Test-retest reliability and responsiveness of isokinetic dynamometry to assess wrist flexor muscle spasticity in subacute post-stroke hemiparesis

IntroductionTo overcome the limitations of clinical scales, objective measurement methods are becoming prominent in spasticity assessment. The aim of this study was to assess the test–retest reliability and responsiveness of isokinetic dynamometry to evaluate wrist flexor spasticity in patients with subacute stroke.MethodsTwenty six patients with hemiparetic stroke (13 men, 13 women, mean age 51.38 ± 12.64 years) volunteered to take part in this study. Resistive torque in the wrist flexor muscles was measured twice, 1 day apart, with an isokinetic dynamometer. Wrist extension was tested at four speeds (5, 60, 120 and 180°/s). Torque response at the lowest speed (5°/s) was attributed to the non-neural component of the wrist flexor muscles, and was subtracted from the torque response at the higher speeds to calculate reflex torque (spasticity). The reliability of reflex torque measurements at 60, 120 and 180°/s was evaluated with the intraclass correlation coefficient (ICC_2,1) and standard error of measurement (SEM and SEM%), which reflect reproducibility and measurement error, respectively. Responsiveness was calculated as the smallest real difference (SRD and SRD%).ResultsReproducibility was excellent at different movement speeds (ICC_{2, 1} 0.76–0.85). SEM% ranged from 11% to 21%, and SRD% ranged from 30% to 58%. ICC values increased, and SEM% and SRD% decreased, as test speed increased.ConclusionOur results support the reliability and responsiveness of isokinetic dynamometry to quantify spasticity in wrist flexor muscles in patients with subacute stroke. Reliability and responsiveness increased as the speed of wrist movement increased.     

小切口加可吸收螺丝钉治疗肱骨节骨折

目的探讨小切口加可吸收螺丝钉治疗肱骨大结节骨折的临床疗效。方法回顾分析2002年10月至2005年11月41例应用可吸收钉治疗肱骨大结节骨折，术后评价：肩关节功能进行评价分析。结果41例患者经6月～14月随访，平均9个月，根据Neer关节功能评定标准，优36例，良3例，可2例，优良率95．12％。结论该方法具有固定可靠，创伤小，骨折愈合快，避免二次手术的优点。     

Monitoring of Hematopoietic Chimerism after Transplantation for Pediatric Myelodysplastic Syndrome: Real-Time or Conventional Short Tandem Repeat PCR in Peripheral Blood or Bone Marrow?

Quantitative real-time PCR (qPCR) has been proposed as a highly sensitive method for monitoring hematopoietic chimerism and may serve as a surrogate marker for the detection of minimal residual disease minimal residual disease in myelodysplastic syndrome (MDS), until specific methods of detection become available. Because a systematic comparison of the clinical utility of qPCR with the gold standard short tandem repeat (STR)-PCR has not been reported, we retrospectively measured chimerism by qPCR in 54 children transplanted for MDS in a previous study. Results obtained by STR-PCR in the initial study served as comparison. Because the detection limit of qPCR was sufficiently low to detect an autologous background, we defined the sample as mixed chimera if the proportion of recipient-derived cells exceeded .5%. The true positive rates were 100% versus 80% (qPCR versus STR-PCR, not significant), and mixed chimerism in most cases was detected earlier by qPCR than by STR-PCR (median, 31 days) when chimerism was quantified concurrently in peripheral blood and bone marrow. Both methods revealed a substantial rate of false positives (22.7% versus 13.6%, not significant), indicating the importance of serial testing of chimerism to monitor its progression. Finally, we propose criteria for monitoring chimerism in pediatric MDS with regard to the subtypes, specimens, PCR method, and timing of sampling.     

枫香树叶抗菌活性研究

目的探讨枫香树叶的体外抗菌活性。方法采用琼脂扩散法和试管连续稀释法测定枫香树叶对常见致病菌和条件致病菌的体外抗菌活性及最低抑菌浓度(MIC)。结果枫香树叶对大肠埃希菌、白假丝酵母菌无抗菌作用;枫香树叶对金黄色葡萄球菌、白色葡萄球菌、福氏志贺氏菌、伤寒沙门氏菌、铜绿假单胞菌皆有抗菌作用,抑菌圈直径在13~25 mm之间。不同方法提取的药液的抗菌作用有明显差别,其中枫香树叶水煎液抗菌作用最好,对金黄色葡萄球菌、白色葡萄球菌、福氏志贺氏菌、伤寒沙门氏菌、铜绿假单胞菌的最低抑菌浓度分别为0.5,1,0.5,0.5,0.25 g/ml。结论枫香树叶对金黄色葡萄球菌、白色葡萄球菌、福氏志贺氏菌、伤寒沙门氏菌、铜绿假单胞菌有较好的抗菌作用。     

高龄冠心病患者非体外循环冠状动脉旁路移植术的临床应用

目的比较70岁以上高龄冠心病患者群中,非体外循环和体外循环两种冠脉旁路术式的近期疗效,探讨高龄冠心病的最佳手术方式。方法将170例≥70岁的冠状动脉旁路移植术者分为非体外循环冠状动脉旁路移植术组(OPCAB,n=83)和体外循环下冠状动脉旁路移植术组(CPB-CABG,n=59),回顾性分析其早期疗效。结果OPCAB组的疗效在以下方面优于CPB-CABG组(P<0.05):正性药物的使用(18.1%vs 61%),IABP的使用(8.4%vs 30.5%),围手术期心梗(3.6%vs 11.8%),急性肾衰(1.2%vs5.1%)、呼吸衰竭(9.6%vs 18.6%)、肺部感染(8.4%vs 25.4%)、脑梗死(0 vs 8.5%)、缺氧性脑病(1.2%vs6.7%)、呼吸机使用时间(12.3±5.6)vs(27.7±8.3)h,住ICU时间(2.3±1.2)vs(6.5±2.3)d,住院时间(16.4±7.1)vs(28.2±7.8)d,病死率(4.8%vs 10.2%)。结论非体外循环冠状动脉旁路移植术在高龄冠心病患者中能明显降低因为高龄而增加的手术病死率和术后并发症,应作为高龄冠心病的外科治疗首选方法;正确掌握其手术适应证、手术配合、手术技巧和围手术期处理,是确保手术疗效的关键。     

试论扶正法在微小残留白血病治疗中的作用

通过探讨"扶正法"在微小残留白血病治疗中的运用,认为正气虚弱,余毒留伏阴分是微小残留白血病基本病机.运用扶持正气,培植元气来调节阴阳气血、脏腑经络生理功能,提高患者的抗病能力,增强免疫达到防治微小残留白血病,间接抗肿瘤的目的.     

AN EPIDEMIOLOGICAL INVESTIGATION OF MINIMAL BRAIN DYSFUNCTION IN SIX ELEMENTARY SCHOOLS IN BEIJING

Six elementary schools from urban, suburban and mountain areas of Beijing (containing 2770 school children) were screened with a standardized questionnaire and each suspected case was interviewed to determine whether diagnostic criteria were met for attention deficit disorder with hyperactivity (DSM-III), with some cultural modification. The MBD prevalence rate was 3.1% in the urban, 7.8% in the suburban and 7.0% in the mountain area. Lower rates were found in the families of scientific and technical professionals or in those with higher education than others. The mean score or the severity of some clinical manifestations of MBD children showed differences in families with different occupations or educational levels. Social environmental factors were considered to play an important role in the development of MBD, which is possibly based on biological factors.     

Clinicl Significance of Mesangial IgM Deposits in Minimal Change Nephrotic Syndrome

The clinicopathologic features and the response to corticosteroid therapy were compared in 9 patients with minimal change nephrotic syndrome (MCNS) and diffuse mesangial IgM deposits (Group I) and in 32 of those without IgM deposits (Group II). However, serum IgM levels in Group I in both relapse and remission were significantly higher than those of Group II and controls (p<0.001). In Group I mesangial IgM deposits were diffuse in 9 (100%), mesangial C_1q was present in 4, IgA and fibrinogen were each observed in 1, respectively. Electron dense deposits in the mesangium were also present in 2 to 5 patients in Group I. No significant differences were found between the two groups in age of onset, sex ratio, laboratory data except for serum IgM level, duration before biopsy, follow-up periods, outcome, and response to steroid therapy. Our data suggest that a more severe degree of either impairment of mesangial clearance of IgM or overproduction of IgM may be involved in patients with MCNS and mesangial IgM deposits but that these patients could not be considered a distinct group of patients.