踝背伸和跖屈肌群的最大等长收缩:脑卒中急性期患者与同龄健康老人表面肌电图对照研究

目的　比较健康老人与脑卒中急性期患者的踝背伸和踝跖屈肌群的收缩功能 ,为脑卒中急性期康复提供客观依据。方法　 2组对象参加研究 ,对照组为 11位健康老人 ,年龄 62 .3± 5 .7岁 ;脑卒中组为12位初发患者 ,年龄 66.6± 8.3岁。测试时下肢固定在支架上 ,压力传感器放在足底 ,肌电图的表面电极放在胫骨前肌和腓肠肌的体表上 ,记录踝背伸或踝跖屈时最大等长收缩、胫骨前肌和腓肠肌的肌电活动 ,并计算力矩和积分肌电图的变化。结果　健康老人左、右侧踝背伸和踝跖屈肌群收缩各参数之间的差异无显著性 ,脑卒中组患侧与健侧比较差异有显著性 (P <0 .0 5 ) ;协方差分析 (年龄作为协变量 )发现 ,脑卒中组的患侧与对照组比较 ,踝背伸和踝跖屈力矩、积分肌电图以及协同收缩率的差异有高度显著性 (P <0 .0 1) ,脑卒中组健侧与对照组的踝背伸协同收缩率差异有显著性 (P <0 .0 5 )。结论　脑卒中急性期患者踝背伸和踝跖屈肌群收缩功能明显降低 ,增强这些肌群的收缩功能 ,特别是增强主动肌的收缩 ,抑制拮抗肌的协同收缩应作为脑卒中急性期康复的目标     

TENS对脑卒中患者踝跖屈内翻的影响

目的评价经皮神经电刺激（TENS）治疗脑卒中患者踝跖屈内翻的临床疗效，并探讨其作用机制。方法32例恢复期脑卒中患者，存在不同程度的踝跖屈内翻，随机分为TENS组和对照组各16例，在神经发育疗法、手法治疗以及配戴足托治疗的基础上，TENS组加用患侧胫前肌和腓骨长短肌的TENS治疗。于治疗前后用综合痉挛量表（CSS）、肌电图H反射评定腓肠肌的痉挛程度。结果治疗后，TENS组和对照组CSS评分都有明显降低，和治疗前相比均有统计学意义，TENS组CSS降低较对照组明显，但两组间差异无统计学意义；TENS组H反射波潜伏期延长、H／M降低，和治疗前相比差异有统计学意义，对照组无明显变化；目测TENS组患者的痉挛偏瘫步态得到明显改善。结论TENS能减轻脑卒中患者腓肠肌痉挛，有助于踝跖屈内翻和痉挛偏瘫步态的改善。     

重复性外周磁刺激联合运动疗法对脑卒中患者踝跖屈肌痉挛的影响

目的 观察重复性外周磁刺激联合运动疗法对脑卒中患者踝跖屈肌痉挛的影响。 方法 选取脑卒中患者60例,按随机数字表法分为治疗组和对照组,每组30例,2组患者均行常规运动疗法,治疗组在此基础上辅以重复性外周磁刺激疗法。分别于治疗前及治疗4周后（治疗后）,采用表面肌电图记录踝关节背伸最大等长收缩时胫前肌及腓肠肌的积分肌电值（IEMG）,计算协同收缩率（CO）;采用Fugl-Meyer下肢运动功能评分(FMA-LE)、Holden功能性步行分级（FAC）和综合痉挛量表（CSS）分别评定2组患者的下肢运动功能、步行功能以及踝跖屈肌张力。 结果 治疗后,2组患者踝背伸最大等长收缩时的胫前肌积分肌电值（IEMG）［治疗组(52.25±6.97)μV·s、对照组(47.01±9.02)μV·s］、FMA-LE评分［治疗组(20.13±6.20)分、对照组(16.07±5.10)分］及FAC分级［治疗组(2.53±0.90)分、对照组(2.03±0.81)分］均较组内治疗前明显提高（P<0.05）;2组患者的综合痉挛评分（CSS）［治疗组(8.90±1.81)分、对照组(9.83±1.49)分］及踝背伸协同收缩率（CO）［治疗组(33.50±4.95)％、对照组(39.93±4.58)％］均较组内治疗前明显降低（P<0.05）;组间比较,治疗组治疗后的上述指标改善较对照组更为明显,组间差异均有统计学意义(P<0.05)。 结论 重复性外周磁刺激联合运动疗法可以更有效的减轻脑卒中患者踝跖屈肌痉挛,同时提高下肢的运动功能和步行能力。     

指压穴位刺激对早期脑卒中偏瘫患者踝背屈功能的影响

目的:观察指压穴位刺激对早期脑卒中偏瘫患者踝背屈功能的影响。方法:45例偏瘫患者,随机分为指压穴位组、电针组和神经肌肉电刺激组各15例。3组在常规药物和物理治疗的基础上,指压穴位组增加前期系列研究制定的指压穴位刺激法提高偏瘫侧胫前肌、腓骨长短肌兴奋性的综合方案干预;电针组电针偏瘫侧足三里穴、足临泣穴;神经肌肉电刺激组电刺激偏瘫侧胫前肌、腓骨长短肌。3组踝关节干预时间均为每次10min,每天1次,每周5天,疗程8周。分别于治疗前、治疗4w后、治疗8w后,评估以下指标:患侧踝背屈协同收缩率(co-contraction ratio,CCR)、患侧踝背屈主动活动范围(active range of motion,AROM)、患侧简式Fugl-Meyer运动功能评分(踝关节运动控制部分)。结果:①3组治疗前后比较:3组的各项指标治疗前、治疗4w后、治疗8w后两两比较均有显著性差异(P0.05),患侧踝背屈CCR逐步降低、患侧踝背屈AROM和简式Fugl-Meyer运动功能评分逐步增高;②3组间比较:患侧踝背屈CCR、AROM:3组间治疗前两两比较均无显著性差异(P0.05);指压穴位组的治疗4w后、治疗8w后的患侧踝背屈CCR分别低于电针组、神经肌肉电刺激组,具有显著性差异(P0.05),而AROM分别高于电针组、神经肌肉电刺激组,具有显著性差异(P0.05);电针组较神经肌肉电刺激组的治疗4w后、治疗8w后均无显著性差异(P0.05);简式Fugl-Meyer运动功能评分:3组间治疗前、治疗4w后、治疗8w后两两比较均无显著性差异(P0.05)。结论:指压穴位刺激法可有效改善早期脑卒中偏瘫患者踝背屈功能。     

TENS配合PNF治疗脑卒中后踝跖屈内翻

目的：观察经皮神经电刺激（TENS）配合神经肌肉本体促进技术（PNF）对脑卒中后踝跖屈内翻患者的临床疗效,并探讨其作用机制。方法：48例恢复期脑卒中患者,均存在不同程度的踝跖屈内翻,随机分为A、B2组各24例,均接受神经内科常规治疗和康复训练,包括良肢位、关节被动运动及Bobath疗法等。A组同时增加TENS及PNF。治疗前后分别采用Barthel指数（BI）评定ADL、Fugl-Meyer运动功能评价法（FMA）及Berg评定下肢功能和平衡功能,踝关节综合痉挛量表（CSS）评定腓肠肌痉挛程度。结果：治疗4周后,2组患者FMA、BI及Berg评分均较治疗前明显提高,CSS评分明显下降（P〈0.01、0.05）;2组间比较A组表现更明显（P〈0.05）。结论：TENS配合PNF治疗脑卒中后踝跖屈内翻更能有效改善脑卒中患者腓肠肌痉挛,促进正常步态的恢复。     

肌电生物反馈联合运动疗法对脑卒中跖屈肌痉挛的疗效观察

目的：观察肌电生物反馈联合运动疗法对脑卒中后跖屈肌痉挛的疗效。方法：将112例脑卒中患者跖屈肌痉挛患者分为观察组60例和对照组52例,2组均给予常规性康复训练,观察组在此基础上给予肌电生物反馈治疗。2组均给予临床痉挛指数（CSI）评定,并测量踝关节主动背伸角度。结果：训练10周后,2组CSI评分均较治疗前明显降低（P＜0．05）,且观察组更低于对照组（P＜0．05）;2组踝关节主动背伸角度均较训练前明显提高（P＜0．05）,且观察组更高于对照组（P＜0．05）。结论：肌电生物反馈联合运动疗法能明显改善脑卒中后跖屈肌的痉挛。     

不同踝背屈诱发方法对脑卒中患者患侧踝背屈功能的影响

目的比较不同踝背屈诱发方法对脑卒中患者踝背屈功能恢复的影响。方法 2016年9月至2018年9月,脑卒中后踝主动背屈障碍患者60例随机分为A组、B组和C组,各20例,分别采用常规治疗、叩击区法和丘墟点穴法治疗6周,治疗前后采用三维步态分析和表面肌电图进行检测。结果治疗后,三组患侧踝关节屈伸活动度、峰力矩和胫前肌表面肌电积分均升高(t 2.318, P 0.05),B组和C组优于A组(P 0.05),C组优于B组(P 0.05)。结论丘墟点穴法和叩击区法均能促进脑卒中患者踝背屈功能恢复,丘墟点穴法效果更好。     

综合康复干预对脑卒中偏瘫患者肢体功能恢复的影响

目的 观察综合康复干预（包括常规康复训练、肌电生物反馈训练及穴位按摩等）对脑卒中偏瘫患者肢体功能恢复的影响。 方法 采用随机数字表法将60例脑卒中后偏瘫患者分为观察组及对照组,每组30例。对照组患者给予常规康复训练,观察组患者在此基础上辅以肌电生物反馈训练及患肢肌肉、穴位按摩治疗。于治疗前、治疗10周后分别采用Fugl-Meyer运动功能量表（FMA）、改良Ashworth痉挛量表(MAS)及改良Barthel指数评分（MBI）对2组患者进行疗效评定。 结果 治疗前2组患者屈腕肌、踝跖屈肌MAS评分、上肢及下肢FMA评分、MBI评分组间差异均无统计学意义（P>0.05）;经10周治疗后发现2组患者上述疗效指标均较治疗前明显改善（P<0.05）,并且观察组屈腕肌、踝跖屈肌MAS评分［分别为（1.5±0.5）分、（1.8±0.4）分］、上肢及下肢FMA评分［分别为（51.3±2.1）分、（26.4±4.1）分］、MBI评分［（62.7±20.9）分］均显著优于对照组水平,组间差异均具有统计学意义（P<0.05）。 结论 在常规康复干预基础上辅以肌电生物反馈训练及患肢肌肉、穴位按摩治疗,能进一步促进脑卒中偏瘫患者肢体功能恢复,提高患者生活质量。     

指压太冲、丘墟穴诱发训练对脑卒中患者踝背屈功能的影响

目的:观察指压太冲、丘墟穴诱发训练对脑卒中患者踝背屈功能的影响。方法:将32例脑卒中患者随机分为治疗组和对照组,两组均进行常规康复治疗,治疗组另加用指压太冲、丘墟穴诱发踝背屈的方法治疗,并于治疗前后分别采用常规临床评价方法和表面肌电仪进行评估。结果:治疗后两组踝关节活动度、患肢胫前肌表面肌电图均方根值(RMS)、Fugl-Meyer评分较治疗前均有所改善(P0.05),且治疗组优于对照组(P0.05)。结论:指压太冲、丘墟穴对改善脑卒中患者踝背屈功能较单独使用常规康复治疗效果好。     

不同节律踝泵运动在下肢中心静脉导管置管患儿中的应用效果

目的:旨在筛选和优化下肢中心静脉导管(central venous catheter,CVC)置管患儿踝泵运动的操作规范。方法:共纳入2018年1月至2019年12月在无锡市儿童医院行下肢CVC的患儿92例,随机分为4组(每组23例),并采用不同节律的踝泵运动:A组跖屈2 s、背伸2 s,B组跖屈3 s、背伸3 s,C组跖屈4 s、背伸4 s,D组跖屈5 s、背伸5 s。比较不同节律的踝泵运动对患儿CVC相关并发症[包括深静脉血栓(deep vein thrombosis,DVT)]的发生率、股静脉血管直径、血流峰速度和肢体肿胀发生率的影响。结果:4种不同节律的踝泵运动对患儿CVC相关性并发症无明显影响(P0.05)。4种不同节律的踝泵运动对患儿股静脉的血管直径和血流峰速度有不同程度的影响,其中跖屈5 s、背伸5 s节律的踝泵运动能够明显扩张患儿股静脉血管直径,增加股静脉血流峰速度(P0.05)。而且跖屈5 s、背伸5 s节律的踝泵运动能够明显减少患儿的肢体肿胀发生率(P0.05)。结论:跖屈5 s、背伸5 s是适合CVC患儿踝泵运动的最佳节律,能够有效扩张静脉,增加血流速度,降低肢体肿胀发生率。     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.