单侧肢体电刺激训练对双侧肢体力量和表面肌电的影响

目的:运用表面肌电技术观察单侧肢体电刺激训练对双侧肢体力量和表面肌电(sEMG)的影响,为临床单侧肢体损伤、外科术后等引起的肌萎缩的康复治疗以及建立床边客观的训练效果评定方法提供依据.方法:选择18-30岁未经专项体育训练的青年男性30例为实验对象,随机分为电刺激组,随意等长收缩组和对照组.采用重复等长收缩模式对右侧胫骨前肌进行6周的电刺激和随意力量训练.训练前后进行双侧肌肉力量和sEMG测试.结果:电刺激组(右33.6％,左27.8％)和随意等长收缩组(右37.4％,左28.5％)训练侧和未训练侧的足背屈肌肉力量在训练后均有显著提高,与对照组(右1.3％,左0.8％)有显著性差异(P＜0.05);随意等长收缩组(右100.4％,左59.4％)与电刺激组(右68.1％,左57.7％)双侧肌电平均振幅(AEMG)均有明显变化,并与对照组(右5.04％,左-4.07％)有显著性差异(P＜0.05);肌肉不同等长用力和肌电振幅之间表现出非线性的关系,以指数y=43.762(9.584)分布.结论:6周单侧肢体电刺激训练和随意等长收缩训练不仅能够明显的提高训练侧的肢体力量,亦能提高对侧未受训练肢体的肌肉力量;训练导致的力量增长与使用表面肌电观察到的AEMG的变化有关;肌肉力量和肌电振幅之间表现出非线性的关系,可以利用肌电振幅与相对力量的关系(y=43.762(9.584)',在力量测试中评估受试者的用力程度,为临床康复训练提供理论依据和测试评价手段.     

单侧前臂等长旋转肌肉力量训练交叉迁移现象的研究

目的观察右前臂等长旋转训练能否产生前臂肌肉力量的交叉迁移。 方法将健康女青年志愿者20例按随机数字表法分成训练组和对照组,每组10例。训练组进行6周右前臂等长旋转训练,左前臂不训练,对照组不进行任何训练。2组受试者均于训练前和训练6周后（训练后）测试双侧前臂旋前峰力矩（PPT）和旋后峰力矩（SPT）。 结果训练前,2组受试者双侧的PPT和SPT组间比较,差异均无统计学意义（P&rt;0.05）;训练后,训练组右侧的PPT和SPT分别与组内训练前和对照组训练后比较,差异均有统计学意义（P<0.05),且训练组左侧的PPT和SPT分别为（6.8±0.9）Nm和（4.6±1.0）Nm,与组内训练前和对照组训练后比较,差异亦均有统计学意义（P<0.05)。 结论右前臂等长旋转训练能明显提高训练侧和未训练侧前臂肌肉旋转力量,产生良好的交叉迁移。     

腕关节等长屈曲和伸展肌力训练的交叉迁移现象及其机制研究

目的观察右腕等长屈曲和伸展训练能否产生交叉迁移现象并研究及其机制。 方法将健康女性青年志愿者20例按随机数字表法分为训练组和对照组,每组10例。训练组进行6周的右腕等长屈曲和伸展训练,左腕不进行训练,对照组不进行任何训练。2组受试者均于训练前和训练6周后（训练后）测定其腕屈、伸肌等长肌力（PT）及表面肌电变化。 结果训练后,训练组右腕关节最大等长屈曲和伸展PT与组内训练前和对照组训练后比较,均显著提高（P<0.05),且训练组左腕关节最大等长屈曲和伸展PT分别为（12.9±2.0）Nm和（6.4±1.3）Nm,与组内训练前和对照组训练后比较,差异均有统计学意义（P<0.05)。训练后,训练组右腕关节经最大等长伸展测试,其尺侧腕伸肌的AV与组内训练前和对照组训练后比较,差异均有统计学意义（P<0.05）;且训练组左腕关节经最大等长伸展测试,其尺侧腕伸肌的iEMG与组内训练前和对照组训练后比较,差异均有统计学意义（P<0.05）。 结论右腕等长屈曲和伸展训练后可改变前臂肌群募集策略,增强双侧前臂肌力,产生交叉迁移现象。     

基于交叉迁移理论的健侧肢体力量训练对偏瘫患者运动功能的影响

目的 观察健侧力量训练后脑卒中偏瘫患者是否能产生交叉迁移现象。 方法 选取脑卒中偏瘫患者30例,按随机数字表法分为实验组和对照组,每组患者15例。2组患者均接受常规康复治疗,实验组给予健侧肢体踝背屈等长抗阻训练。2组患者在训练前、训练6周后测定最大随意收缩力量(MVC)和表面肌电变化,采用简化Fugl-Meyer运动功能评定量表(FMA)下肢部分评定下肢运动功能。 结果 训练后,治疗组FMA评分为（26.53±2.64）分,与组内治疗前和对照组治疗后比较,差异均有统计学意义(P<0.05);训练后,治疗组胫骨前肌IEMG、腓肠肌IEMG与组内治疗前和对照组治疗后同侧比较,差异均有统计学意义(P<0.05)。治疗后,治疗组双侧胫骨前肌MVC和腓肠肌MVC与组内治疗前和对照组治疗后同侧比较,差异均有统计学意义(P<0.05)。 结论 健侧踝背屈等长抗阻力量训练可引起脑卒中偏瘫患者对侧胫骨前肌和拮抗肌的力量增长,存在力量训练的交叉迁移现象;健侧等长抗阻力量训练可改善下肢运动功能。     

单侧电刺激训练对双侧同源肌肉生长因子mRNA表达的影响

目的：观察单侧电刺激训练对双侧同源肌肉生长因子表达的影响,探讨电刺激促进肌肉生长修复和对侧交叉迁移现象的机制。方法：SD大鼠30只,随机分为5组,每组6只,分别为对照组和1、2、3、4周电刺激组,刺激部位为右侧腓肠肌,实时荧光定量PCR法分别检测双下肢腓肠肌和前肢肱二头肌的胰岛素样生长因子-1（IGF-1）不同变构体肝型胰岛素样生长因子（IGF-1Ea）和机械力生长因子（MGF）以及成肌分化因子（Myogenin,MyoG）mRNA表达。结果：训练侧各电刺激组MGF mRNA表达较对照组分别增长了3.97、4.05、4.13、4.25倍;IGF-1Ea mRNA表达较对照组分别增长了1.55、3.99、5.11、5.27倍;MyoG mRNA表达较对照组分别增长了2.14、2.48、2.99、3.02倍,与对照组相比差异有显著性（P＜0.01）,而MGF和MyoG mRNA表达在各训练组之间无显著性差异（P＞0.05）;IGF-1Ea mRNA表达在1、2、3周训练组间有显著差异（P＜0.01）,第4周与第3周间无显著性差异（P＞0.05）;对侧同源肌肉和前肢肱二头肌IGF-1Ea、MGF、MyoG mRNA表达与对照组相比无显著性变化。结论：电刺激训练促进肌肉生长与修复机制中肌肉生长因子高表达可能起着重要作用;而对侧肌肉生长因子无显著性增长,表明对侧交叉迁移现象的机制可能不是由于肌肉生长因子表达所致,提示内分泌机制不占主导地位。     

电刺激下肌肉收缩状态的研究

目的:使用可以准确反映肌肉收缩状态的肌音图来明确在不同电刺激频率下肌肉收缩对肌肉电生理的影响。方法:选取25名健康人群,在5%～20%最大随意收缩和4种电刺激(20,50,100和1000Hz)2种状态下进行肌音图的肌肉收缩状态的比较,分析平均功率值、总能量含有量和振幅的变化。结果:波形解析图显示≥100Hz的电刺激和随意收缩时的波形图有相关性;在振幅的变化分析中,随着电刺激频率的增加,振幅出现显著的减少。结论:对于以抑制挛缩为主要目的的电刺激训练时,可采用≥100Hz的电刺激频率来完成。     

膝关节骨性关节炎患者股四头肌动员能力和肌力储备改变的研究

目的:观察膝关节骨性关节炎(KOA)患者股四头肌肌力,肌肉动员能力及肌力储备并探讨其改变原因,为KOA功能评定和康复治疗提供新的途径和依据。方法:本次研究对象20例KOA患者为实验组和10例健康人为对照组,利用肌肉随意收缩电刺激叠加法测定股四头肌最大随意收缩力量、肌力储备和动员能力。结果:KOA组左、右腿股四头肌相对肌力分别为0.22和0.21,两腿没有显著差异(P>0.05);对照组左腿和右腿相对肌力分别为0.34和0.32,KOA患者相对肌力显著低于对照组(P<0.05)。KOA组左、右腿肌力储备分别为31.09%和29.90%;对照组左、右腿肌力储备分别为18.56%和20.75%,KOA组双侧股四头肌肌力储备显著高于对照组(P<0.01);KOA组左、右腿动员能力分别为68.95%和70.05%;对照组左、右腿的股四头肌动员能力分别为81.40%和79.20%,KOA组双侧肌肉动员能力显著低于对照组(P<0.05)。结论:KOA患者存在着股四头肌肌力低下、股四头肌动员能力不足的情况,其肌力下降主要是由于神经肌肉控制能力较差所致,肌肉随意收缩电刺激叠加法可以敏感地反映这一变化。康复治疗可以训练股四头肌神经肌肉控制能力,增加KOA患者股四头肌肌力和关节稳定性。     

慢性下腰痛患者腰部肌肉放电的均衡性

目的:观察慢性下腰痛患者腰部肌肉放电的均衡性.方法:实验于2007-05在沈5H体育学院重点实验室完成.以14名健康受试者和14名慢性下腰痛患者为观察对象,让其在静力性收缩的条件下观察腰部肌肉放电的情况.使用表面肌电技术测量受试者腰部3个节段(L1,L2,L5)两侧最长肌、铭腰肋肌、多裂肌的放电情况,令受试者躯干分别在40%最大随意收缩和80%最大随意收缩的情况做等长收缩30 s,观察受试者腰部脊柱两侧肌肉的疲劳时的失衡情况.结果:慢性下腰痛患者腰部肌肉的最大随意收缩仅仅足对照组最大随意收缩的55%,与对照组相比慢性下腰痛患者腰部肌肉疲劳程度较低,可能与他们并没有产生真正的最大随意收缩有关;慢性下腰痛患者腰部两侧肌肉失衡程度较大.结论:下腰痛患者出现疼痛时,其腰部两侧的肌肉活动重新分布;同时表血肌电可能成为一种无创伤地检测肌肉失衡的有效工具.     

肌肉力量神经调控与停止训练的关系

背景:当运动员遇到疾病、受伤、旅行等情况时往往会停止训练,这对机体骨骼肌的神经调控的可能产生影响.目的:全面了解停止训练对机体肌肉力量神经调控能力的影响及其机制.方法:检索Medline数据库1983/2006收录的停止训练与肌肉力量神经调控的相关综述和论文报告,并根据检索到的文献中所列出的相关参考文献进行追溯查找.结果与结论:共纳入停止训练与肌肉力量神经调控的相关文献48篇.发现一定持续时间的停止训练可引起最大随意收缩力下降,但可能受到骨骼肌本身、脊髓及脊髓以上中枢的影响;同时,由于运动训练模式、肌肉收缩形式、测试部位、停止训练的状况等不同,可能会使最大随意收缩力及相关神经学适应在停止训练期间被不同程度地保留下来.     

髋人字石膏制动下肢等长收缩训练预防肌肉废用性萎缩

目的：观察髋人字石膏制动下肢肌肉等长收缩训练预防制动下肢肌肉萎缩的作用。方法：将47例髋人字石膏制动患者分为治疗组(37例)和对照组(10例)。对照组采用常规护理；治疗组在伤口拆线后开始进行由轻至强的肌肉等长收缩训练。拆除石膏后，测量患者的双侧股部和小腿周径，所得数据进行统计学处理。结果：治疗组患者肢体肌肉废用性萎缩程度明显轻于对照组。结论：髋人字石膏制动下肢进行肌肉等长收缩训练可有效预防肌肉废用性萎缩。     

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.     

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.     

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.     

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.     

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.