运动想象联合优化运动技能训练对脑卒中患者上肢运动功能的影响

目的:探讨运动想象联合优化运动技能训练对脑卒中患者上肢运动功能改善的影响。方法:将45例脑卒中患者按随机数字表分为联合组、运动想象组(MI)和优化运动技能组(OMP),每组各15例。三组患者均接受常规康复训练,30min/次,2次/d,5d/周,共4周。MI组常规康复训练的同时进行4周的运动想象疗法,20min/次,1次/d,5d/周;OMP组常规康复训练的同时进行4周的优化运动技能训练,20min/次,1次/d,5d/周;联合组则在常规康复训练的同时进行4周的运动想象疗法20min/次和优化运动技能训练20min/次,均1次/d,5d/周。于治疗前及治疗4周后对患者进行功能评定,采用简Fugl-Meyer运动功能评分(FMA)和手臂动作调查测试量表(ARAT)评价上肢运动功能;改良Barthel指数量表(MBI)评价日常生活活动能力,比较三组的疗效。结果:①治疗前,三组患者上肢FMA评分、ARAT评分和MBI评分无显著性差异(P0.05);治疗4周后,三组患者的上肢FMA评分、ARAT评分和MBI评分与治疗前比较均明显提高(P0.01)。②治疗4周后联合组上肢FMA评分、ARAT评分和MBI评分均明显优于MI组和OMP组(P0.05);而MI组和OMP组之间评分的差异无显著性意义(P0.05)。结论:在常规康复治疗的基础上,运动想象和优化运动技能训练均能提高脑卒中患者上肢运动功能和日常生活活动能力,两者联合治疗效果更加显著。     

影响脑卒中患者脑机接口上肢训练效果的相关因素

探讨影响接受基于运动想象的脑机接口(MI-BCI)综合康复训练的亚急性期脑卒中患者上肢运动功能疗效的相关因素。     

视觉运动诱导的脑机接口技术应用于脑卒中患者上肢运动功能和认知功能的效果

目的 探讨视觉运动诱导的脑机接口(BCI)技术应用于脑卒中患者上肢运动功能和认知功能的治疗效果。方法 2021年7月至2022年3月，陕西省康复医院患有上肢手功能障碍和认知障碍的脑卒中患者50例随机分为对照组(n=25)和试验组(n=25)。两组均接受常规康复，对照组进行传统被动式手功能康复训练，试验组进行视觉运动诱导的BCI康复训练，共2周。治疗前后分别比较两组Fugl-Meyer评定量表上肢部分(FMAUE)、改良Barthel指数(MBI)和蒙特利尔认知评估量表(MoCA)评分，并对计算试验组的脑参与度。结果 治疗前，两组FMA-UE、MBI和MoCA评分比较均无显著性差异(P> 0.05)。治疗2周后，两组FMA-UE、MBI和MoCA评分均较治疗前显著提高(t> 2.481, P <0.001)，且试验组优于对照组(t> 2.453, P <0.05)；试验组平均脑参与度在治疗后上升21%。结论 基于视觉运动诱导的BCI康复训练有利于促进脑卒中患者上肢运动功能的恢复以及认知功能的提升。     

运动想象治疗脑卒中患者手部运动功能的疗效研究

目的:探讨运动想象(MI)疗法的可行性及有效性,总结适合脑卒中后偏瘫患者的训练方案。方法:将16例脑卒中偏瘫患者随机分为运动想象组(MI)6例、执行运动(EM)组5例、空白组(CG)5例。MI组给予运动想象治疗,EM组进行动作的实际操作训练,CG组仅进行常规康复治疗。使用简易上肢机能检查(STEF)、Fugl-Meyer上肢功能检查(FMA)、改良巴氏指数(MBI)评价患者训练前后的上肢运动功能、日常生活活动能力检查。结果:治疗4周后,MI组及EM组上肢FMA、STEF、评分较训练前及CG组训练后均有明显提高(P0.05),且MI改善更优于EM组(P0.05)。治疗4周后,3组MBI评分组内及组间比较差异均无统计学意义。结论:运动想象结合手部运动疗法对患手运动功能的提高比常规训练有更显著的优势。     

基于脑机接口电刺激在脑卒中患者上肢康复中的应用研究

目的 探讨基于脑机接口（BCI)电刺激在脑卒中患者上肢康复训练中的可行性及作用机制。 方法 选取5例脑卒中患者并采用基于BCI电刺激技术对其上肢功能进行康复训练（共训练1次）,观察入选患者康复训练前、后在执行运动想象(MI)任务时的在线准确率（CA）以及事件相关去同步电位（ERD）。 结果 5例入选患者康复训练前执行运动想象任务时的平均在线准确率为50.70%,康复训练后其在线准确率提升至58.94%;康复训练前2例患者两侧中央运动区均表现ERD特征,康复训练后该2例患者两侧中央运动区ERD特征较治疗前明显增强,并且患侧中央运动区ERD特征亦明显强于健侧中央运动区,1例脑卒中患者在训练前无明显ERD特征,经康复训练后患侧中央运动区表现出ERD特征,另外2例患者在康复训练前、后其双侧中央运动区均无明显ERD特征。 结论 基于BCI电刺激技术对促进脑卒中患者上肢功能恢复具有显著疗效,其治疗机制可能与促进患侧运动相关脑区激活有关。     

功能近红外光谱成像技术评估运动想象疗法对脑卒中患者脑功能的影响

目的:利用功能近红外光谱成像技术(fNIRs)探讨运动想象疗法对上肢功能障碍的脑卒中患者脑功能的影响。方法:将卒中后上肢功能障碍患者20例随机分为治疗组和对照组,每组各10例。对照组患者予以常规药物、常规运动康复训练;治疗组在对照组基础上予以运动想象训练。于治疗前、治疗4周、8周后,采用功能独立性评定量表(FIM)和Fugl-Meyer上肢功能评定量表(FMA-U)评估疗效,同时采用f NIRs采集系统检测大脑组织氧合血红蛋白(Oxy-Hb)相对变化,以探讨特定脑区激活模式和响应特征。结果:治疗前,2组患者FIM、FMA-U评分差异无统计学意义(P>0.05)。治疗4周、8周后,2组患者FIM、FMA-U评分均较同组治疗前提高(P<0.05),且治疗组评分均高于同时间点的对照组评分(P<0.05)。f NIRs三维脑成像图显示,康复训练刺激脑组织的兴奋部位主要是皮质运动区的中上段(Brodmann 4区),随着治疗时间的增加,2组患者皮质兴奋区域面积增加,且治疗组增加的程度更大;与治疗前比较,2组治疗4周、8周后脑组织Oxy-Hb浓度均显著提高(P<0.05),且治疗组Oxy-Hb浓度高于对照组(P<0.05)。相关性分析结果显示,FIM得分与Oxy-Hb浓度相对值呈正相关(r=0.657,P<0.05),FMA-U与Oxy-Hb浓度相对值呈正相关(r=0.807,P<0.05)。结论:卒中后上肢功能活动障碍患者大脑运动前区、运动区皮质存在明显抑制现象。单纯运动康复训练、运动想象疗法联合运动康复训练均能激活相关脑区功能活动,且后者激活效果及功能改善更显著。     

悬吊下虚拟现实技术训练对脑卒中偏瘫患者上肢功能恢复的影响

目的:观察悬吊下进行虚拟现实技术训练对脑卒中偏瘫患者上肢运动功能恢复的影响。方法:将脑卒中偏瘫患者60例随机分为2组各30例,对照组给予常规上肢康复训练,观察组在常规上肢康复训练基础上给予悬吊下虚拟现实技术训练,治疗4周。治疗前后采用简式Fugl-Meyer量表上肢部分(FMA评分)、改良Barthel指数(MBI评分)及Brunnstrom分期(包括上肢和手)进行评价。结果:治疗后2组患者FMA评分、MBI评分及Brunnstorm分期(包括上肢和手)均较治疗前有明显改善(P0.05)。治疗后观察组患者的FMA评分、MBI评分及上肢Brunnstorm分期均明显优于对照组(P0.05),而治疗后观察组患者的手Brunnstorm分期较对照组无显著性差异(P0.05)。结论:悬吊下进行虚拟现实技术训练能明显改善脑卒中偏瘫患者的上肢运动功能及日常生活能力。     

脑卒中运动功能障碍的局部一致性fMRI研究

目的:运用静息态功能性磁共振成像探究不同程度运动功能障碍脑卒中的脑局部一致性(regional homogeneity,ReHo)变化。方法:对单侧皮质下脑卒中患者(其中轻度和重度运动功能障碍患者各13例)和13例健康志愿者分别进行静息态功能磁共振成像检查。分别计算三组被试的全脑ReHo值,运用双样本t检验得到组间的差异脑区,进一步将差异脑区的ReHo值与临床上肢运动功能评分及手腕运动功能评分作相关性分析。结果:与健康对照组比较,轻度组病灶同侧皮质下的尾状核和丘脑的ReHo显著减小,辅助运动区及病灶对侧颞下回、梭状回及小脑的ReHo显著增高。重度组病灶同侧的初级运动皮质、扣带前回、颞下回、脑岛、枕中回及丘脑的ReHo显著减小,病灶对侧额上回、颞下回及小脑的ReHo显著增高。患者子组比较,重度组病灶同侧枕中回和病灶对侧颞上回的ReHo均显著低于轻度组,其中枕中回的ReHo值与上肢和"手+腕"FMA(Fugl-Meyer Assessment)评分显示正相关(分别为r=0.647,r=0.682,P<0.001),颞上回的ReHo值亦与上肢和"手+腕"FMA评分显示正相关(分别为r=0.646,r=0.718,P<0.001)。结论:单侧皮质下脑卒中运动功能障碍静息态神经功能活动异常与运动功能严重程度密切相关,主要涉及邻近病灶的皮质下组织和远离病灶的脑皮质。其中一些脑区的ReHo值与患者运动功能评分存在相关性,或许说明ReHo分析可以作为评估卒中患者运动功能障碍的一个重要影像学指标。     

经皮穴位电刺激对脑卒中后手功能的康复效果

目的评价经皮穴位电刺激对脑卒中后手功能障碍者的康复疗效。方法 2013年3月至2015年6月,56例脑卒中手功能障碍者分成A组(n=28)和B组(n=28),A组接受基础康复训练,B组接受经皮穴位电刺激和基础康复训练,共6周。治疗后采用Brunnstrom偏瘫手功能分级、徒手肌力检查(MMT)、Fugl-Meyer评定(FMA)手指运动功能部分、运动功能状态量表(MSS)、改良Ashworth量表(MAS)、美国国立卫生院脑卒中量表(NIHSS)、手运动功能状态评分和Barthel指数(BI)进行评定。结果治疗后,B组FMA评分、Brunnstrom上肢和手分级、MMT腕关节掌屈肌力、MSS评分、MAS评分及BI评分均高于A组(t2.2527,P0.05),NIHSS评分显著低于A组(t=3.5559,P0.001);手运动功能评分和MMT腕关节背屈肌力两组间无显著性差异(t0.3095,P0.05)。结论经皮穴位电刺激能促进脑卒中后手功能恢复,提高脑卒中患者的日常生活活动能力。     

运动想象疗法对脑卒中偏袒患者上肢功能恢复的影响

目的观察运动想象疗法对脑卒中偏瘫患者上肢功能恢复的影响。 方法共选取30例脑卒中偏瘫患者,将其随机分为治疗组及对照组。2组患者均给予常规康复治疗,其中治疗组患者在此基础上辅以运动想象疗法。分别于治疗前、治疗2周、4周及8周时采用Fugl-Meyer上肢运动功能评分(FMA)、运动功能评估量表(MAS)对患者上肢功能进行评定。 结果治疗前2组患者上肢FMA及MAS评分组间差异均无统计学意义（P&rt;0.05）;治疗2周后,发现治疗组MAS评分较治疗前改善,但组间差异仍无统计学意义（P&rt;0.05）;治疗4周后,2组患者上肢FMA及MAS评分均较治疗前明显提高,并且治疗组上肢FMA评分明显优于对照组（P<0.05）;治疗8周后,发现2组患者上肢FMA及MAS评分均较治疗前进一步改善（P<0.05）,此时治疗组上述指标均显著优于对照组（P<0．05）。 结论在常规康复治疗脑卒中偏瘫患者基础上辅以运动想象治疗,可进一步改善患者肢体运动功能,提高康复疗效。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."