高频经颅磁刺激联合镜像治疗对男性脑卒中患者上肢功能恢复的影响

目的 探讨10Hz高频重复经颅磁刺激（rTMS）联合镜像治疗(MT)对男性慢性期脑卒中患者上肢功能恢复的影响。 方法 选取45例男性首次脑卒中住院慢性期患者（病程3~6个月）,采用随机数字表法将其分为A组、B组及C组,每组15例,在治疗过程中B组有1例患者脱落。3组患者均给予常规药物及康复治疗,A组患者在此基础上给予60min MT治疗;B组患者则先给予患侧M1区高频(10Hz)rTMS治疗,再辅以MT治疗;C组则先进行MT治疗,再给予患侧M1区高频rTMS治疗。以上治疗每天1次,每周治疗5d,共持续治疗4周。于治疗前、治疗4周后分别检测各组患者患侧拇短展肌运动诱发电位(MEP)皮质潜伏期、中枢运动传导时间（CMCT）及上肢运动功能指标,包括上肢Fugl-Meyer评分（FMA）、上肢运动力指数（MI）及偏瘫上肢功能测试-香港版（FTHUE-HK）分级等。 结果 治疗4周后,3组患者MEP皮质潜伏期和CMCT均比治疗前明显缩短（P<0.05）,其中B组患者MEP皮质潜伏期较A组明显缩短,CMCT较A组、C组均明显缩短。治疗4周后3组患者上肢FMA、MI评分和FTHUE-HK分级均较治疗前明显改善（P<0.05）,其中B组患者上肢FMA评分明显优于A组和C组（P<0.05）,FTHUE-HK分级明显优于A组（P<0.05）。 结论 单纯MT或10Hz rTMS联合MT治疗均可改善脑卒中慢性期患者大脑运动皮质兴奋性和上肢运动功能,并以rTMS治疗结束后辅以MT的联合干预方案效果更优。     

重复经颅磁刺激诱导下运动想象疗法对脑卒中患者上肢运动功能的影响

目的 观察重复经颅磁刺激（rTMS）诱导下运动想象疗法（MIT）对脑卒中患者上肢运动功能的影响。 方法 按照随机数字表法将90例脑卒中患者分为对照组、运动想象组、联合治疗组,每组30例。3组患者均给予常规康复,运动想象组在此基础上增加MIT治疗,联合治疗组在运动想象组基础上增加rTMS诱导（健侧皮质M1区、1 Hz）。治疗前、治疗4周后（治疗后）,采用上肢Fugl-Meyer评定量表（FMA）、香港版偏瘫上肢功能测试（FTHUE-HK）评估3组患者的上肢功能,记录患者的运动诱发电位（MEP）、皮质潜伏期（CL）和中枢运动传导时间（CMCT）。 结果 治疗前,3组患者的上肢FMA评分、FTHUE-HK评分、CL、CMCT比较,差异无统计学意义（P＞0.05）。与组内治疗前比较,3组患者治疗后的上肢FMA、FTHUE-HK评分均显著改善（P＜0.05）,运动想象组和联合治疗组治疗后的CL、CMCT均缩短（P＜0.05）。与对照组治疗后比较,运动想象组和联合治疗组的上述指标均较为优异（P＜0.05）。联合治疗组治疗后上肢FMA［（43.87±8.04）分］、FTHUE-HK评分［（3.67±1.01）分］、CL［（23.87±2.81）ms］、CMCT［（10.37±1.82）ms］较运动想象组改善更明显,差异有统计学意义（P＜0.05）。 结论 单纯MIT治疗和rTMS诱导下的MIT治疗均可改善脑卒中患者的上肢运动功能,其中以rTMS诱导下的MIT治疗效果更明显。     

重复经颅磁刺激对脑梗死患者上肢运动功能的影响

目的:研究不同频率重复经颅磁刺激(r TMS)对脑梗死偏瘫患者上肢运动功能的影响。方法:符合入组条件完成研究的45例患者按随机数字表法分为低频刺激组(14例)、假rTMS组(14例)和高频刺激组(17例)。所有患者均给予常规药物治疗和康复训练,低频刺激组则在非受累侧初级运动皮质区(M1区)进行1Hz的rTMS治疗;高频刺激组及假rTMS组则在患侧M1区给予10Hz的rTMS治疗;所有患者接受2周治疗,每周5天。分别于治疗前、治疗2周后对患者进行评估,包括患侧脑区运动诱发电位(MEP)皮质潜伏期、中枢运动传导时间(CMCT)、患侧上肢Fugl-Meyer评分(FMA)、患侧上肢MAS量表,将各组所得数据进行统计学分析比较。结果:(1)治疗前,3组患者上述指标组间比较,差异均无显著性意义(P0.05);(2)神经电生理学变化:治疗2周后,3组患者的MEP皮质潜伏期、CMCT均较组内治疗前缩短(P0.05);1Hz组和10Hz组较前明显缩短且优于假r TMS组(P0.05);1Hz组和10Hz组组间比较差异无显著性意义(P0.05);(3)上肢功能改善:治疗2周后,3组患者上肢FMA评分均较组内治疗前提高(P0.05),其中1Hz组和10Hz组与假rTMS组比较有显著性意义(P0.05);但1Hz组和10Hz组组间比较差异无显著性意义(P0.05);(4)3组患者患侧上肢MAS量表评分均较组内治疗前有明显增加,有显著性差异(P0.05),但3组患者治疗后MAS评分组间比较,差异无显著性意义(P0.05)。结论:高频及低频rTMS治疗均有利于脑梗死患者上肢运动功能的恢复且两者间疗效无明显差异。     

低频重复经颅磁刺激联合作业治疗对脑卒中患者上肢运动功能恢复的临床研究

目的:探讨低频重复经颅磁刺激(rTMS)联合作业治疗对脑卒中恢复期患者上肢功能恢复的影响。方法:将60例脑卒中恢复期患者随机分为治疗组和对照组各30例。对照组接受常规的作业治疗,治疗组在常规作业治疗的同时给予1Hz的rTMS治疗。在治疗前及治疗4周后采用上肢Fugl-Meyer评分(FMA)、偏瘫上肢功能测试-香港版(FTHUE-HK)及改良的Barthel指数(MBI)对患者上肢功能进行评定。结果:治疗4周后,2组的FMA、FTHUE-HK评分和MBI均较治疗前明显提高(均P0.05),且治疗组各项评分均高于对照组(均P0.05)。结论:rTMS联合作业治疗可改善脑卒中恢复期患者上肢运动功能,提高日常生活活动能力。     

高频重复经颅磁刺激结合外周磁刺激 治疗脑卒中后肌痉挛的临床研究

目的：观察高频重复经颅磁刺激（HF-rTMS）结合外周磁刺激治疗脑卒中后肌痉挛的临床效果。方 法：卒中患者120例随机分为联合组、rTMS组和对照组,每组40例。在脑卒中后二级预防用药治疗及常规 康复训练治疗基础上,联合组加用HF-rTMS和外周磁刺激,rTMS仅加用HF-rTMS,对照组不给予磁刺激。 于治疗前、治疗4周后检测患者患侧拇短展肌运动诱发电位（MEP）潜伏期及脑皮质到脊髓α前角运动神经 元的传导时间（CMCT）;采用改良Ashworth痉挛量表（MAS）和下肢痉挛指数（CSI）评定肢体痉挛情况,采 用上肢Fugl-Meyer运动量表（FMA）和改良Barthel指数（MBI）评定肢体运动功能。结果：3组治疗前的屈腕 MAS、CSI指数、上肢FMA评分、MBI评分、MEP潜伏期和CMCT差异无统计学意义（P＞0.05）。经4周治 疗后,各组患者上肢FMA评分、MBI评分均较治疗前明显升高（P＜0.05）,屈腕MAS、CSI指数均较治疗前 明显降低（P＜0.05）;rTMS组和联合组MEP潜伏期和CMCT均较治疗前缩短（P＜0.05）。联合组对以上指 标的改善作用最强,治疗效果最佳,rTMS次之,均明显优于对照组（P＜0.05）。治疗期间无诱发癫痫病例发 生。结论：HF-rTMS结合外周磁刺激比单用HF- rTMS治疗脑卒中后肌痉挛的效果更好,可减轻上肢屈肘 肌和下肢痉挛指数,改善患者运动功能及活动能力,缩短MEP潜伏期和CMCT,且安全性高。     

不同频率重复经颅磁刺激对脑梗死患者上肢功能的影响

目的:比较不同频率的重复经颅磁刺激(rTMS)对脑梗死患者上肢功能的影响。方法:将30例患者随机分为0.5Hz组、1Hz组和2Hz组,常规药物治疗和康复训练基础上对健侧大脑皮质M1区进行不同频率(0.5Hz、1Hz、2Hz)的rTMS治疗,持续治疗20d,于治疗前、治疗第10天及第20天时对各组患者进行疗效评定,采用上肢Fugl-Meyer评分法、上肢运动力指数(MI)、偏瘫上肢功能测试(香港版)对患者上肢功能进行评定,同时检测各组患侧脑区运动诱发电位(MEP)皮质潜伏期及中枢运动传导时间(CMCT)。结果:①上肢功能变化:治疗后3组上肢功能均明显提高,治疗10d时,0.5Hz组上肢MI评分明显高于2Hz组(P<0.05),1Hz组与其他两组组间差异无显著性意义(P>0.05);治疗20d时,0.5Hz组各项评分均优于2Hz组(P<0.05),1Hz组上肢MI评分优于2Hz组(P<0.05),0.5Hz组与1Hz组组间差异不具有显著性意义(P>0.05)。②神经电生理学变化:治疗后3组MEP皮质潜伏期及CMCT均较治疗前明显缩短,治疗10d时,0.5Hz组CMCT明显短于2Hz组(P<0.05);1Hz组与其他两组组间差异无显著性意义(P>0.05);治疗20d时,0.5Hz组MEP皮质潜伏期明显短于2Hz组(P<0.05),CMCT明显短于1Hz组和2Hz组(P<0.05);1Hz组CMCT较2Hz组缩短明显(P<0.05)。结论:0.5Hz或1Hz的重复经颅磁刺激作用于脑梗死患者健侧半球均可明显提高患侧脑区运动皮质的兴奋性,促进患侧上肢功能的恢复,且0.5Hz的刺激频率对提高患侧运动皮质的兴奋性最有效。     

低频重复经颅磁刺激联合镜像疗法对脑梗死患者上肢运动功能恢复的临床研究

目的：探讨低频重复经颅磁刺激（rTMS）联合镜像疗法（MT）对脑梗死患者上肢运动功能恢复的影响。方法：60例脑梗死患者随机分为观察组和对照组各30例。2组患者均接受常规的临床药物治疗及规范的运动疗法和物理因子治疗。2组患者每天先进行rTMS治疗,观察组再进行MT治疗,对照组进行常规作业治疗。治疗前后采用简化Fugl-Meyer上肢运动功能评分(FMA)和上肢运动力指数(MI)评价患侧上肢运动功能,运动诱发电位(MEP)潜伏期和中枢运动传导时间(CMCT)指标进行神经电生理学评价。结果：治疗4周后,2组患者FMA和MI评分较治疗前均明显提高（均P<0.05）,且观察组2项评分均明显高于对照组（均P<0.05）;2组患者 MEP潜伏期和CMCT均较治疗前缩短（均P<0.05）,且观察组MEP潜伏期和CMCT均较对照组更短（均P<0.05）。结论：低频重复经颅磁刺激结合镜像疗法治疗能提高脑梗死患者的偏瘫上肢运动功能,且疗效优于低频重复经颅磁刺激结合常规作业疗法治疗。     

不同频率重复经颅磁刺激治疗缺血性脑卒中患者的疗效观察

目的 观察不同频率重复经颅磁刺激（rTMS）对缺血性脑卒中患者运动功能恢复的影响。 方法 采用随机数字表法将45例缺血性脑卒中偏瘫患者分为高频组、低频组及假刺激组,每组15例。3组患者均给予常规康复干预,高频组患者在此基础上针对患侧运动皮质M1区给予10 Hz高频rTMS治疗,低频组患者则针对健侧运动皮质M1区给予0.5 Hz低频rTMS治疗,假刺激组则针对患侧运动皮质M1区给予假磁刺激治疗。于治疗前、治疗3周后分别检测3组患者运动诱发电位（MEP）皮质潜伏期及中枢运动传导时间（CMCT）,同时采用Fugl-Meyer运动功能量表（FMA）、Berg平衡量表（BBS）及改良Barthel指数量表（MBI）对3组患者运动功能恢复情况进行评定。 结果 治疗后3组患者MEP皮质潜伏期、CMCT及FMA、BBS、MBI评分均较治疗前明显改善（P<0.05）,并且高频组、低频组上述疗效指标亦显著优于假刺激组水平（P<0.05）,同时低频组MEP皮质潜伏期、CMCT均较高频组明显缩短,组间差异均具有统计学意义（P<0.05）;治疗后低频组与高频组FMA、BBS及MBI评分组间差异仍无统计学意义（P>0.05）。 结论 低频及高频rTMS治疗均有利于缺血性脑卒中患者运动功能恢复,并且低频rTMS刺激健侧M1区较高频rTMS刺激病灶侧M1区能更显著改善病灶侧皮质兴奋性。     

高频及低频重复经颅磁刺激对急性期脑梗死患者运动功能恢复的临床研究

摘要 目的：观察高频（10Hz）、低频（1Hz）及高低频相结合的重复经颅磁刺激（rTMS）对急性期脑梗死患者运动功能恢复的疗效。 方法：选取60例急性期脑梗死后偏瘫患者,采用单盲法完全随机设计分为4组（各15例）：低频组、高频组、高低频结合组、对照组。四组均接受药物治疗及肢体康复为常规治疗。所有患者接受rTMS,治疗前和治疗后进行Fugl-Meyer（FMA）评分、美国国立卫生院神经功能缺损评分（NIHSS评分）、Barthel指数（BI）。每组各随机挑选6例患者于治疗前后进行神经电生理检查,记录运动诱发电位（MEP）潜伏期。 结果：①rTMS治疗后四组FMA、NIHSS、BI均较治疗前改善（P＜0.05）;②rTMS治疗后高频组、低频组以及高低频结合组较对照组的FMA、BI、NIHSS评分改善（P＜0.05）。且高低频结合组较高频及低频组FMA、BI评分的改善更明显（P＜0.05）。③rTMS治疗后高频组和高低频结合组较本组治疗前MEP潜伏期降低（P＜0.05）。且高频组较高低频结合组MEP潜伏期降低更明显（P＜0.05）。 结论：高频（10Hz）、低频（1Hz）、高频（10Hz）与低频（1Hz）相结合的rTMS较对照组患者运动功能的恢复更有效。其中高低频结合组的效果更为明显。另外高频（10Hz）、高频（10Hz）与低频（1Hz）相结合的rTMS能够更有效的增强患侧大脑M1区的兴奋性,促进肢体运动功能的恢复。     

重复经颅磁刺激联合肌电生物反馈对脑卒中患者上肢功能恢复的影响

目的 观察重复经颅磁刺激（rTMS）联合肌电生物反馈训练对脑卒中患者上肢功能恢复的影响。 方法 采用随机数字表法将135例脑卒中后上肢功能障碍患者分为磁刺激组、肌电反馈组及观察组,每组45例。所有患者均给予常规药物治疗及康复干预（包括主动训练、被动训练及抗阻训练等）,磁刺激组在此基础上辅以低频rTMS治疗,肌电反馈组辅以肌电生物反馈训练,观察组则辅以rTMS及肌电生物反馈训练。于治疗前、治疗4周后检测3组患者皮质潜伏期、中枢运动传导时间(CMCT),同时采用Fugl-Meyer运动功能量表（FMA）上肢部分及改良Ashworth痉挛量表对患者上肢功能恢复情况进行评定。 结果 治疗后磁刺激组、肌电反馈组及观察组皮质潜伏期、CMCT均较治疗前明显缩短;观察组皮质潜伏期［(23.5±1.1)ms］、CMCT［(11.2±0.8)ms］亦较磁刺激组、肌电反馈组明显缩短（P＜0.05）。治疗后3组患者上肢FMA评分均较治疗前明显增加（P＜0.05）;并且观察组上肢FMA评分［(39.8±6.3)分］亦显著高于磁刺激组、肌电反馈组水平（P＜0.05）,肌电反馈组上肢FMA评分［(33.8±6.7)分］亦显著高于磁刺激组水平（P＜0.05）。治疗后3组患者偏瘫侧腕屈肌MAS评级均较治疗前明显改善（P＜0.05）,并且观察组腕屈肌MAS评级亦显著优于磁刺激组及肌电反馈组水平（P＜0.05）。 结论 在常规干预基础上辅以rTMS或肌电生物反馈训练均可有效改善脑卒中患者上肢受损功能,如rTMS与肌电生物反馈训练联用则具有协同作用,能进一步提高康复疗效,有利于脑卒中患者上肢功能全面恢复。     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.