下肢康复机器人训练对脑卒中偏瘫患者下肢运动功能的影响

目的 观察下肢康复机器人训练对脑卒中偏瘫患者下肢运动功能的影响。 方法 采用随机数字表法将40例脑卒中偏瘫患者（病程<12周）分为治疗组及对照组。对照组患者给予常规康复干预,治疗组患者在常规康复干预基础上辅以下肢康复机器人步行训练,每天治疗1次,共连续治疗6周。于治疗前、治疗6周后分别采用简式Fugl-Meyer运动功能量表（FMA）下肢评分及上田敏式偏瘫下肢功能量表对2组患者下肢运动功能进行评定,同时采用功能性步行分级（FAC）评价2组患者步行能力改善情况。 结果 治疗前2组患者下肢FMA评分、上田敏式分级及FAC评分组间差异均无统计学意义（P>0.05）;治疗6周后发现2组患者下肢FMA评分、上田敏式分级及FAC评分均较治疗前明显改善（P<0.05）,并且治疗组患者下肢FMA评分［(28.14±3.37)分］、上田敏式分级［(10.29±1.69)级］及FAC评分［(3.86±0.77)分］均显著优于对照组水平［分别为（24.62±3.69）分、（8.85±1.73）级和（2.92±0.86）分］,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下肢康复机器人步行训练,能进一步提高脑卒中偏瘫患者下肢运动功能,该疗法值得临床推广、应用。     

下肢康复机器人训练对脑卒中患者运动功能恢复的影响

目的观察下肢康复机器人联合常规康复训练对脑卒中患者下肢运动功能恢复的影响。 方法采用随机数字表法将40例恢复期脑卒中患者分为观察组及对照组,每组20例。2组患者均给予常规康复干预,对照组在此基础上增加治疗师徒手辅助下肢步行训练,观察组则在常规康复训练基础上增加下肢康复机器人辅助步行训练。于治疗前、治疗12周后分别采用Berg平衡量表(BBS)、简式Fugl-Meyer评分(FMA)、改良Barthel指数(MBI)评分、功能性步行分级(FAC)及10m最大步行速度（10m MWS）对2组患者疗效进行评定。 结果治疗后2组患者BBS、FMA评分及FAC分级均较治疗前明显改善(P<0.05),并且治疗组患者BBS评分［（45.00±4.47）分］、FMA评分［（28.67±3.66）分］、FAC分级［（3.55±0.94）级］及10m MWS［（0.83±0.23）m/s］均显著优于对照组,组间差异均具有统计学意义(P<0.05);治疗后2组患者MBI评分（除大便控制以外）均较治疗前明显改善,并且观察组患者如厕评分［（7.50±2.02）分］、转移评分［（13.06±1.65）分］、步行评分［（12.55±2.04）分］、上楼梯评分［（8.20±1.48）分］及MBI总分［（74.60±7.74）分］均显著优于对照组,组间差异均具有统计学意义(P<0.05)。 结论下肢康复机器人联合常规康复训练能显著改善脑卒中患者下肢运动功能及平衡能力,该联合疗法值得临床推广、应用。     

下肢运动控制训练联合核心稳定性训练对脑卒中偏瘫患者下肢功能恢复的影响

目的观察基于虚拟游戏的下肢运动控制训练联合核心稳定性训练对脑卒中后下肢功能恢复的影响。 方法采用随机数字表法将60例脑卒中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及核心稳定性训练,观察组患者在此基础上辅以基于虚拟游戏的下肢运动控制训练。于治疗前、治疗8周后分别采用下肢Fugl-Meyer运动功能评分（FMA）、Berg平衡量表（BBS）、改良Barthel指数（MBI）、功能性步行分级（FAC）及10m最大步行速度（MWS）对2组患者进行疗效评定。 结果治疗前2组患者FMA、BBS、MBI评分、MWS及FAC分级组间差异均无统计学意义（P&rt;0.05）;分别经8周治疗后,发现观察组患者FMA评分［（27.81±4.52）分］、BBS评分［（49.08±5.15）分］、MBI评分［（70.64±16.15）分］、MWS［（45.33±13.27）m/min］及FAC分级（评级达4～5级者共有25例,占83.3％）均较治疗前及对照组明显改善（P<0.05）。 结论基于虚拟游戏的下肢运动控制训练联合核心稳定性训练能更有效改善脑卒中偏瘫患者下肢运动功能,该联合疗法值得临床推广、应用。      

核心稳定性训练联合眼针治疗对脑卒中偏瘫患者运动功能的影响

目的观察核心稳定性训练联合眼针治疗对脑卒中偏瘫患者运动功能恢复的影响。 方法采用随机数字表法将80例脑卒中偏瘫患者分为观察组及对照组,每组40例。2组患者均给予常规康复训练,观察组在此基础上辅以眼针治疗及核心稳定性训练（包括腰部、腹部肌群训练及肩胛骨、躯干、骨盆控制训练等）。于治疗前、治疗6周后对2组患者躯干控制能力、平衡功能、日常生活活动(ADL)能力、步行能力及肢体运动功能进行评定。 结果治疗后2组患者躯干控制测试(TCT)评分、Berg平衡量表(BBS)评分、改良Barthel指数（MBI）、上肢及下肢Fugl-Meyer量表 (FMA)评分、Holden步行功能分级（FAC）均较治疗前明显改善(P<0.05),并且观察组患者TCT评分［（100±0）分］、BBS评分［（49.27±5.21）分］、MBI评分［（66.69±9.32）分］、上肢FMA评分［（35.58±9.18）分］、下肢FMA评分［（26.76±7.23）分］及FAC评分［（4.31±0.46）分］均显著优于对照组水平［分别为（92.15±7.39）分、（42.29±5.47）分、（56.22±9.81）分、（28.32±9.76）分、（21.32±7.76）分和（3.75±0.38）分］,组间差异均具有统计学意义(P<0.05)。 结论核心稳定性训练联合眼针治疗对提高脑卒中偏瘫患者运动功能具有显著疗效,该联合疗法值得临床推广、应用。     

多通道功能性电刺激对脑卒中偏瘫患者下肢功能的影响

目的 观察多通道功能性电刺激(FES)对脑卒中偏瘫患者下肢功能的影响。 方法 将30例脑卒中偏瘫患者按随机数字表法分为对照组、电刺激A组和电刺激B组,每组10例。3组患者均接受常规康复治疗和药物治疗,电刺激A组每日进行15 min常规康复治疗和15 min多通道FES治疗,共计30 min,每日1次;电刺激B组在电刺激A组基础上,增加FES治疗时间至30 min,每日1次。治疗前及治疗4周后（治疗后）,采用Fugl-Meyer量表（FMA）下肢部分、起立-行走测试（TUGT）、10米最大步行速度测试(10 mMWS）、功能性步行分级（FAC）、Barthel指数（BI）进行评定。 结果 治疗前,3组患者TUGT、10 mMWS、FMA、FAC、BI比较,差异无统计学意义（P>0.05）。治疗后,3组患者TUGT、10 mMWS、FMA、FAC、BI均较组内治疗前改善（P<0.05）。与对照组治疗后比较,电刺激A组和电刺激B组TUGT、10 mMWS、FMA、FAC、BI较为优异（P<0.05）,且电刺激B组TUGT［（18.01±6.16）s］、10 mMWS［（0.83±0.14）m/s］、FMA［（24.57±2.59）分］、FAC［（4.37±0.43）级］、BI［（71.50±9.14）分］优于电刺激A组（P<0.05）。 结论 增加多通道FES治疗时间可以明显改善脑卒中患者的下肢运动功能,提高生活质量。     

强化训练对脑卒中后抑郁患者下肢运动功能及抑郁状态的影响

目的 观察强化训练对脑卒中后抑郁患者下肢运动功能及抑郁状态的影响。 方法 采用随机数字表法将30例脑卒中后抑郁患者分为强化组及普通组,每组15例。2组患者均给予常规脑卒中药物治疗、抗抑郁药物治疗及康复训练,强化组在此基础上每日增加1次下肢运动功能训练。于治疗前、治疗2周、4周后分别采用汉密尔顿抑郁量表（HAMD）、下肢Fugl-Meyer运动功能评分（FMA）、10m最大步行速度(10MWT)、Holden步行功能分级(FAC)对2组患者进行评定,同时检测2组患者上述时间点血清中β-内啡肽（β-EP）及脑源性神经营养因子（BDNF）水平。 结果 治疗4周后2组患者下肢FMA评分、10MWT、BDNF及β-EP均较治疗前明显改善（P<0.05）。治疗2周后2组患者下肢FMA评分、10MWT、BDNF及β-EP组间差异均无统计学意义（P>0.05）,治疗4周后强化组下肢FMA评分［（20.67±6.79）分］、10MWT［（0.48±0.22）m/s］、血清中BDNF含量［（10.81±2.33）μg/L］及β-EP含量［（164.02±42.15）ng/L］均较普通组明显改善（均P<0.05）。治疗2周及4周后强化组HAMD评分［分别为（16.33±6.74）分和（12.13±5.44）分］均较普通组明显改善（均P<0.05）;治疗2周、4周后2组患者FAC分级组间差异均无统计学意义（P>0.05）。 结论 强化训练能进一步促进脑卒中后抑郁患者下肢运动功能及抑郁状态改善,该疗法值得临床推广、应用。     

骨盆辅助式康复机器人训练对急性期脑梗死患者躯干控制及步行功能的影响

目的 观察骨盆辅助式康复机器人训练对急性期脑梗死患者躯干控制及步行功能的影响。 方法 采用随机数字表法将40例急性期脑梗死偏瘫患者分为观察组及对照组,每组20例。2组患者均给予常规药物治疗及康复训练,观察组患者在此基础上给予骨盆辅助式康复机器人训练,每天训练1次,每周训练5 d,连续干预4周。于治疗前、治疗4周后（治疗后）分别采用简式Fugl-Meyer运动功能量表（下肢部分）、功能性步行分级量表（FAC）、躯干控制测试（TCT）及机器人检测系统对2组患者下肢运动功能、步行能力、躯干控制能力和骨盆运动情况进行评估。 结果 治疗后,2组患者下肢FMA评分、FAC分级、TCT评分及骨盆运动参数均较治疗前明显改善（P＜0.05）,并且观察组下肢FMA评分［（19.35±2.54）分］、FAC分级［（2.85±0.67）级］、TCT评分［（74.65±7.86）分］及骨盆侧向位移［（10.05±1.54）cm］、高度位移［（14.25±1.94）cm］、旋转角度［（9.15±1.72）°］、侧倾角度［（21.35±2.18）°］均显著优于同期对照组水平,组间差异均具有统计学意义（P＜0.05）。 结论 骨盆辅助式康复机器人训练能显著改善急性期脑梗死患者躯干控制及步行功能,且疗效明显优于常规康复训练。     

姿势解密技术对脑卒中后偏瘫肩痛的影响

目的 探讨姿势解密技术对脑卒中偏瘫患者肩痛的影响。 方法 选取2018年10月至2020年6月青岛大学附属医院康复医学科收治的患者40例,按随机数字表法分为对照组和治疗组,每组20例。对照组接受常规康复训练,常规康复训练采取良肢位摆放、肩关节主被动活动、神经发育疗法进行治疗,治疗为每日40 min,每周5 d,共治疗4周。治疗组接受姿势解密技术治疗,通过评价肩关节复合体、胸椎、腰椎和骨盆带中立位姿势,找到处于异常位置的关节和肌肉,将调整其结构和功能,治疗为每日40 min,每周5 d,共治疗4周。分别于治疗前和治疗后,采用目测类比评分法（VAS）评分、上肢Fugl-Meyer运动功能评定（FMA）及改良Barthel指数（MBI）对2组患者的疼痛程度、上肢运动功能及日常生活活动能力进行评估。 结果 治疗后,治疗组VAS［（2.00±2.29）分］、MBI［(78.65±17.99)分］和FMA［(46.30±10.20)分］评分均较组内治疗前［(7.50±0.89)分、(43.75±13.85)分和（24.10±9.13）分］均有明显改善（P<0.01）,且治疗组的改善显著优于对照组［VAS评分(4.90±1.02)分、MBI评分（63.25±11.15）分和FMA评分（37.00±9.51）分］,组间差异均有统计学意义（P<0.01）。 结论 姿势解密技术可有效缓解脑卒中后偏瘫肩痛并改善上肢功能。     

悬吊运动疗法结合Bobath疗法对脑卒中后偏瘫患者下肢功能恢复的影响

目的 观察悬吊运动疗法结合Bobath疗法对脑卒中后偏瘫患者下肢功能恢复的影响。 方法 将60例脑卒中后偏瘫患者随机分为悬吊组20例、联合组20例、对照组20例，3组患者均给予常规康复训练，悬吊组在此基础上给予悬吊运动疗法，联合组在此基础上给予悬吊运动疗法和Bobath疗法。3组患者于治疗前和治疗4周后（治疗后）进行评估，采用简式Fugl-meyer评定法（FMA）、功能性步行量表（FAC）、10m最大步行速度测试（10m MWS）评估治疗效果。 结果 治疗前，3组患者下肢FMA、FAC、10m MWS比较，差异无统计学意义（P>0.05）。治疗后，3组患者下肢FMA、FAC、10m MWS均较组内治疗前改善（P<0.05）。治疗后，悬吊组、联合组下肢FMA、FAC、10m MWS均较对照组改善，且联合组下肢FMA［(28.35±3.69)分］、FAC［(4.25±0.55)分］、10m MWS［(0.60±0.15)m/s］改善优于悬吊组，差异有统计学意义（P<0.05）。 结论 悬吊运动疗法结合Bobath疗法可以有效提高脑卒中偏瘫患者的下肢功能。     

优化运动技巧对脑卒中后上肢及手部精细功能恢复的影响

目的探讨优化运动技巧对脑卒中后上肢及手部精细功能恢复的影响。 方法选取脑卒中患者68例,按随机数字表法将其分为训练组和对照组,每组34例。2组患者均给予常规康复训练,训练组在此基础上增加优化运动技巧训练。训练前及训练6周后,采用Fugl-Meyer量表（FMA）上肢运动功能评分、改良Barthel指数（MBI）、Carr-Shepherd手精细功能评分对2组患者的康复疗效进行评定。 结果训练前,2组患者FMA上肢运动功能评分、MBI及Carr-Shepherd手精细功能评分比较,差异无统计学意义（P&rt;0.05）。与组内训练前比较,2组患者训练6周后FMA上肢运动功能评分、MBI及Carr-Shepherd手精细功能评分均大幅度提高（P<0.05）。训练6周后,训练组FMA上肢运动功能评分［（41.41±15.05）分］、MBI［（83.46±15.65）分］及Carr-Shepherd手精细功能评分［（7.48±1.55）分］较对照组FMA上肢运动功能评分［（30.05±12.98）分］、MBI［（71.59±15.28）分］及Carr-Shepherd手精细功能评分［（4.19±1.52）分］高（P<0.05）。 结论在常规康复训练基础上增加优化运动技巧训练,可有效改善脑卒中患者上肢及手部的精细协调功能,提高其日常生活活动（ADL）能力。     

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.     

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.     

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.