209例产瘫患儿的神经电生理分析

目的:介绍分娩性臂丛神经损伤(产瘫)患儿神经电生理检测所见及应用价值.方法:对209例产瘫病例进行肌电图检测,测定息儿臂丛五大神经主要支配肌的肌电情况及运动诱发电位情况,并根据结果进行分类及加做同步兴奋检测.结果:第一型病例为C5、6损伤(肩外展、屈肘不能)共14例,占总病例数的6.7％;第二型病例为C5、6、7损伤(肩外展、屈肘,伸腕不能),共131例,占总病例数的62.7％,第三型病例为C5、6、7、8、T1损伤(单侧上肢瘫痪,但Horner征阴性),共63例,占总病例数的30.1％.另有单纯下干损伤伤(Klumpke麻痹)病例1例(0.5％).209例患儿分别检测正中神经、尺神经、桡神经、肌皮神经、腋神经及其支配肌损伤情况,分别为80例(38.3％)、80例(38.3％)、143例(68.4％)、199例(95.2％)及199例(95.2％).肩外展肌群活动时,肩外展肌群存在同步兴奋的有48例,不存在同步兴奋的有161例.结论:产瘫患儿Ⅰ型6.7％、Ⅱ型62.7％,大部分患儿未经手术均有不同程度的恢复.由于产瘫患儿动作的准确度不高、主动募集反应准确度较低,故正尖波、纤颤电位、峰值宽大电位就成为患儿神经损伤的定性依据.如患儿出现正尖波、纤颤电位,提示损伤较重,对确定是否需要手术探查非常有必要.术后定期进行电生理的复查,有利于恢复及对预后的判断.肩外展肌同步兴奋检测旨在明确患儿的外展障碍类型,以确定治疗方案、指导患儿家属对患肢关节进行被动活动,对进一步预防和减少关节挛缩的发生有重要意义.     

Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial

Background

The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress.

Objective

Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).

Methods

The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations—teachers and nurses—that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation.

Results

Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs CG=0.5%) in chronic “trait” anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill.

Conclusions

Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management.

Trial Registration

ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01683617","term_id":"NCT01683617"}}NCT01683617; http://clinicaltrials.gov/show/{"type":"clinical-trial","attrs":{"text":"NCT01683617","term_id":"NCT01683617"}}NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h).     

A role for affectivity in rapid facial mimicry: An electromyographic study

ABSTRACT

Emotional expressions evoke rapid facial reactions in the perceiver that are consistent with the valence of the observed expression. We aimed to investigate whether this robust facial reaction is purely a motor matching response or instead represents underlying affective processes. Participants’ (N = 60) corrugator supercilii and zygomaticus major muscle activity was quantified using facial electromyography (EMG) while they viewed three sets of images; (i) upright happy and angry facial expressions, (ii) inverted happy and angry facial expressions, and (iii) sad and happy eyes and mouth expressions. Participants displayed patterns of EMG responding that were consistent with the affective valence of the emotional expression, as opposed to merely matching the observed stimuli (i.e. a motor matching response). Using a novel methodological approach, these findings provide evidence for the contention that affective processing underlies rapid facial mimicry reactions.     

Electromyographic power spectrum of jaw muscles during clenching in unilateral temporomandibular joint osteoarthritis patients

The relationship between temporomandibular joints (TMJ) osteoarthritis and masticatory muscle disorders is poorly understood. The data are sparse, the results are conflicting, and electromyographic (EMG) power spectrum analysis has not been used. The aims of this study were to compare the differences in EMG power spectrum during, and pressure pain thresholds (PPTs) before and after, sustained clenching in patients with unilateral TMJ osteoarthritis and healthy control subjects. Nineteen patients with unilateral TMJ osteoarthritis without masticatory muscle pain and 20 control subjects were evaluated. We measured EMG amplitudes at maximum voluntary contraction, median frequency from the EMG power spectrum during sustained clenching at 70% and PPTs before and after the clenching in both temporalis and masseter muscles. There were no significant differences in PPT decrease between muscles or between groups during sustained clenching. There were no significant differences in maximum voluntary contraction EMG activity ratios of affected to unaffected sides between groups, or of masseter to temporalis muscles between affected and unaffected side of patients with TMJ osteoarthritis. Median frequencies decreased from the beginning to the end of the sustained clench, and the interaction between group and clench was significant: the median frequency decrease was larger in the osteoarthritis group. Our results suggested that masticatory muscles of patients with unilateral TMJ osteoarthritis are more easily fatigued during sustained clenching than normal subjects.     

Treatment options to improve anorectal function following rectal resection: a systematic review

Aim Common problems after rectal resection are loose stools, faecal incontinence, increased frequency and evacuation difficulties, for which there are various therapeutic options. A systematic review was conducted to assess the outcome of treatment options aimed to improve anorectal function after rectal surgery. Method Publications including a therapeutic approach to improve anorectal function after rectal surgery were searched using the following databases: MEDLINE, PubMed, EMBASE, Pedro, CINAHL, Web of Science, PsychInfo and the Cochrane Library. The focus was on outcome parameters of symptomatic improvement of faecal incontinence, evaluation of defaecation and quality of life. Results The degree of agreement on eligibility and methodological quality between reviewers calculated with kappa was 0.85. Fifteen studies were included. Treatment options included pelvic floor re‐education (n = 7), colonic irrigation (n = 2) and sacral nerve stimulation (SNS) (n = 6). Nine studies reported reduced incontinence scores and a decreased number of incontinent episodes. In 10 studies an improvement in resting and squeeze pressure was observed after treatment with pelvic floor re‐education or SNS. Three studies reported improved quality of life after pelvic floor re‐education. Significant improvement of the Fecal Incontinence Quality of Life Scale was found in three studies after SNS. Conclusion Conservative therapies such as pelvic floor re‐education and colonic irrigation can improve anorectal function. SNS might be an effective solution in selected patients. However, methodologically qualitative studies are limited and randomized controlled trials are needed to draw evidence‐based conclusions.     

生物反馈盆底肌肉锻炼与电刺激治疗产后压力性尿失禁的临床疗效研究

目的：评价神经肌肉刺激治疗仪行盆底康复治疗产后压力性尿失禁的治疗效果。方法将我院2012年1月~2013年12月产后 SUI 妇女分为两组,实验组（90例）采用神经肌肉刺激治疗仪行电诊断和生物反馈临床（biofeedback）联合阴道锥体训练,对照组（90例）采用 Kegel 运动训练进行治疗,并对两组近期疗效进行比对和评价,观察并评价其两组的治疗效果。结果实验组组总有效率为94.4%（85/90）,显著（P ﹤0.05）高于对照组73.3%（66/90）;实验组组治愈率为72.2%（65/90）,显著（P ﹤0.01）高于对照组18.9%（17/90）。表明实验组治疗方案能显著改善中晚期宫颈癌的生存率。结论神经肌肉刺激治疗仪行盆底康复治疗产后压力性尿失禁疗效显著,值得临床推广。     

肌电生物反馈联合康复训练对脑卒中偏瘫患者上肢运动及认知功能的改善效果

目的探讨肌电生物反馈(EMG-BF)联合康复训练对脑卒中偏瘫患者上肢运动及认知功能的改善效果。方法将80例脑卒中偏瘫患者随机分为观察组和对照组,各40例。对照组给予康复治疗,观察组给予康复训练联合EMG-BF治疗。比较两组治疗效果。结果治疗后,两组肩关节外展、外旋、内旋的活动度、上肢各项FMA评分、MoCA、SS-QOL评分均升高,且观察组高于对照组(P<0.05)。结论EMG-BF联合康复训练治疗脑卒中偏瘫患者,可有效改善上肢运动运动、认知功能及生活质量。     

Multifocal enlargement and increased vascularization of peripheral nerves detected by sonography in CIDP: A pilot study

ObjectiveDetection of nerve enlargement in polyneuropathies by sonography is a new research area. No systematic investigation has been done yet in chronic inflammatory demyelinating polyneuropathy (CIDP). Therefore we investigated this in CIDP.MethodsEleven patients with CIDP fulfilling the international criteria on CIDP underwent ultrasonographic examination of the median, ulnar, fibular and posterior tibial nerves and sometimes the brachial plexus bilaterally, using a standardized protocol. We assessed presence of nerve thickening and increased nerve vascularization.ResultsIn 7 of the 11 patients multiple nerve enlargements were detected: ulnar nerve 7, fibular nerve 5, posterior tibial nerve 4 and median nerve in 4 patients. The number of enlarged nerves was related with the MRC sum-score (p = 0.03) and the total protein in the cerebrospinal fluid (CSF) at diagnosis (p = 0.02). Increased vascularization was seen in 6 of the 11 patients: 4 in one nerve and in 2 in multiple nerves. The number of nerves with increased vascularization was associated with the number of enlarged nerves (p = 0.01) and total protein in the CSF (p = 0.006).ConclusionMultiple nerve enlargements occur in CIDP showing a relation with a lower MRC sum-score, increased nerve vascularization and a higher total protein of the CSF.SignificanceOur findings of nerve enlargement and increased nerve vascularization may be tools to monitor disease activity in CIDP, but further studies are needed.     

Is there a polysomnographic signature of augmentation in restless legs syndrome?

Objective

Augmentation of restless legs syndrome (RLS) is a potentially severe side-effect of dopaminergic treatment. Data on objective motor characteristics in augmentation are scarce. The aim of this study was to investigate in detail different variables of leg movements (LM) in untreated, treated, and augmented RLS patients.

Methods

Forty-five patients with idiopathic RLS [15 untreated, 15 treated (non-augmented), 15 augmented] underwent RLS severity assessment, one night of video-polysomnography with extended electromyographic montage, and a suggested immobilization test (SIT).

Results

Standard LM parameters as well as periodicity index (PI) and muscle recruitment pattern did not differ between the three groups. The ultradian distribution of periodic leg movements (PLM) in sleep during the night revealed significant differences only during the second hour of sleep (P < 0.05). However, augmented patients scored highest on RLS severity scales (P < 0.05) and were the only group with a substantial number of PLM during the SIT.

Conclusion

This study demonstrates that polysomnography is of limited usefulness for the diagnosis and evaluation of RLS augmentation. In contrast, the SIT showed borderline differences in PLM, and differences on subjective scales were marked. According to these results, augmentation of RLS is a phenomenon that predominantly manifests in wakefulness.     

The face of control: Corrugator supercilii tracks aversive conflict signals in the service of adaptive cognitive control

Cognitive control is the ability to monitor, evaluate, and adapt behavior in the service of long-term goals. Recent theories have proposed that the integral negative emotions elicited by conflict are critical for the adaptive adjustment of cognitive control. However, evidence for the negative valence of conflict in cognitive control tasks mainly comes from behavioral studies that interrupted trial sequences, making it difficult to directly test the link between conflict-induced affect and subsequent increases in cognitive control. In the present study, we therefore use online measures of valence-sensitive electromyography (EMG) of the facial corrugator (frowning) and zygomaticus (smiling) muscles while measuring the adaptive cognitive control in a Stroop-like task. In line with the prediction that conflict is aversive, results showed that conflict relative to non-conflict trials led to increased activity of the corrugator muscles after correct responses, both in a flanker task (Experiment 1) and in a prime-probe task (Experiment 2). This conflict-induced corrugator activity effect correlated marginally with conflict-driven increases in cognitive control in the next trial in the confound-minimalized task used in Experiment 2. However, in the absence of performance feedback (Experiment 3), no reliable effect of conflict was observed in the facial muscle activity despite robust behavioral conflict adaptation. Taken together, our results show that facial EMG can be used as an indirect index of the temporal dynamics of conflict-induced aversive signals and/or effortful processes in particular when performance feedback is presented, providing important new insights into the dynamic affective nature of cognitive control.