视觉反馈增益对力量输出影响的fMRI研究

目的 运用全脑fMRI技术研究视觉反馈增益在运动功能执行中的调节作用.方法 设计快、慢两种变化速度的力量跟踪任务,在高低不同的两种视觉反馈增益下令15名正常受试者做右手握力运动,同时接受BOLD-fMRI扫描;采用t检验分析获得不同运动状态与静息状态信号对比的脑功能图,对比观察脑皮层兴奋区的异同.结果 四种模式握力运动均可激活初级躯体感觉运动区(SMC)、双侧前运动区(PMC)、辅助运动区(SMA)、小脑、基底节(BG)和对侧后顶叶(PPC)等.随着反馈增益的提高:S1、PPC、PMC、小脑等激活强度、范围均降低,BG恰好相反;SMA激活强度提高但范围缩小,M1表现不明显.结论 视觉反馈增益对力量输出有显著影响,不同增益所激活的脑区不同.PPC、PMC、小脑、基底节等参与调节过程.     

缺血性脑卒中患者患手主动运动及被动运动时的功能性磁共振研究

目的观察缺血性脑卒中患者患手执行主动及被动运动时的脑激活模式,探讨主动运动和被动运动治疗脑卒中后手功能障碍的中枢机制。 方法对5例左侧大脑皮质下脑卒中患者患手执行主动及被动抓握-释放动作,执行动作期间采用血氧水平依赖性功能性磁共振（BOLD-fMRI）进行脑扫描,利用SPM5软件对上述患者试验数据进行分析,使用XJVIEW toolbox 8.11版软件得出入选患者在上述两种运动状态下的脑激活区分布图,并对其在不同运动状态下的脑激活模式特点进行分析比较。 结果入选患者患手在执行主动运动时其脑激活部位主要位于对侧感觉运动区(SMC)、运动前区(PMC)、双侧小脑及双侧辅助运动区(SMA),另外同侧SMC及PMC区也有轻度激活;激活脑区主要位于对侧大脑及小脑半球。患手执行被动运动时的脑激活部位主要位于双侧SMC、PMC区、双侧小脑、SMA区;激活脑区平均分布于两侧大脑及小脑半球。与患手主动运动比较,患手被动运动时的脑区激活范围较广泛,激活强度也较高。 结论患手执行主动运动和被动运动均可激活脑卒中患者运动相关脑区,提示对脑卒中患者进行主动运动及被动运动均可促进其脑功能重组。     

健康成年人手部主动及被动运动时大脑功能区

利用血氧水平依赖性功能性磁共振成像技术探讨健康成年人手部主动、被动对掌运动时的脑激活区的特点,为运动疗法治疗脑卒中提供理论依据。9名健康成年人参加实验。以右手主动及被动对掌运动作为刺激模式,采用区块设计,利用SPM5软件进行数据处理。测量位于对侧感觉运动区及运动前区的脑激活区的中点,并统计各脑区出现激活的频数。 结果主动及被动手对掌运动时主要激活的脑区包括：对侧感觉运动皮质（SMC）区、对侧运动前皮质（PMC）区、双侧辅助运动区（SMA）及同侧小脑,其中对侧SMC区的激活频率最高;被动运动时所激活的对侧SMC和PMC区的几何中心较主动运动时偏后。主动和被动对掌运动均可引起运动相关脑区激活,两种运动模式所激活脑区在分布上无明显差别,但被动运动所激活的对侧SMC和PMC区几何中心较主动运动偏后。     

健康成年人手部主动及被动运动时大脑功能区的功能性磁共振成像研究

目的 利用血氧水平依赖性功能性磁共振成像技术探讨健康成年人手部主动、被动对掌运动时的脑激活区的特点,为运动疗法治疗脑卒中提供理论依据.方法 9名健康成年人参加实验.以右手主动及被动对掌运动作为刺激模式,采用区块设计,利用SPM5软件进行数据处理.测量位于对侧感觉运动区及运动前区的脑激活区的中点,并统计各脑区出现激活的频数.结果 主动及被动手对掌运动时主要激活的脑区包括:对侧感觉运动皮质(SMC)区、对侧运动前皮质(PMC)区、双侧辅助运动区(SMA)及同侧小脑,其中对侧SMC区的激活频率最高;被动运动时所激活的对侧SMC和PMC区的几何中心较主动运动时偏后.结论 主动和被动对掌运动均可引起运动相关脑区激活,两种运动模式所激活脑区在分布上无明显差别,但被动运动所激活的对侧SMC和PMC区几何中心较主动运动偏后.

Abstract：

Objective To assess differences in brain activation between active and passive movement of the right hand using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI). Methods Nine healthy adult right handed volunteers were studied. fMRI was performed with active and passive finger-to-finger movement. Results Right hand active and passive movement produced significant activation in the contralateral sensorimotor cortex ( SMC ), the contralateral premotor cortex ( PMC ), bilaterally in the supplementary motor area (SMA) and in the ipsilateral cerebellum. The activated brain areas were centered on the contralateral SMC and PMC and located more forward during active movement than during passive movement. The contralateral SMC was the most strongly and the most frequently activated brain area. The contralateral posterior parietal cortex (PPC) was less relevant to the hand movements. Unlike active movement, passivemovement activated more areas in the posterior central gyrus than in the anterior central gyrus. Conclusions Both active and passive movement significantly activate the brain areas which are responsible for hand movement, but there are some differences in the locations of the cortex areas activated and in the incidence activation except in the contralateral SMC.     

共济失调患者手运动时脑激活区域的定量分析

目的利用血氧水平依赖性功能性磁共振成像（BOLD-fMRI）技术,探讨共济失调患者在主动与被动复杂对指运动模式下关键脑功能区激活体积和强度的变化。 方法选取共济失调患者16例作为病例组,另选10名健康志愿者作为正常组。入选者均进行主动与被动复杂对指运动,在这两种运动模式下进行BOLD-fMRI检查,记录相应脑运动功能区的激活体积和强度并进行定量分析。采用共济失调量表（ICARS）对共济失调患者的共济运动进行评分。 结果病例组患手主动运动时,同侧辅助运动区（SMA）激活体积大于正常组同侧手的测定结果,激活强度也高于正常组;同侧小脑的激活体积和激活强度则小于正常组,小脑激活区的出现率也低于正常组。病例组患手主动运动时,同侧小脑激活区的体积、激活强度与共济失调量表评分无相关性。 结论共济失调患者患侧小脑功能下降,而同侧SMA可以发挥代偿作用,临床共济失调量表的评分尚不能准确反映小脑功能情况。     

运动想象治疗脑卒中患者手部运动功能的功能磁共振研究

目的：探讨运动想象（MI）治疗对脑卒中后脑功能重塑的影响。方法：将16例脑卒中患者随机分为运动想象组（MI）6例、执行运动（EM）组5例、对照组（CG）5例。3组在常规康复治疗基础上,MI组、EM组分别进行运动想象、实际动作治疗,每次30min,每周5次,为期4周。治疗前、后进行运动功能评价,并使用功能磁共振（fMRI）观察患手对指实际动作、想象时偏瘫对侧感觉运动区的激活情况,定量分析治疗前后cSMC区的激活强度t、LI变化。结果：治疗4周后,MI组及EM组FMA、STEF评分较前均有明显提高（均P＜0.05）,且MI组上述评分均更高于其它2组（均P＜0.05）。治疗后,3组MBI评分均有提高,但组内及组间差异无统计学意义。运动想象与运动执行的激活部位相似：治疗前运动想象激活区主要位于双侧SMC区、双侧SMA区,治疗后,各组双侧SMC区激活强度有增大趋势,MI组对侧SMC区激活显著（P＜0.05）,且对侧偏侧化优势较CG组显著（P＜0.05）。结论：运动想象治疗能够明显改善脑卒中后患者手功能,其机制可能与运动想象促进脑功能重塑有关。     

共济失调患者手运动时脑激活区域的定量分析

目的 利用血氧水平依赖性功能性磁共振成像(BOLD-fMRI)技术,探讨共济失调患者在主动与被动复杂对指运动模式下关键脑功能区激活体积和强度的变化.方法 选取共济失调患者16例作为病例组,另选10名健康志愿者作为正常组.入选者均进行主动与被动复杂对指运动,在这两种运动模式下进行BOLD-fMRl检查,记录相应脑运动功能区的激活体积和强度并进行定量分析.采用共济失调量表(ICARS)对共济失调患者的共济运动进行评分.结果 病例组患手主动运动时,同侧辅助运动区(SMA)激活体积大于正常组同侧手的测定结果,激活强度也高于正常组;同侧小脑的激活体积和激活强度则小于正常组,小脑激活区的出现率也低于正常组.病例组患手主动运动时,同侧小脑激活区的体积、激活强度与共济失调量表评分无相关性.结论 共济失调患者患侧小脑功能下降,而同侧SMA可以发挥代偿作用,临床共济失调量表的评分尚不能准确反映小脑功能情况.     

共济失调患者手运动时脑激活区域的定量分析

目的 利用血氧水平依赖性功能性磁共振成像(BOLD-fMRI)技术,探讨共济失调患者在主动与被动复杂对指运动模式下关键脑功能区激活体积和强度的变化.方法 选取共济失调患者16例作为病例组,另选10名健康志愿者作为正常组.入选者均进行主动与被动复杂对指运动,在这两种运动模式下进行BOLD-fMRl检查,记录相应脑运动功能区的激活体积和强度并进行定量分析.采用共济失调量表(ICARS)对共济失调患者的共济运动进行评分.结果 病例组患手主动运动时,同侧辅助运动区(SMA)激活体积大于正常组同侧手的测定结果,激活强度也高于正常组;同侧小脑的激活体积和激活强度则小于正常组,小脑激活区的出现率也低于正常组.病例组患手主动运动时,同侧小脑激活区的体积、激活强度与共济失调量表评分无相关性.结论 共济失调患者患侧小脑功能下降,而同侧SMA可以发挥代偿作用,临床共济失调量表的评分尚不能准确反映小脑功能情况.     

fMRI评价正常老年人腕关节被动运动下脑激活区

目的 用功能磁共振技术观察正常老年人双侧腕关节被动运动时脑区激活情况.方法 对30例正常的右利手老年受试者分别进行双侧腕关节被动运动的功能MR扫描,采用SPM2软件进行数据分析和脑功能区定位.结果 利手(右手)运动主要激活对侧感觉运动皮质、运动前区,双侧辅助运动区、后顶叶及同侧小脑;非利手运动时除激活上述脑区外,还激活了同侧运动感觉区和对侧小脑,且对侧运动前区、双侧辅助运动区和同侧小脑的激活体积明显大于利手腕关节运动.结论 被动运动依赖于大脑皮质和小脑等许多与运动相关的脑功能区的参与;与利手腕关节运动相比,非利手腕关节运动更依赖于对侧PMC、双侧SMA和同侧小脑等运动区.     

Bold-fMRI联合DTT技术在缺血性脑卒中患者上肢功能恢复磁共振研究中的应用

目的联合Bold-fMRI及DTT技术研究皮质脊髓束（CST）在不同损伤情况下脑皮质功能重组模式及其与偏瘫上肢运动功能恢复的关联性。 方法共选取15例初次发病的急性脑梗死伴单侧严重上肢瘫患者作为研究对象。于发病1周内对患者执行偏瘫侧手指被动伸展任务(FE）下fMRI及DTT联合成像,通过Dtv.Ⅱ.R2软件计算患侧及健侧CST条目数。并于发病后1个月及3个月时行偏瘫侧手指被动FE任务下fMRI成像,通过SPM8软件观察不同时程患者脑功能区激活情况。采用简化Fugl-Meyer评分(FMA)上肢部分对入选患者患侧上肢运动功能进行跟踪评定。 结果根据重建的患侧CST条目数与健侧CST条目数的比值分为3型,Ⅰ型患者患侧纤维束根数大于健侧2/3,Ⅱ型患者患侧纤维束根数大于健侧1/3但小于2/3,Ⅲ型患者患侧纤维束根数小于健侧1/3。I型患者Bold-fMRI初期显示双侧初级感觉运动区（SMC）及患侧为主辅助运动区（SMA）激活,1个月及3个月时健侧SMC区激活逐渐减弱,患侧SMC区激活强度逐渐增强。II型患者Bold-fMRI初期表现为患侧SMC区及SMA区激活,1个月时表现为以健侧为主双侧SMC区及SMA区明显激活,3个月时患者SMC区激活增强,患侧激活减弱。Ⅲ型患者Bold-fMRI初期表现为SMA区及后顶叶皮质区(PPC)轻度激活,1个月时健侧SM1区有轻度激活,3个月时双侧SMC区及SMA区均无激活。发病1周内Ⅰ型、Ⅱ型及Ⅲ型患者上肢FM评分分别为（5.6±4.3）分、（4.8±5.0）分及（6.5±4.5）分,组间差异均无统计学意义（P>0.05）;发病1个月时Ⅰ型、Ⅱ型及Ⅲ型患者上肢FM评分分别为（48.5±5.6）分、（36.5±6.8）分及（12.3±3.4）分,组间差异均具有统计学意义（P<0.05）;发病3个月时Ⅰ型与Ⅱ型患者上肢FM评分分别为（62.8±3.2）分、（60.2±5.2）分,组间差异均无统计学意义（P>0.05）,但均显著高于Ⅲ型患者上肢FM评分［（10.2±6.0）分］（P<0.05）。 结论不同CST损伤情况下脑皮质功能重组模式各异,颅内功能重组是一个动态过程,不同脑区激活模式与患者临床预后密切相关。     

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.     

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.     

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.     

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.     

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.