偏瘫患者膝关节伸屈肌等速肌力测试研究

目的了解偏瘫病人恢复独立行走后患肢和健肢的肌力、屈伸肌力比,探讨膝关节不稳定的原因。方法采用Ｃｙｂｅｘ ＮＯＲＭ系统对１０例脑卒中偏瘫病人进行膝伸、屈肌等速肌力测试。结果３种角速度６０、１２０、１８０（°／ｓ）向心和６０°／ｓ离心伸屈肌峰力矩平均值健侧均高于患侧,伸肌１２０°、１８０°／ｓ和屈肌６０°、１８０°／ｓ健侧峰力矩显高于患侧（Ｐ值均＜０．０５）,离心伸肌６０°／ｓ时（Ｐ＜０．０５）;离     

偏瘫患者膝屈伸肌力等速测试的研究

目的　探讨对偏瘫患者是否需要进行下肢肌力训练。方法　运用Cybex 60 0 0型等速肌力测试系统对3 1例病程大于 6个月和能独立行走的偏瘫患者的两侧膝关节伸肌和屈肌进行肌力测试。结果　 (1)患膝屈、伸肌的峰力矩在不同的运动速度下 (60°/s ,12 0°/s ,180°/s)均较健侧明显下降 ;(2 )患膝屈、伸肌的峰力矩出现的时间与健侧相比有提前趋势 ;(3 )虽然患膝的屈肌和伸肌肌力同时下降 ,但屈肌的肌力较伸肌下降明显 ,患膝屈肌和伸肌的峰力矩比值较健侧有明显差异。结论　偏瘫患者的下肢肌力、肌耐力、爆发力明显下降 ,因此 ,应加强患侧下肢屈肌和伸肌的肌力训练 ,尤应加强屈肌的肌力训练     

膝关节外伤后的等速肌力测试研究

运用Ｃｙｂｅｘ－３３０型等速测力系统对４８例膝关节外伤患者的双侧膝伸肌和屈肌进行了肌力测试。结果表明两侧膝伸肌和屈肌的峰力矩值在不同运动速度（６００°／ｓ、１２０°／ｓ和１８０°／ｓ）时均有下降，两侧比较差异非常显著。不同性别间，健侧膝伸肌和屈肌峰力矩值间无显著性差异。认为等速测试配合膝关节镜检查对某些膝关节内损伤的诊断有一定的帮助。康复训练可以提高膝屈、伸肌力（尤其是膝屈肌和伸肌峰力矩比值），对保持膝关节稳定性有重要意义。     

等速肌力测试在膝关节损伤后康复训练中的应用

运用Ｃｙｂｅｘ３３０型等速运动仪对４５例膝关节外伤后患者进行双侧膝关节等速肌力测试，并依据慢速测试（６０°／ｓ）结果指导患者进行为期２个月的渐进抗阻练习。结果发现，患膝屈伸肌峰力矩值在训练后明显增加，屈肌与伸肌峰力矩比值接进正常。康复训练前后比较，患膝功能的差别有显著性（Ｐ＜００１），说明抗阻练习对膝关节功能恢复有明显的促进作用。     

正常青壮年膝屈伸肌等速肌力测试研究

应用Ｃｙｂｅｘ－３３０型等速肌力测试系统对３４名正常青壮年膝屈伸肌进行等速肌力测试评定。测试结果表明，正常膝屈伸肌的峰力矩值、单次做功量在不同运动速度（６０°／ｓ、１２０°／ｓ、１８０°／ｓ）时随测试速度的增加而降低，其测试结果为膝伸肌大于屈肌，慢速测试大于快速测试，优势膝大于非优势膝，男性高于女性；膝屈伸肌的平均功率随测试速度增高而增加。左右侧膝测试结果比较相差无显著性（Ｐ＞００５）。在相同测试速度时，不同性别之间相同侧膝同名肌峰力矩值比较有显著性差异（Ｐ＜００１）。认为正常青壮年左右膝屈伸肌等速肌力测试结果之间的正常相差为１５％左右，膝屈肌力矩值／膝伸肌力矩值的比值为５０％～７０％。     

肘部骨折患者屈伸肘肌群的等速肌力测定

用Ｃｙｂｅｘ－６０００型等速肌力测试系统对２０例肘部骨折患者的肘关节屈伸肌力进行评价。结果表明：患肘屈伸肌群的峰力矩６０°／ｓ、１２０°／ｓ和１８０°／ｓ时均较健侧显著降低，患肘的总作功量、平均功率和力矩加速能量亦显著下降。患侧屈伸肌群的峰力矩比值较健侧虽有增高，但未见明显差异，废用性肌肉萎缩和关节源性肌肉抑制是导致肌肉功能降低的主要原因。在肘关节损伤后的康复治疗中，应加强肘关节屈伸肌力的训练，以改善肘关节的功能。     

腰椎间盘突出症伴神经异常屈、伸膝的肌力变化

目的为制定腰椎间盘突出症患者的康复训练计划提供依据.方法腰椎间盘突出症患者16例,根据肌电图检查分为L4和L5/S1神经损伤组.用Cybex330型等速运动测试装置,测试60°/s、180°/s、300°/s3种速度屈、伸膝向心性等速运动峰力矩,选用t检验比较双侧屈、伸膝的峰力矩和屈/伸膝比值有无差异.结果患侧3种速度屈、伸膝的峰力矩均低于健侧,屈膝时相差17.1%～22.5%,伸膝相差11.8%～17.3%,差异均显著(P＜0.05～0.001);L4组患侧3种速度的屈/伸比值均大于健侧,而L5/S1组患侧3种速度的屈/伸比值均小于健侧.结论腰椎间盘突出症患者患侧屈、伸膝肌力均明显下降,当患者症状缓解,进行康复治疗训练腰背肌的同时,不要忽略屈、伸膝肌力的训练.     

膝关节损伤后期膝屈伸肌等速肌力测试随访研究

目的：研究膝关节损伤后期伴有膝功能障碍患者膝屈伸肌的功能状态，探索膝屈伸肌力量比值与保持关节稳定、退行性骨关节病变与关节损伤的关系。方法：采用Ｃｙｂｅｘ３３０型等速运动测试仪对２４例膝关节损伤患者的双侧膝屈伸肌进行等速肌力测试，并结合双膝关节Ｘ线摄片检查进行评定。结果：患膝、健膝屈伸肌峰力矩、单次最大做功量和平均功率在不同测试速度（６０°／ｓ、１２０°／ｓ和１８０°／ｓ）时均有不同程度下降，患膝下降更明显，双侧比较有显著性差异（Ｐ＜００１）；由于膝屈伸肌力量的同步下降，在慢、中速测试时屈膝肌力矩值与伸膝肌力矩值的比值保持在正常值范围；Ｘ线检查患膝或健膝均有不同程度的退行性骨关节病变发生。结论：膝关节损伤后期影响关节功能的因素是膝屈伸肌力量的下降、退行性骨关节炎等；认为对膝关节损伤病人的康复训练应同步增强膝屈伸肌力量，这对保持膝关节的稳定性，防治退行性骨关节病变的发生、发展有重要作用     

膝关节骨关节炎患者的肌肉功能与功能性行为能力

屈伸膝肌群的肌肉功能在膝关节骨关节炎（ｋｎｅｅｏｓｔｅｏａｒｔｈｒｉｔｉｓ，ＯＡ）的病程中起重要作用。本文的目的在于了解ＯＡ的肌肉功能以及它与功能性行为能力之间的关系。随机抽样的２１例ＯＡ与对照组相比，其等速肌力参数明显减低。另外，ＯＡ在６０°／ｓ等速运动的伸膝肌力与功能性状态参数呈负线性相关，１８０°／ｓ等速运动的伸膝肌爆发力与２０ｍ行走时间呈明显负线性相关。     

膝关节骨关节炎患者等长、等速向心和等速离心测试的比较观察

目的 评价膝关节骨关节炎（OA）患者患侧及健侧膝伸肌和屈肌在等长、等速向心和等速离心收缩时的功能特性及相互间的关系。方法 应用Biodex System 3型等速测试系统对54例单侧膝OA患者进行患侧和健侧膝伸肌和屈肌的等长、等速向心及等速离心肌力测试。结果 膝OA患者患侧膝关节伸肌和屈肌在不同收缩模式下的肌力均较健侧显著下降（P＜0．05），特别是在低速向心和低速离心收缩状态时的降低幅度尤为显著；同时患者的膝关节屈／伸肌肌力（H／Q）比值和动态控制率均提示其患侧肢体存在肌力平衡异常。结论 在对膝OA患者肌肉功能进行评定时，应选用等速肌力测试并同时分析其H／Q比值及动态控制率，只有这样才能对患者的肌肉状况作出全面而客观的评定。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.