人-机接口技术在残疾人功能辅助方面的开发与应用

目的：解决人和计算机的接口问题，为辅助上肢残疾者操纵计算机提供适宜技术。方法：比较分析国内外利用脑电和肌电生理电信号检测技术，在进行残疾人功能辅助研究的基础上，利用计算机虚拟现实和电磁跟踪技术相结合实现人-机接口。结果：提出了一种新的应用于上肢残缺者操纵计算机的人-机接口技术。结论：该技术在计算机辅助残疾人功能重建方面有广阔的应用前景。     

人体上肢表面肌电反馈康复训练系统的研制

目的：研究临床康复训练中急需解决的肌肉疲劳的保护问题。方法：开发了一种采用功能电刺激方式和表面肌电反馈控制的康复训练系统。该系统由功能电刺激器、被动训练发生器、表面肌电信号放大器及管理控制软件4部分组成。管理控制软件控制表面肌电信号放大器、功能电刺激器和被动训练发生器3部分的协调运作。结果：该系统可以实时分析康复训练过程中采集到的表面肌电信号，并以此判定肌肉是否疲劳，亦可设定功能电刺激系统的刺激参数，通过控制电路控制训练发生器运动参数等功能。结论：该系统可以有效地防止主动训练过程中因肌肉过度疲劳而造成的损伤。     

基于闭环脑机接口的脑卒中患者的手功能康复研究

目的:探讨基于运动想象(MI)的闭环式脑机接口(BCI)在脑卒中后手功能康复中的大脑运动皮质激活状态评估与治疗效果。方法:将6例有上肢手功能障碍的脑卒中患者随机分为MI-BCI组(3例)和MI组(3例),均接受常规的康复治疗,MIBCI组进行为期1个月,每周3次的闭环BCI的康复训练,MI组为同等量的运动想象训练。在治疗前和1个月的治疗结束后,分别对两组患者进行BCI脑电评估,针对上肢手进行改良Ashworth评分(MAS)、上肢Fugl-Meyer评估(FMA)和运动功能状态量表(MSS)评分,MI-BCI组在治疗结束后1周再进行一次脑电评估。结果:经过1个月的康复训练,两组患者在FMA、MSS评分上较治疗前均有所提高,MI-BCI组较MI组在脑区激活上更为明显。结论:基于运动想象的闭环式脑机接口康复训练可促进脑卒中患者大脑的脑区激活,从而有利于其皮质重塑,促进上肢及手功能康复疗效的提高。     

基于脑机接口电刺激在脑卒中患者上肢康复中的应用研究

目的 探讨基于脑机接口（BCI)电刺激在脑卒中患者上肢康复训练中的可行性及作用机制。 方法 选取5例脑卒中患者并采用基于BCI电刺激技术对其上肢功能进行康复训练（共训练1次）,观察入选患者康复训练前、后在执行运动想象(MI)任务时的在线准确率（CA）以及事件相关去同步电位（ERD）。 结果 5例入选患者康复训练前执行运动想象任务时的平均在线准确率为50.70%,康复训练后其在线准确率提升至58.94%;康复训练前2例患者两侧中央运动区均表现ERD特征,康复训练后该2例患者两侧中央运动区ERD特征较治疗前明显增强,并且患侧中央运动区ERD特征亦明显强于健侧中央运动区,1例脑卒中患者在训练前无明显ERD特征,经康复训练后患侧中央运动区表现出ERD特征,另外2例患者在康复训练前、后其双侧中央运动区均无明显ERD特征。 结论 基于BCI电刺激技术对促进脑卒中患者上肢功能恢复具有显著疗效,其治疗机制可能与促进患侧运动相关脑区激活有关。     

基于上肢康复机器人的人机交互软件系统设计与实现

为解决现有上肢康复机器人其人机交互系统重治疗、轻评估的弊端，本课题以中央驱动上肢康复机器人为研究对象，设计一种基于Qt、数据库（MYSQL）和虚拟现实技术，并集成用户信息管理、康复评定、康复训练、生成康复报告等功能模块为一体的医-机-人三者交互系统。通过功能测试验证了结合训练与评估系统的上肢康复机器人系统，发现其不仅能提高康复治疗师工作效率，同时也为患者提供了一种高效、富有趣味性的康复训练模式。     

上肢康复系统对脑卒中后偏瘫患者上肢运动功能康复的效果

目的：探讨上肢康复训练系统对脑卒中后偏瘫患者上肢运动功能康复的效果。方法：将脑卒中患者 44例随机分为观察组23例和对照组21例。在常规治疗的基础上,对照组进行常规运动疗法及作业治疗,观 察组则在对照组基础上增加上肢康复系统治疗,共4周。分别于治疗前、治疗4周后采用Fugl-Meyer上肢运 动量表（FMA-U）及Carroll上肢功能测试（UEFT）对脑卒中患者的上肢运动功能进行评定。结果：治疗4周 后,2组患者上肢FMA评分及UEFT评分均较治疗前显著提高,且观察组高于对照组（均P＜0.05）。结论：上 肢康复训练系统可有效改善脑卒中后偏瘫患者上肢运动功能。     

基于脑-机接口的残疾人环境控制装置的设计

目的：脑-机接口是指大脑和外部设备间直接进行通讯的系统。本文基于此技术为有运动功能障碍的残疾人设计了一个环境控制器。方法：提取受试者的稳态视觉绣发脑电信号进行处理，分辨出受试者所注视的目标，并将该控制目标对应的命令代码发送给执行机构，执行机构接收命令并将其转化为相应的控制动作。结果：经过一般的训练过程后，使用者能正确地利用稳态视觉诱发脑电控制常规电器的起停，能通过红外遥控设备控制电视和空调，能拨打电话并启动语音播放。结论：该系统提供了一种全新的基于脑-机接口技术的环境控制器，为残疾人的日常生活带来了方便。     

脑机接口康复训练机器人在脑卒中患者上肢功能康复中的研究进展

<正>脑卒中是当前世界导致残疾的主要原因之一，约60%的患者在发生急性脑卒中之后会有上肢功能障碍[1]。由于近年来人工智能的飞速发展，脑机接口系统成为了上肢功能障碍患者的一个重要解决方案。脑机接口系统是一种可以记录中枢神经系统活动并将其转换为可替代、恢复、增强，补充或改善中枢神经系统自然输出的人工输出的系统[2]。脑机接口系统的主要作用是捕捉并转换（解码）大脑信号同时生成高精度的命令，以在患者的真实环境中控制机器人手臂/腿或轮椅等外部设备。典型的脑机接口系统主要包含三个部分：     

基于脑电的脑-机接口系统研究现状

目的：就近年来国内外有关脑-机接口系统的研究近况，探讨脑-机接口系统框架结构及其特征提取和分类算法等方面的研究进展。资料来源：应用计算机检索Medline 1996-01／2005-08脑-机接口方面的文献，检索词“brain-computer interface，Rehabilitation”，并限定语言为English；同时检索CNKI-KNS 1994-01／2005-08脑-机接口方面的文献，检索词为“信号处理、脑电”，并限定语言为中文。资料选择：对资料进行初审，纳入标准：选取包括脑-机接口、信号处理方面的文献。排除标准：综述文献、重复研究文章。资料提炼：共收集到33篇关于脑-机接口的英文文献，中文文献45篇，总共纳入17篇符合标准的文献。资料综合：脑-机接口技术是在人脑与计算机或其他电子设备之间建立的直接的交流和控制通道，它不依赖于脑的正常输出通路（外周神经系统及肌肉组织），是一种全新的对外信息交流和控制方式。概述脑-机接口国内外最新研究进展，并在此基础上全面介绍了整个脑-机接口系统的结构框架及其研究情况，最后分析了当前脑-机接口存在的主要问题及研究方向。结论：脑-机接口的研究正成为脑科学、康复工程、生物医学工程及人机自动控制研究领域的一个新的前沿热点；整体上讲，脑-机接口系统的研究正处于发展阶段。现有的脑-机接口系统还存在通讯速度低、效果不稳定等技术障碍，特别是信号处理算法的选择与改进等方面有待进一步研究。     

基于脑-机接口的康复辅助机械手控制

目的：研究一种基于脑-机接口技术的康复辅助机械手运动的控制方法，并论证其可行性。方法：构建基于脑-机接口的控制系统机架。通过基于稳态视觉诱发电位构造的脑-机接口获取控制指令，通过可编程逻辑控制器(PLC)控制机械手完成规划的动作。结果：实现了利用稳态诱发脑电控制多自由度机械手完成倒水动作的过程。结论：通过脑-机接口技术控制康复辅助机械手进行复杂运动是一种可行的方法，这种新的控制方法可以应用于残疾人对假肢的控制。     

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.