氨基末端脑钠肽前体对儿童重症手足口病心力衰竭评估价值

目的心肺功能衰竭是重症手足口病患儿的主要死亡原因。通过快速检测心力衰竭指标——血清氨基末端脑钠肽前体(NT-proBNP)水平,探讨其在评估急症手足口病患儿并发心力衰竭的临床价值。方法选择在湖南省儿童医院就诊和住院的392例手足口病患儿,根据卫生部"肠道病毒71型(EV71)感染重症病例临床救治专家共识(2011年版)",按病情进展分为5组:第一期(手足口病出疹期)组、第二期(神经系统受累期)组、第三期(心肺功能衰竭前期)组、第四期(心肺功能衰竭期)组、第五期(恢复期)组。5组患儿入院后立即检测肌酸激酶同工酶(CKMB)、血清NT-proBNP和心肌肌钙蛋白I(cTnI)水平,并进行床旁超声心动图检查。结果采用spearman相关分析血清心功能指标与超声心动图指标左室射血分数(LVEF)相关性,cTnI、CKMB与LVEF无相关(P0.05)。NT-proBNP浓度与LVEF呈负相关(r=-1,P0.05),NT-proBNP水平随着手足口病患儿病情加重,呈增高趋势。手足口病第三期组NT-proBNP中位数为921 pg/mL,而第二期组仅为55 pg/mL。通过ROC曲线分析,NT-proBNP水平对重症手足口病患儿心力衰竭前期的检测阈值是400 pg/mL(灵敏度94%、特异度83%),对重症手足口病患儿心肺衰竭期的检测阈值是1 500 pg/mL(灵敏度92%、特异度94%)。12例死亡患儿血清NT-proBNP水平均大于5 000 pg/mL,显著高于同期存活患儿水平。结论急诊快速检测NT-proBNP水平可反映手足口病患儿的严重程度,有效的甄别第二期和第三期。NT-proBNP是预警重症手足口病患儿心力衰竭的一项非常有用的生化指标。     

手足口病患儿血清25-羟维生素D水平的临床意义及预后影响

目的探讨手足口病患儿血清25-羟维生素D[25(OH)D]水平的临床意义及预后影响。方法对2016年6月至2018年6月在本院收治的手足口病儿童进行了一项前瞻性观察研究。69名住院的手足口病患者分为不严重组(n=25)、重度组(n=26)和危重组(n=18)。选择同期门诊体检的30名健康儿童作为对照组。在所有受试者中测量血清25(OH)D浓度,同时对重症手足口病患儿进行儿科危重病评分(PCIS),并分析血乳酸、无血清钙离子(Ca2+)、D-二聚体、乳酸脱氢酶和肌酸激酶-MB水平。结果危重手足口病组的血清25(OH)D浓度显著低于其他3个组(P0.05),并且血清25(OH)D缺乏症的发生率显著高于其他3个组(P0.05)。在重症手足口病患儿中,与25(OH)D正常和不足组相比,25(OH)D缺乏组具有显著更高的血乳酸、乳酸脱氢酶、肌酸激酶-MB和D-二聚体水平(P0.05);脑干脑炎、神经元肺水肿和循环衰竭的发病率较高(P0.05);死亡率较高(P0.05)。此外,25(OH)D缺乏组的PCIS显著低于其他两组(P0.05)。44名重症手足口病患儿中有9人死亡,死亡率为20.5%。Logistic回归分析结果表明,25(OH)D(OR=2.04,95%CI:1.02-4.10,P=0.044)、D-二聚体(OR=0.30,95%CI:0.10-0.94,P=0.047)和PCIS(OR=1.51,95%CI:1.06-2.14,P=0.033)是影响重度和危重手足口病患儿14天死亡率的独立因素。结论患有危重手足口病的儿童血清25(OH)D浓度显著降低,并且与手足口病的严重程度和预后相关。     

小儿危重病例评分与儿童死亡风险评分对重症手足口病病情评估和病情进展预测的作用

【目的】比较分析小儿危重病例评分（Pediatric Clinical Illness Score ,PCIS）和儿童死亡风险评分（Pediatric Risk of Mortality Score ,PRISM ）对重症手足口病患儿病情进展的预测价值。【方法】选取于2010年1月至2013年6月入住本院重症监护室（ICU ）的符合重症手足口诊断标准的424名患儿。收集小儿PCIS和PRISM评分系统的相关生理参数及结局资料,通过受试者工作特征曲线（ROC）下的面积（AUC）来评估评分系统对并发症和结局的分辨力。【结果】死亡组患儿总住院天数和住IC U天数明显少于存活组患儿,且两者相比较差异有显著性（ P ＜0．05）。死亡组患儿肺水肿和肺出血的发生率明显高于存活组,且两者相比较差异有显著性（ P ＜0．05）。采用PCIS和PRISM评分来评价重症手足口病患儿病情发现,死亡组PCIS评分要明显低于存活组（Z＝－6．48,P ＝0．000）,死亡组PRISM 评分明显高于存活组（Z＝－7．39,P ＝0．000）,而且两评分系统存在相关性。PCIS和PRISM两评分系统分辨是否发生肺水肿、肺出血和死亡的AUC分别是0．74和0．78、0．82和0．87、0．83和0．87。【结论】PCIS、PRISM 均能够反映重症手足口病的危重程度,且相关程度高。两评分系统对重症手足口病发生严重并发症或者死亡的分辨力均到达可接受水平,且PRISM评分系统更优。     

原发性醛固酮增多症患者血清NT-proBNP改变及临床意义研究

目的探讨原发性醛固酮增多症(PA)患者血清脑利钠肽前体N末端(NT-proBNP)改变及临床意义。方法纳入2012年1月至2015年12月疑似PA的高血压患者140例,分为PA组(n=30)和原发性高血压(EH)组(n=110)。检测两组患者血清NT-proBNP和肾素水平,并通过受试者工作特征曲线(ROC曲线)分析以及相关性分析比较血清NT-proBNP水平与PA的相关性。结果 PA组患者血清NT-proBNP水平[(93.9±7.3)pg/mL]明显高于EH组患者[(69.5±10.4)pg/mL],差异有统计学意义(P0.05)。单侧亚组PA患者肾素[(6.8±1.3)pg/mL vs.(5.1±0.6)pg/mL]、血浆醛固酮/血浆肾素比值(ARR)[(65.5±16.4)vs.(57.1±14.4)]和NT-proBNP[(101.9±14.1)pg/mL vs.(90.4±8.1)pg/mL]水平明显高于双侧亚组,差异均有统计学意义(P0.05)。NT-proBNP预测PA的AUC为0.809,95%CI:0.734~0.865,cut-off为98.4pg/mL,敏感度为83.4%,特异度为78.6%。预测单侧PA的AUC为0.733,95%CI:0.648~0.804,cut-off为109.6pg/mL,敏感度为79.9%,特异度为81.5%。血清NT-proBNP水平与ARR(r=0.765,P0.05)、PA(r=0.728,P0.05)和单侧PA(r=0.778,P0.05)呈正相关。结论 PA患者相比EH患者血清NT-proBNP水平轻度升高,有助于PA患者的早期诊断和筛查。     

血清PCT、NT-proBNP、WBC检测对重症慢性阻塞性肺疾病患者疾病转归的预测价值

目的 分析血清降钙素原(PCT)、氨基末端B型脑钠肽前体(NT-proBNP)、白细胞计数(WBC)对重症慢性阻塞性肺疾病(简称慢阻肺)患者疾病转归的预测价值。方法 回顾性分析2020年12月至2022年12月濮阳市人民医院收治的63例重症慢阻肺患者的临床资料，根据患者的28 d疾病转归情况划分为存活组(n=52)与死亡组(n=11)。两组均接受血清PCT、NT-proBNP、WBC检测并进行对比，采用Logistic多因素分析重症慢阻肺患者死亡的危险因素，并绘制受试者工作特征(ROC)曲线，分析血清PCT、NT-proBNP、WBC检测对重症慢阻肺患者疾病转归的预测价值。结果 死亡组的血清PCT、NT-proBNP、WBC水平均明显高于存活组(P<0.05);经Logistic多因素分析显示，血清PCT、NT-proBNP、WBC水平升高是重症慢阻肺患者死亡的独立危险因素(P<0.05);经ROC曲线显示，血清PCT+NT-proBNP+WBC联合检测预测重症慢阻肺患者死亡的敏感度(88.33%)、特异度(90.25%)均高于单一PCT(80.91%、82.33%)、单一...     

N末端B型利钠肽原对重症监护病房感染性休克患者预后的预测作用

[目的]探讨N末端B型利钠肽原(NT-proBNP)对重症监护病房感染性休克患者预后的预测作用.[方法]前瞻性记录、观测本院重症监护病房40例感染性休克患者的临床特征,比较不同患者血中NT-proBNP 水平.[结果]40例患者中有18人死亡,死亡组住院24 h时NT-proBNP水平为(240.5±36.7)pg/mL,住院48 h时NT-proBNP水平为(398.6±40.0)pg/mL,与存活组(22例)住院24 h时NT-proBNP水平(149±26.4)pg/mL、住院48 h时NT-proBNP水平(150.1±37.0)pg/mL相比差异均有显著性(P＜0.05).[结论]NT-proBNP能预测重症监护病房感染性休克患者的预后情况.     

内皮素-1在重症手足口病患儿血清中的表达及意义

目的探讨内皮素-1(ET-1)在手足口病重症患儿血清中的表达及意义。方法将80例手足口病患儿按病情严重程度分为2组:重症组和普通组各40例,收集2组患儿临床转归情况、实验室检查指标[白细胞(WBC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酸酶同工酶(CKMB)、肌钙蛋白I(CnTI)、C反应蛋白(CRP)、葡萄糖(GLU)、ET-1]。比较2组急性期实验室指标、绘制并分析血清ET-1诊断重症手足口病的ROC曲线,比较2组病情转归情况及2组急性期和恢复期血清ET-1水平。结果2组急性期WBC、ALT、AST、CKMB、CnTI、CRP、GLU等实验室指标无明显变化,差异无统计学意义(P>0.05);重症组急性期血清ET-1水平明显高于普通组,差异有统计学意义(P<0.001)。血清ET-1的ROC曲线下面积(AUC)为0.918,显示血清ET-1对重症手足口病有诊断价值(P=0.001);当血清ET-1在11.05 pg·mL^-1时其Youden值最大为0.675,血清ET-1水平对重症手足口病预测的灵敏度为83%,特异度为85%。2组治疗好转率(85%比100%)比较,差异有统计学意义(P<0.05)。重症组恢复期血清ET-1水平较急性期明显下降,差异有统计学意义(P<0.001);普通组恢复期血清ET-1水平与急性期比较,差异无统计学意义(P>0.05);重症组恢复期血清ET-1水平与普通组比较,差异无统计学意义(P>0.05)。结论手足口病患儿血清ET-1的检测对重症手足口病具有较高的预测价值。     

脓毒症患儿血RDW水平与PCIS评分及血乳酸的相关性研究

目的探讨脓毒症患儿红细胞分布宽度(red blood cell distribution width,RDW)、小儿危重症评分(pediatric critical illness score,PCIS)和血乳酸的变化及与预后的关系。方法收集某医院重症监护室(intensive care unit,ICU)脓毒症患儿204例,入院后进行小儿危重症评分,并检测24 h内血RDW和乳酸水平。根据临床转归及病情严重程度分组,比较各组血RDW、乳酸的水平及PCIS评分,对血RDW和乳酸及PCIS评分进行相关性研究。结果存活组PCIS评分、RDW(%)、LAC(mmol/L)分别为76.84±3.79,14.12%±0.10%和1.24±1.01 mmol/L,死亡组为71.13±5.55,16.21%±0.32%和4.38±4.27 mmol/L,死亡组较存活组PCIS评分降低,RDW及乳酸水平升高,差异均有统计学意义(t=-8.29,8.06,8.33,均P0.05)。三项指标与PCIS 71～80组(14.44%±1.69%,1.70±2.37 mmol/L和18.3%)相比,PCIS≤70组(15.73%±2.25%,3.76±3.61 mmol/L和62.9%)RDW及乳酸水平均升高,死亡率增加,差异均有统计学意义(t=3.87,4.22,χ~2=13.08,均P0.05)。三项指标与非严重脓毒症组(77.09±3.65,14.26%±1.57%,1.18±1.42 mmol/L和8.18%)相比,严重脓毒症组(73.34±5.56,15.13%±2.06%,3.08±2.99 mmol/L和46.8%)PCIS评分降低,RDW、乳酸水平及死亡率均升高,差异均有统计学意义(t=5.77,3.4,5.28,χ~2=21.63,均P0.05)。与RDW≤14.0组(76.54±4.47,1.57±2.12 mmol/L和12%)相比,RDW14.0组(74.53±5.17,2.40±3.04 mmol/L和36%)PCIS评分降低,乳酸水平和死亡率升高,差异均有统计学意义(t=-2.89,2.18,χ~2=8.09,均P0.05);RDW水平与PCIS评分呈正态分布,两者呈负相关(r=-0.305 7,P0.05),RDW水平与乳酸水平呈正相关(r=0.195 4,P0.05)。结论严重脓毒症患儿及死亡患儿入院24 h内RDW水平明显升高,RDW水平与PCIS评分及乳酸水平具有相关性,RDW水平与脓毒症患儿疾病严重程度和死亡率相关,RDW适用于评价脓毒症患儿危重程度和预后。     

GDF-15和NT-proBNP联合检测对老年急性心力衰竭患者预后预测价值的研究

目的探讨转化生长因子-15(GDF-15)和N末端B型利钠肽原(NT-proBNP)联合检测在老年急性心力衰竭患者预后预测中的应价值。方法分析2014年2月至2017年2月在该院接诊的165例AHF患者,根据随访结果分为生存组(120例)和死亡组(45例),对患者血清GDF-15和NT-proBNP进行检测。分析两组患者临床资料的差异以及血清GDF-15和NT-proBNP水平对急性心力衰竭患者预后的预测价值。结果生存组与死亡组患者的心功能分级、心率(HR)、左心射血分数(LVEF)、左心室舒张末期内径(LVDD)等资料间差异无统计学意义(P0.05);生存组GDF-15和NT-proBNP表达水平显著低于死亡组(t=-2.985、-3.912,P=0.004、0.000);ROC曲线显示,应用血清GDF-15和NT-proBNP表达水平预测急性心力衰竭患者预后具有较高的预测效能,其曲线下面积(AUC)分别为0.855和0.847,差异间无统计学意义(P0.05);血清GDF-15和NT-proBNP联合检测预测急性心力衰竭患者预后的AUC为0.932,明显高于血清GDF-15单独预测(Z=2.958,P=0.003)和血清NT-proBNP单独预测(Z=3.324,P=0.000);约登指数提示血清GDF-15和NT-proBNP预测老年急性心力衰竭患者预后的最佳截点分别为209.54pg/mL和1 962.63pg/mL;血清GDF-15和NT-proBNP联合检测急性心力衰竭预后的准确率、灵敏度、特异度、阳性预测值和阴性预测值分别为88.48%、82.22%、90.83%、77.08%和93.16%,灵敏度显著高于各项指标单独诊断(P0.05)。结论联合检测血清GDF-15和NT-proBNP对急性心肌梗死患者预后预测具有较高的灵敏度,值得临床推广。     

B型钠尿肽预测社区获得性肺炎严重程度的意义

目的 通过对社区获得性肺炎(community-acquired pneumonia,CAP)患者BNP(B型钠尿肽)与肺炎严重程度之间相关性的研究,评估BNP预测CAP严重程度的意义.方法 2011年12月至2012年12月就诊我科并确诊CAP患者202例,测定BNP、C-反应蛋白(CRP)、白细胞计数(WBC),以及肺炎严重度评分(PSI)所需相关指标,计算PSI评分并分级.分析不同肺炎严重程度分级之间BNP水平、C-反应蛋白、白细胞计数的差异,以及BNP与PSI的相关性.进一步根据PSI水平分为高风险组(PSI分级Ⅳ、Ⅴ级)和低风险组(PSI分级Ⅰ～Ⅲ级);根据患者预后分为存活组和死亡组.比较两组间BNP差异、BNP水平与肺炎严重程度的受试者工作特征(ROC)曲线.结果 BNP水平随着CAP严重程度增加而升高(r =0.782,P＜0.001);高风险组患者BNP水平显著高于低风险阻[(263.2±119.6)pg/mLvs.(71.5±54.3) pg/mL,P＜0.001].相比存活组,死亡组BNP水平更高[(343.86±125.49)vs.(183.00±121.71) pg/mL,P＜0.001].BNP与PSI评分、CRP以及WBC呈正相关(r=0.782,P＜0.001,r=0.560,P＜0.001和r=0.513,P＜0.001).BNP对于CAP严重程度的预测有较高的准确性(AUC =0.952),区分高、低风险的BNP最佳截点为125.0 pg/mL,敏感性0.891,特异性0.946.BNP能预测死亡(AUC =0.823),其预测死亡最佳截点为299.0 pg/mL,敏感性0.675,特异性0.816,阴性预测值0.926,阳性预测值0.426.结论 BNP与CAP严重程度呈正相关关系,BNP大于125.0 pg/mL的CAP患者建议住院治疗,BNP大于299.0 pg/mL的CAP患者具有死亡高风险.BNP预测CAP严重程度具有一定实用性.     

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.     

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.     

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.     

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.