高血压病患者平衡功能测定及其临床意义

目的：为探讨正常人与高血压病（Ⅲ期）患者姿势图及有关参数的改变，以期为高血压病并发脑血管病论断提供参考。指导康复治疗及疗效评定。方法：采用日本阿尼马身体重心动摇测定仪（GS－10）进行测试（与计算机联机），测试34例高血压病（Ⅲ期）患者的姿势图有有关参数，并与42例健康者对照。结果：测试结果健康对照者中心型占28例（87．5％），而高血压病人（Ⅲ期）弥散型占20型（792％），无论是睁眼，闭眼，高血压患者组总轨迹长（LNG），外周面积（ENV），单位面积轨迹长（总轨谱长／外周面积，LNG／ENV，单位轨迹长（LNG／60秒），矩形面积（REC，AREA），实效值面积（RMS，AREA），Rombery试验均较健康对照者明显升高（Ｐ＜0．05－0．001），而单位面积轨迹长（LNG／ENV，AREA）较健康对照组明显下降（P＜0．001），结论：本文测试结果高血压病（Ⅲ期）患者与健康者对比，平衡功能有明显障碍，平面图显示弥散型为主，提示为中枢性病变，主要特点为重心晃动面积大，轨迹长，晃动速度快，可作为高血压病合并脑血管损伤检测方法之一，对脑损伤平衡功能的评定及康复治疗疗效判定有一定意义。     

太极拳和快步走锻炼对老年人静态平衡功能的改善效果

目的探讨太极拳和快步走锻炼改善老年人静态平衡功能的效果。方法在该市公园内随机选取122名老年人,根据是否进行日常锻炼及主要锻炼方式分为太极拳组41人,健步走组43人,无锻炼组38人。采用平衡测试及训练系统对研究对象静态平衡功能进行测试,对比三组老年人6种不同姿势(A:双脚睁眼站立,B:双脚闭眼站立,C:单足左脚睁眼站立,D:单足左脚团眼站立,E:单独右脚睁眼站立,F:单足右脚闭眼站立)下的静态平衡能力。结果太极拳组A^F姿势下重心动摇轨迹长明显低于无锻炼组,健步走组B、D姿势下重心动摇轨迹长明显低于无锻炼组;太极拳组A、D、E、F姿势下重心动摇轨迹长均明显低于无锻炼组。太极拳组和健步走组BF姿势下重心动摇轨迹长明显低于无锻炼组,健步走组B、D姿势下重心动摇轨迹长明显低于无锻炼组;太极拳组A、D、E、F姿势下重心动摇轨迹长均明显低于无锻炼组。太极拳组和健步走组B^F姿势下重心包罗面积均明显低于无锻炼组;太极拳组D姿势下重心包罗面积明显低于无锻炼组。太极拳组CF姿势下重心包罗面积均明显低于无锻炼组;太极拳组D姿势下重心包罗面积明显低于无锻炼组。太极拳组C^F姿势下重心X方向动摇轨迹长明显低于无锻炼组,健步走组E、F姿势下明显低于无锻炼组;太极拳组CF姿势下重心X方向动摇轨迹长明显低于无锻炼组,健步走组E、F姿势下明显低于无锻炼组;太极拳组C^F姿势下重心X方向动摇轨迹长均明显低于无锻炼组。太极拳组和健步走组DF姿势下重心X方向动摇轨迹长均明显低于无锻炼组。太极拳组和健步走组D^F姿势下重心Y方向动摇轨迹长明显低于无锻炼组;太极拳组A、B、C、F姿势下重心Y方向动摇轨迹长均明显低于无锻炼组。结论太极拳锻炼和健步走锻炼均能有效缓解老年人的静态平衡能力下降,同时太极拳作用明显优于健步走。     

动静态平衡功能在老年脑卒中偏瘫患者中的临床评定

平衡功能的评定对制定康复方案和训练效果的评价具有重要意义。平衡评定的内容包括动态平衡、静态平衡和被动平衡三个方面。临床上，中心摆动测量法在测定直立姿式和静态平衡方面日益受到重视；而Berg平衡量表（Berg balance scale，BBS）和计时起立行走测试（time up andgotest，TUG）是常用的动态平衡测量方法。BBS主要用于评测老年个体平衡功能；TUG应用于评测老年人平衡功能对预测跌倒风险具有可靠性。本文主要探讨老年脑卒中偏瘫患者康复训练中动静态平衡功能的评定及参数之间的相关性。     

肌电图在肌萎缩侧索硬化和脊髓型颈椎病鉴别诊断中的应用

对肌萎缩侧索硬化（ALS）和脊髓型颈椎病（CSM）患者各32例行三肢肌肌电图（EMG）和胸锁乳突肌EMG检查，结果显示ALS与CSM患者肢体肌、胸锁乳突肌的失神经电位、MUP时限增宽、MUP波幅增高、单纯相或单混相发生率均存在显著差异（P〈0．01）。认为EMG对二者的早期鉴别诊断有重要价值。     

脊髓型颈椎病的微创治疗研究进展

脊髓型颈椎病（CSM）多发生于40岁以上患者,多由于颈椎椎体退化和相邻软组织退变,压迫脊髓所致。CSM早期的临床表现^[1]有颈部不适、疼痛,上肢麻木、无力、手部精细运动功能减弱,躯体紧束感,下肢快速步态困难、双足踩棉花感,晚期表现有行走不稳、常规步态困难、大小便困难、下肢痉挛等。     

脊髓型颈椎病合并窦性心动过缓的前瞻性研究

目的探讨脊髓型颈椎病（CSM）合并窦性心动过缓的发生率及可能的相关因素。方法选择121例CSM患者,术前常规进行心电图检查、日本矫形外科学学会（JOA）评分,测定颈椎MRI上T2加权像压迫最重节段的脊髓横断面积并记录脊髓有无信号改变。对合并窦性心动过缓的患者术后6个月时复查心电图,了解术后窦性心动过缓的恢复情况。结果121例中合并窦性心动过缓28例,发生率为23．14％,明显高于一般人群的发生率（P=0．0173）。合并窦性心动过缓与非合并窦性心动过缓患者MRI T2加权像上脊髓信号改变差别具有高度统计学意义（P=0．0001）。术后6个月随访,窦性心动过缓转阴率80．77％。结论CSM合并窦性心动过缓的发生率明显高于一般人群,CSM不仅影响到感觉神经和运动神经的传导,还影响到交感神经的功能。     

前路减压植骨融合内固定术治疗脊髓型颈椎病的疗效分析

目的分析前路减压植骨融合内固定术治疗脊髓型颈椎病(CSM)的疗效,提高植骨融合率。方法将72例CSM患者随机分为两组,每组36例,两组均行前路减压,对照组实施单纯植骨融合术,观察组实施纳米羟基磷灰石/聚酰胺66(n-HA/PA66)支撑体内植骨+Atlantis杂合性钢板内固定术,于术前、术后1周、6个月、1年对患者进行JOA评分、NDI评分及Nurick评级,术后1年采用Odom's标准评价整体疗效,并观察术后植骨融合情况。结果两组术后各时间段JOA评分、Nurick评级较术前均有所改善(P0.05),但组间比较无统计学意义(P0.05);观察组术后各时段NDI评分高于对照组(P0.05);观察组术后6个月、1年手术节段屈伸活动度均高于对照组(P0.01);观察组Odom's评分优良率为86.11%、植骨融合率为100.00%,均高于对照组的63.89%、77.78%(P0.05)。结论前路减压植骨融合内固定术治疗CSM疗效显著,可促进手术节段运动功能的恢复,提高植骨融合率。     

运动神经元疾病误诊为脊髓型颈椎病1例

运动神经元疾病误诊为脊髓型颈椎病１例山东医科大学附属医院（２５００１２）张力陈国端患者男，５１岁。因双下肢乏力、行走不稳７个月，在外院诊为脊髓型颈椎病。ＣＴ、ＭＲＩ检查示Ｃ４．５间盘轻度后突，椎管矢状径７ｍｍ，行经后路单开门椎管扩大成形术。因术后症状...     

太极拳锻炼对老年女性平衡功能的影响

目的探讨太极拳锻炼对老年女性平衡功能的影响。方法对96例老年女性随即分为太极拳锻炼组（50例）和对照组46（例）,进行win-pod静态平衡及星状图动态平衡检测,并对结果进行分析。结果太极拳组在睁眼测试中的轨迹长、外周面积两项指标上小于对照组（P〈0．05）,在闭眼测试中的各项指标均小于对照组（P〈0．05）;太极拳组在正左、左后、正后、正右、右前等指标均与对照组有显著差异（P〈0．05）。结论太极拳锻炼可以提高老年女性的静、动态平衡功能。     

大众健美操对中老年妇女平衡能力的影响

目的探讨大众健美操对中老年妇女平衡能力的影响。方法选择该市经常参加大众健美操运动的中老年妇女60例作为研究组,不经常参加运动及锻炼的中老年妇女60例作为对照组。观察对比两组双足睁、闭眼平衡水平测试结果及闭目原地踏步测试的持续时间。结果两组受试者在双足睁眼时,单位面积轨迹长(L/A)、包络面积(Area)、重心动遥速度(Avg.Q.speed)有显著差异(P0.05或P0.01);在双足闭眼时,心动摇轨迹长(Length)、Area、X轴摆速度(X speed)及Y轴摆动速度(Y speed)有显著差异(P0.05或P0.01)。研究组闭目原地踏步的持续时间显著长于对照组(P0.01)。结论大众健美操可以提高中老年女性的肌肉力量及机体的稳定性,加强平衡能力。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.