extracranial complications. The incidence rate of extracranial complications is highest for labyrinthitis. Patients with otitis media who complained dizziness should raise clinical suspicion for potential labyrinthitis. The second most prevalent extracranial complication is peripheral facial paralysis, and early facial nerve decompression surgery is critical for better recovery of facial paralysis symptoms. Brain abscess is the most common intracranial complications, which has the highest fatality rate. Clinicians should be alert to otogenic brain abscess. Otolaryngology and neurosurgery teams should cooperate and evaluate patients' middle ear lesions and brain abscess, and jointly develop personalized treatment plans.
Humans ; Cholesteatoma, Middle Ear/surgery* ; Retrospective Studies ; Facial Paralysis/etiology* ; Brain Abscess/diagnosis* ; Male ; Female ; Otitis Media/complications* ; Meningitis/etiology* ; Labyrinthitis/etiology* ; Adult ; Middle Aged ; Young Adult

Humans ; Spinal Cord Injuries/complications* ; Paralysis/etiology* ; Nervous System Diseases ; Brain

Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children's medical centers nationwide, have formulated this consensus document.
Humans ; Child ; Vocal Cord Paralysis/therapy* ; Consensus ; Vocal Cords/surgery* ; Larynx ; Voice ; Laryngeal Diseases/complications*

Central nervous system involvement in primary Sjögren's syndrome (pSS) is less common and usually presents as white matter lesions, neuromyelitis optica spectrum disorder (NMOSD), or transverse myelitis. NMOSD is an immune-mediated inflammatory demyelinating disease of the central nervous system with a high rate of relapse and significant disability. Studies have shown that patients with pSS combined with NMOSD have more severe symptoms and poorer prognosis. Here, we present a case of critical illness in pregnancy-associated NMOSD combined with Sjögren's syndrome. The patient was a 30-year-old pregnant woman with a history of Sjögren's syndrome who was diagnosed with NMOSD. She received combination therapy with steroids, intravenous immunoglobulin (IVIG), and hydroxychloroquine during pregnancy, resulting in partial resolution of numbness below the waist. However, due to irregular medication adherence outside the hospital setting, she developed weakness in her right lower limb accompanied by inability to move it, while her left lower limb still had some mobility but occasional numbness along with urinary and fecal incontinence. Ten days later, she was admitted to the emergency department where an emergency cesarean section was performed to deliver a healthy baby boy. However, her condition worsened postpartum as she developed high fever accompanied by bilateral lower limb paralysis and weakness along with loss of voluntary control over urination and defecation. The patient underwent ano-ther course of treatment consisting of steroids and IVIG; however there was limited improvement in symptoms observed after this intervention. Following administration of rituximab for the first time, the patient developed urinary tract infection which was successfully managed before continuing regular infusions. In later stages the patient could walk slightly with a limp and regained control over urination and defecation, allowing her to resume normal activities. This case suggests that combination therapy with steroids, IVIG, and hydroxychloroquine should be considered for the patients with pregnancy-associated NMOSD combined with Sjögren's syndrome. Rituximab can significantly improve symptoms such as postpartum paralysis in patients with NMOSD, however, there may be a risk of infection associated with its use.
Adult ; Female ; Humans ; Pregnancy ; Cesarean Section/adverse effects* ; Critical Illness ; Hydroxychloroquine/therapeutic use* ; Hypesthesia/complications* ; Immunoglobulins, Intravenous/therapeutic use* ; Inflammation/complications* ; Neuromyelitis Optica/diagnosis* ; Paralysis/complications* ; Pregnancy Complications/therapy* ; Rituximab/therapeutic use* ; Sjogren's Syndrome/complications* ; Steroids/therapeutic use* ; Vision Disorders

OBJECTIVE: To observe the effect of staged acupuncture on serum irisin level, neurological deficit, balance ability and spasticity in patients with ischemic stroke. METHODS: Sixty patients with ischemic stroke were randomly divided into a staged acupuncture group and a routine acupuncture group, 30 cases in each group; another 30 healthy subjects were selected as a normal group. The patients with ischemic stroke were treated with aspirin (100 mg each time, once a day, changing to 50 mg for prophylactic dose after 4 weeks). The patients in the staged acupuncture group were treated with staged acupuncture (acupoints were selected according to the soft paralysis period, spasticity period and recovery period, sequelae period) and rehabilitation treatment, while the patients in the routine acupuncture group were treated with acupuncture of soft paralysis-period as the staged acupuncture group and rehabilitation treatment. All the treatment was given once a day, 5 times a week, 2 weeks as a course of treatment, and 4 consecutive courses of treatment were provided. Before treatment and at 2 weeks, 4 weeks, 6 weeks and 8 weeks into treatment, the serum irisin level was measured, and the scores of National Institutes of Health stroke scale (NIHSS), Fugl-Meyer assessment scale-balance (FM-B) and comprehensive spasticity scale (CSS) were compared, and the correlation between the serum irisin level and NIHSS and FM-B scores in the two groups was analyzed. RESULTS: Before treatment, the serum irisin levels in the two groups were lower than those in the normal group (P<0.01). Compared before treatment, the serum irisin levels and FM-B scores were increased (P<0.01), and the NIHSS scores were decreased at 2, 4, 6 and 8 weeks into treatment in the two groups (P<0.01). At 4, 6 and 8 weeks into treatment, in the staged acupuncture group, the serum irisin levels and FM-B scores were higher than those in the routine acupuncture group (P<0.01, P<0.05), and the NIHSS scores were lower than those in the routine acupuncture group (P<0.01). After treatment, the CSS scores in the two groups were increased first and then decreased. Compared before treatment, the CSS scores were increased at 2, 4, 6 and 8 weeks into treatment in the two groups (P<0.01). At 4, 6 and 8 weeks into treatment, the CSS scores in the staged acupuncture group were lower than those in the routine acupuncture group (P<0.01). The serum irisin level was negatively correlated with NIHSS score (r =-0.772, P =0.000), and positively correlated with FM-B score (r =0.675, P =0.000). CONCLUSION The severity of neurological deficit and balance ability are related to serum irisin level in patients with ischemic stroke. The staged acupuncture could increase the serum irisin level, improve the neurological function, balance ability and spasticity in patients with ischemic stroke.
Acupuncture Therapy ; Fibronectins ; Humans ; Ischemic Stroke ; Muscle Spasticity ; Neurological Rehabilitation ; Paralysis/complications* ; Stroke/therapy* ; Stroke Rehabilitation ; Treatment Outcome

Since December 2019, COVID-19, an acute infectious disease, has gradually become a global threat. We report a case of thoracolumbar fractures (T and L) and incomplete lower limb paralysis in a patient with COVID-19. After a series of conservative treatment which did not work at all, posterior open reduction and pedicle screw internal fixation of the thoracolumbar fracture were performed in Wuhan Union Hospital. Three weeks later, the patient could stand up and the pneumonia is almost cured. We successfully performed a surgery in a COVID-19 patient, and to our knowledge it is the first operation for a COVID-19 patient ever reported.
Betacoronavirus ; Coronavirus Infections ; complications ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Pandemics ; Paralysis ; surgery ; Pedicle Screws ; Pneumonia, Viral ; complications ; Spinal Fractures ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial 'side'-to-side neurorrhaphy in rats.

METHODSA total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups (n = 6 each) that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement.

RESULTSAt 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed.

CONCLUSIONThe results of this study demonstrated that hemiHN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.

Animals ; Disease Models, Animal ; Facial Nerve ; surgery ; Facial Nerve Injuries ; complications ; surgery ; Facial Paralysis ; etiology ; surgery ; Hypoglossal Nerve ; surgery ; Nerve Regeneration ; Neurosurgical Procedures ; methods ; Rats, Sprague-Dawley ; Treatment Outcome

OBJECTIVES: To analyze the clinical characteristics of paroxysmal laryngospasm in adult. METHODS: A retrospective analysis was performed on 149 patients with paroxysmal laryngospasm in adult. All patients underwent the strobolaryngoscopy, completed the reflux symptom index (RSI) or the reflux finding score (RFS). Partial patients underwent an ambulatory 24-hour pH measurement. RESULTS: Laryngospasm was diagnosed in 76 females and 73 males. The average age was 55.4±11.4. The episode time of 149 (98%) patients last from several seconds tominutes, and 139 (93.3%) episodes could have a spontaneous remission. 84 (56.4%) episodes occurred only in the daytime, 28 (18.8%) only in the nighttime. There were 45.6% over weight/obesity patients, including 40 males and 28 females. The smokers were 28.9% (43/149) including 40 males and 3 females, and the drinkers were 29.5% (44/149) with 39 males and 5 females. 76 (51.0%) patients had no induced factor, while some caused by irritable cough/bucking (53,35.6%), cold (15, 10.1%), excitant food/smell (10, 6.7%), or regurgitation (6.5, 4.0%). Strobolaryngoscopy revealed laryngopharyngeal lesions in 46.3% (69/149) patients, including the glottic lesions with 40 (26.8%), unilateral vocal fold paralysis (21, 14.1%) and supraglottic lesions (8,5.4%). RSI/RFS showed 74.5% (111/149) patients had laryngopharyngeal reflux. Two patients treated with dietary and lifestyle modifications get improved, and 15/16 of the patients responded to antireflux treatment. CONCLUSIONS Episode of paroxysmal laryngospasm occurs more in the daytime, and could have a spontaneous resolution. Paroxysmal laryngospasm is much easier to occur in the male who are overweight or obesity, or with a long-term history of smoking or drinking. Almost half of the patients have an induced factor; partial may have laryngopharyngeal lesions simultaneously. Paroxysmal laryngopharyngeal reflux may be closely related to laryngospasm.
Adult ; Aged ; Female ; Humans ; Hypopharynx ; Laryngismus ; Laryngopharyngeal Reflux ; complications ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Vocal Cord Paralysis ; complications ; pathology