BTE系统对颈脊髓损伤后上肢肌力强化训练的效果

目的研究BTE系统对不同病程颈脊髓损伤患者进行上肢肌力强化训练的有效性。方法2019年6月至2020年1月,创伤性完全性C6-7脊髓损伤住院患者60例按病程分为亚急性期组(术后1~2个月,n=15)和恢复期组(术后3~6个月,n=15),术后6个月以上者分为稳定期组和对照组,各15例。对照组行常规综合康复,其余三组每天采用BTE系统行上肢肌力强化训练,共4周。治疗前后,采用上肢运动评分(UEMS)和功能独立性测量(FIM)进行评定,并测量双侧伸肘肌群等长峰值力矩(IPT)和等张极限肌耐力(IEE)。结果治疗后,每组各项评分均明显提高(t>3.500,P<0.01);各组间均有非常高度显著性差异(F>9.257,P<0.001),其中亚急性期组UEMS、IPT最高,恢复期组IEE、FIM最高,稳定期组较差。结论采用BTE系统对颈脊髓损伤患者进行上肢肌力强化训练疗效明显,亚急性期患者上肢运动功能、爆发力恢复更快,恢复期患者耐力和日常生活活动能力进步更快;稳定期患者各项功能也有不同程度提高。     

武汉地区中年长江船员血管健康状况调查

目的 对武汉地区长江航运部门部分中年职工进行血管健康状况调查.方法 采取横断面整群抽样方法,回顾性分析武汉长江航运行政管理单位在职公务员(公务员组,195人)与海事部门在职职工(船员组,217人)体检资料,主要有全自动动脉硬化测定仪记录的四肢血压及左右侧臂-踝脉搏波传导速度(BAPWV)、心-踝脉搏波传导速度(HAPWV)、右侧心-臂脉搏波传导速度(HBPWV)以及收缩时间间期(STI)以及血脂、血糖.结果 船员组高血压患病率为28.6％,公务员组为17.4％,2组比较差异有统计学意义(P＜0.05).女性船员高血压患病率为23.3％(10/43),女性公务员为14.6％(7/48),2组比较差异有统计学意义(P＜0.05);男性船员高血压患病率为29.9％ (52/174),男性公务员为18.4％(27/147),2组比较差异有统计学意义(P＜0.05).用协方差计算,男性公务员代谢正常者51.4岁时BAPWV为(1448.3 ±20.7) cm,95％可信区间为1407.4 ～ 1489.2 cm;船员组为(1372.8± 20.0) cm,95％可信区间为1333.3 ～1412.3 cm.2组比较差异有统计学意义(P＜0.05),2组年龄差异也有统计学意义(P＜0.05).结论 高血压是中年船员血管危险的主要因素.中年男性公务员代谢正常者51.4岁起至少有95％的人存在主动脉僵硬度增高、易患血管粥样硬化的风险.     

Variable velocity encoding in a three‐dimensional,three‐directional phase contrast sequence: Evaluation in phantom and volunteers

Purpose:

To evaluate accuracy and noise properties of a novel time‐resolved, three‐dimensional, three‐directional phase contrast sequence with variable velocity encoding (denoted 4D‐vPC) on a 3 Tesla MR system, and to investigate potential benefits and limitations of variable velocity encoding with respect to depicting blood flow patterns.

Materials and Methods:

A 4D PC‐MRI sequence was modified to allow variable velocity encoding (VENC) over the cardiac cycle in all three velocity directions independently. 4D‐PC sequences with constant and variable VENC were compared in a rotating phantom with respect to measured velocities and noise levels. Additionally, comparison of flow patterns in the ascending aorta was performed in six healthy volunteers.

Results:

Phantom measurements showed a linear relationship between velocity noise and velocity encoding. 4D‐vPC MRI presented lower noise levels than 4D‐PC both in phantom and in volunteer measurements, in agreement with theory. Volunteer comparisons revealed more consistent and detailed flow patterns in early diastole for the variable VENC sequences.

Conclusion:

Variable velocity encoding offers reduced noise levels compared with sequences with constant velocity encoding by optimizing the velocity‐to‐noise ratio (VNR) to the hemodynamic properties of the imaged area. Increased VNR ratios could be beneficial for blood flow visualizations of pathology in the cardiac cycle. J. Magn. Reson. Imaging 2012; 36:1450–1459. © 2012 Wiley Periodicals, Inc.     

Cerebral Blood Flow in Migraine with Aura: A Transcranial Doppler Sonography Study

Transcranial Doppler sonography examination was performed on 44 patients with migraine with aura and 88 controls. All patients were investigated in headache-free periods and 10 of them also during a migraine attack. During the headache-free period a not significant increase of mean flow velocity in patients compared to controls was obtained. The pulsatility index (PI) mean values were also higher in patients than in controls and the differences were significant in the MCA (p < 0.05). No difference between right and left side was observed. During the attack the mean flow velocity (MFV) decreased in all arteries but the decrease was significant only in MCA and ACA (p < 0.05). The mean PI increased in all arteries but not significantly. These variations were observed both on the headache and contralateral side. Nevertheless, the MFV decrease in all arteries was observed in four patients only. In four patients the MFV decrease was found in the anterior arteries and the MFV increase in the posterior arteries, while in two patients the MFV increase was observed both in the anterior and posterior arteries. The correlation between the variations of MFV values during the attacks and the time interval from the onset of attacks showed that the PCA and BA flow velocities were increased in patients examined between 0.5 and 3 hours, while an increase in MCA and ACA flow velocities were observed only in patients examined after 1.5 hours.     

Electrophysiological and functional effects of shock waves on the sciatic nerve of rats

Extracorporeal shockwave therapy (ESWT) has been applied in lithotripsy and treatments of musculoskeletal disorders over the past decade, but its effects on peripheral nerves remain unclear. This study investigated the short-term effects of shockwaves on the sciatic nerve of rats. The nerves were surgically exposed and then stimulated with shockwaves at three intensities. We evaluated the motor nerve conduction velocity (MNCV) of treated sciatic nerves before, immediately after (day 0) and at 1, 4, 7 and 14 d after shockwave treatment. Two functional tests-the sciatic functional index and the withdrawal reflex latency-were evaluated before and at 1, 4, 7 and 14 d after shockwave application. The rats were sacrificed on days 0, 1, 4, 7 and 14 for morphologic observation. The degassed treatment group received high-intensity shockwave treatment using degassed normal saline as the contact medium, and MNCV was measured before and on days 0, 1, 4, 7 and 14. The sham group received the same procedure as the treatment groups (i.e., the surgical operation to expose the sciatic nerve) but with no shockwave treatment. The control group received no surgical operation or shockwave treatment. The results showed moderate decrease in the MNCV after shockwave treatment and damage to the myelin sheath of large-diameter myelinated fibers. The effect was largest (reduction to 60.9% of baseline MNCV) and of longest duration (7 to 14 d) in the high-intensity group. There were no significant changes in functional tests. These results indicated that direct application of shockwaves can induce reversible segmental demyelination in large-diameter fibers, with the electrophysiological changes being positively correlated with the intensity of the shockwaves.     

定量组织速度成像与右心导管法评估肺动脉高压右心室功能的对照分析

目的 探讨定量组织速度成像（QTVI）评估肺动脉高压（PAH）右心室功能的准确性。方法 58例PAH患者入选本研究。常规超声测量右心室舒张末期面积和收缩末期面积（RVEDA，RVESA）并计算右心室面积变化率;获取入选者标准心尖部右心室流入道长轴和四腔观TVI图像，离线分析右心室4个壁三尖瓣环处组织速度曲线，测量右心室游离壁三尖瓣环处收缩期峰值速度（Sa）、舒张早期峰值速度（Ea）、舒张晚期峰值速度（Aa）;依据公式计算右心室4个壁瓣环处Tei指数，取其平均值作为右心室整体心肌做功指数。于超声心动图检查24h内对入选者行右心导管检查，测定每搏量、心输出量、每搏量指数和心脏指数。结果 两种方法测定的右心室功能参数均具有一定的相关性，其中，Tei指数与右心导管测定的右心室功能参数相关性最好，而Aa、Ea与右心导管测定的右心室功能参数呈低度相关，右心室面积变化率、Sa、Ea/Aa与右心导管测定的右心室功能参数呈中度相关。结论 QTVI技术是评估PAH患者右心室功能的可靠准确技术。     

Systematic and differential myelination of axon collaterals in the mammalian auditory brainstem

A brainstem circuit for encoding the spatial location of sounds involves neurons in the cochlear nucleus that project to medial superior olivary (MSO) neurons on both sides of the brain via a single bifurcating axon. Neurons in MSO act as coincidence detectors, responding optimally when signals from the two ears arrive within a few microseconds. To achieve this, transmission of signals along the contralateral collateral must be faster than transmission of the same signals along the ipsilateral collateral. We demonstrate that this is achieved by differential regulation of myelination and axon caliber along the ipsilateral and contralateral branches of single axons; ipsilateral axon branches have shorter internode lengths and smaller caliber than contralateral branches. The myelination difference is established prior to the onset of hearing. We conclude that this differential myelination and axon caliber requires local interactions between axon collaterals and surrounding oligodendrocytes on the two sides of the brainstem. GLIA 2016;64:487–494     

早期足量蛋白质摄入对极低出生体重儿生长影响的临床研究

目的探讨早期足量蛋白质摄入对极低出生体重儿(very low brith weight infant,VLBWI)早期生长速率的影响。方法将出生体重1 000~1 500g并治愈出院的61例VLBWI随机分为研究组[n=31,氨基酸2.0g/(kg·d)开始,1.0g/(kg·d)递增]和对照组[n=30,氨基酸0.5~1.0g/(kg·d)开始,0.5g/(kg·d)递增],比较两组蛋白质、能量摄入情况及蛋白/能量比,血生化指标、体格增长及合并症等,并对两组蛋白质和能量摄入及蛋白/能量比与体格增长速率的关系进行相关分析。结果研究组体重下降幅度比对照组低(6.2%vs 9.5%),恢复至出生体重时间比对照组早(6dvs10d)(P均0.05);平均每周头围增长速率比对照组快[(0.75±0.32)cm vs(0.45±0.25)cm)](P0.05);每日平均体重增长速率比对照组快[(22.3±3.2)g/kg vs(15.1±2.3)g/kg(P0.05);平均每周身长增长速率差异无统计学意义(P0.05)。第3天、第7天总热卡及蛋白质摄入、蛋白/能量比与恢复出生体重后每日平均体重增长速率及平均每周头围增长速率呈正相关(均P0.05)。两组患儿平均血清总胆汁酸及尿素氮水平差异无统计学意义,但平均白蛋白水平研究组明显高于对照组(P0.05)。结论早期足量蛋白质摄入能够降低VLBWI出生早期的体重下降幅度,更早恢复至出生体重,加速住院期间的体重及头围增长速度。     

Bestrophin 1 – Phenotypes and Functional Aspects in Bestrophinopathies

This is to review the current state of knowledge on the functional and clinical aspects of bestrophin 1, a prominent member of a family of proteins involved in the control and properties of the light peak of the EOG. Initially human bestrophin 1 gene (BEST1) mutations were identified to underlie Best vitelliform macular dystrophy (VMD), a dominantly inherited, juvenile-onset form of macular degeneration. In the recent past the phenotypical spectrum of retinal disorders associated with BEST1 mutations has been extended and the term bestrophinopathies was coined. The physiological role of bestrophin 1 is still not completely understood but has been linked to the generation of a transepithelial chloride current by controlling voltage-dependent calcium channels (VDCC). Dysfunction of bestrophin 1 may result in abnormal ion and fluid transport by the retinal pigment epithelium (RPE) disturbing and even disrupting direct interactions between the RPE and the photoreceptors.