电针头穴及督脉穴治疗帕金森病:随机对照观察

目的:观察电针头穴及督脉穴对帕金森病的临床效果,分析其治疗机制。方法:64例患者随机分为治疗组36例,对照组28例,治疗组在西药美多巴治疗基础上采用电针头部穴位和督脉穴疗法,对照组单纯西药美多巴治疗,15d为1个疗程,共4个疗程,对比观察两组治疗前后Web-ster评分变化情况。结果:治疗组患者显效11例,有效20例,无效5例,总有效率86%(31/36)。对照组显效7例,有效10例,无效11例,总有效率61%(17/28)。两组总有效率比较差异有显著性意义(χ2=5.42,P<0.05)。两组治疗后Webster积分分别为(6.73±0.61),(11.23±0.63),两者比较差异有非常显著性意义(t=28.86,P<0.01)。两组10项继发损害例数均减少。结论:电针头穴及督脉穴可有效改善帕金森病继发性损伤障碍。     

重复局部肌肉振动疗法对脑卒中偏瘫早期患者上肢功能恢复的效果

目的观察重复局部肌肉振动疗法对脑卒中偏瘫早期患者上肢功能恢复的影响。方法 2016年10月至2018年2月,选择在本院住院的脑卒中偏瘫早期患者46例分为对照组(n=23)和观察组(n=23)。两组均接受常规康复治疗。观察组在此基础上,进行重复局部肌肉振动,分别作用于患者的掌心、前臂桡侧腕伸肌腱、肱二头肌及肩胛周围肌肉;对照组接受相同时长的安慰刺激。每天1次,每周5 d,共4周。分别于治疗前、治疗后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、运动力指数上肢部分(MI-UE)、偏瘫上肢功能测试(香港版)(FTHUE-HK)对上肢功能进行评定。结果治疗后,两组FMA-UE、MI-UE及FTHUE-HK评分均较治疗前提高(F2.577,P0.05),且观察组各评分均高于对照组(t2.153,P0.05)。结论重复局部肌肉振动疗法有助于提高偏瘫早期患者上肢功能的恢复。     

改良推拿手法配合关节松动术改善粘连性肩关节周围炎关节活动范围

目的探讨改良推拿手法配合关节松动术治疗粘连性肩关节周围炎的疗效。方法采用改良推拿手法配合关节松动术治疗粘连性肩关节周围炎35例,同时选择35例作为对照组,采用超短波配合中频电疗综合治疗。结果治疗组与对照组比较,治疗组平均治疗时间(10±5)d,痊愈28例,显效7例;对照组平均治疗时间(30±10)d,痊愈21例,显效14例。两组疗效比较差异有极显著性意义(χ2=6.59,P<0.01)。结论改良推拿手法配合关节松动术治疗粘连性肩关节周围炎能更有效改善关节功能。     

针刺治疗脑卒中后抑郁状态的效果分析

目的观察针刺对脑卒中后抑郁状态的治疗效果及对运动功能康复的影响。方法从353例脑卒中患者中选择合并脑卒中后抑郁状态患者129例,分为针灸治疗组89例,多塞平对照组40例。治疗组采用醒脑开窍、舒神开郁、调畅气机针刺法治疗。结果治疗组治疗前汉密顿抑郁量表(HAMD)总评分平均为(19.35±4.33)分,治疗后HAMD总评分平均为(11.12±5.45)分,治疗前后对比差异有显著性意义(t=11.1543,P<0.01),其中临床治愈24例,显效26例,有效31例,无效8例,总有效率为91.0%。对照组,治疗前HAMD总评分平均为(20.02±4.87)分,治疗后HAMD总评分平均为(15.63±6.79)分,治疗前后对比差异有显著性意义(t=3.3228,P<0.01)。其中临床治愈6例,显效7例,有效14例,无效13例,总有效率为67.5%。治疗组和对照组治疗前后MBI,FMA评分比较,差异有显著性意义(t=53.5999,24.2105,P<0.01;t=12.0491,8.6385,P<0.01)。两组总有效率比较差异有显著性意义(χ2=11.1930,P<0.01)。结论针刺疗法与多塞平均能改善脑卒中后抑郁状态且能促进患者运动功能恢复,但针刺组总有效率高于多塞平治疗组。     

电脑中频与温热疗法运动训练综合治疗跖痛症

目的研究以电脑中频疗法、温热疗法、运动疗法、ADL指导为主的综合治疗对跖痛症的康复效果。方法将 70例跖痛症患者随机分为 2组 :对照组 3 5例 ,予常规治疗方法进行处理 ;治疗组 3 5例 ,加用电脑中频疗法、温热疗法、运动疗法及ADL指导等综合治疗 ,3个疗程后采用简易 (足部 )行走能力评分量表对患者进行疗效评价。结果对照组治愈 14例、显效 8例、有效 10例、无效 3例 ;治疗组治愈 2 2例、显效 7例、有效 5例、无效 1例 ;经两样本比较秩和检验 ,u =2 0 9,P <0 0 5。行走能力评分治疗前后差值的均数 :对照组为 ( 2 8 0 0± 2 0 2 6)分 ,治疗组为 ( 3 8 2 9± 2 1 3 5 )分 ,t =2 0 7,P <0 0 5。平均治愈天数 :治疗组为 ( 18 0 0±6 45 )天 ,少于对照组 ( 2 3 0 0± 7 64 )天 ,t=2 11,P <0 0 5。结论综合治疗对跖痛症康复效果显著。     

面部运动疗法结合穴位按压治疗贝尔面瘫的临床观察

目的探讨运用面部运动疗法结合穴位按压治疗贝尔面瘫的有效性。方法58 例贝尔面瘫患者随机分为对照组(n=29)和观察组(n=29)。对照组进行常规治疗;观察组除常规治疗外,增加面部肌肉运动疗法和穴位按压治疗。治疗前、治疗2 周和治疗4 周时两组分别进行面神经功能评分和疗效评估。结果对照组平均治疗时间为(29.62±12.15) d,观察组为(25.63±11.56) d,两组相比无显著性差异(P>0.05)。两组总有效率为100%。对照组完全恢复率58.6%,观察组72.4%,但无显著性差异(P>0.05)。随着治疗时间的延长,两组面神经功能评分显著降低(F=176.578, P<0.001)。两组相比,仅治疗2 周时观察组面神经功能评分低于对照组(P<0.05)。但观察组的面神经功能评分始终存在低于对照组的趋势。结论面部运动疗法结合穴位按压治疗有促进贝尔面瘫恢复的趋势。     

亚低温联合治疗脑溢血的疗效观察

选取200例脑溢血患者为研究对象,随机分作观察组和对照组各100例,观察组接受亚低温联合治疗,对照组接受常规治疗,比较两组的临床疗效、治疗前后神经功能缺损程度评分、治疗前后日常生活活动能力。观察组总有效率(87%)优于对照组(64%),差异明显有统计学意义(χ2=4.39,P<0.05);治疗后观察组神经功能缺损程度评分(9.33±1.23)分优于对照组的(11.21±1.44)分,差异明显,有统计学意义(t=3.58,P<0.05);治疗后观察组日常生活活动能力评分(71.18±1.95)分优于对照组(66.73±1.89)分,差异明显,有统计学意义(t=4.62,P<0.05)。在脑溢血的临床治疗中,亚低温联合疗法具有较为理想的临床疗效,同时在改善神经功能缺损及日常生活活动能力方面也表现出了良好的效果,值得临床步推广应用。     

针刺配合运动疗法治疗膝关节骨性关节炎临床观察

目的:观察针刺配合运动疗法治疗膝关节骨性关节炎的临床疗效。方法:将临床确诊的膝关节骨性关节炎患者70例(共98膝)随机分为2组,治疗组35例(50膝)采用针刺配合运动疗法治疗,对照组35例(48膝)予双氯芬酸钠缓释片内服。各组处理前均根据《中药新药临床研究指导原则》中所制定的症状、体征分级量化表,作为观察量化指标并评定积分,并在治疗20次后再次评分以判定治疗效果。结果:治疗组显效率明显优于对照组(P<0.05),各组治疗前后评分比较均有显著性差异(P<0.05),且治疗组优于对照组(P<0.05)。结论:针刺结合运动疗法治疗膝关节骨性关节炎临床疗效显著,且副作用少。     

强制性运动方案对脑卒中偏瘫上肢功能障碍患者的疗效

目的:观察强制性运动疗法在脑卒中偏瘫上肢功能障碍患者康复治疗中的疗效。方法:选取脑卒中偏瘫上肢功能障碍患者120例,随机分为观察组62例和对照组58例,对照组予常规康复疗法治疗,观察组予强制性运动疗法治疗,比较两组治疗前后简式Fugl-Meyer运动功能评价量表(FMA)、简易上肢功能检查量表(STEF)和观察改良Barthel指数(MBI)评分。结果:治疗前2组FMA、STEF、MBI评分比较,差异无统计学意义(P>0.05);治疗后,2组FMA、STEF、MBI评分高于治疗前,差异有统计学意义(P<0.05);且治疗后观察组的FMA、STEF、MBI评分高于对照组,差异有统计学意义(P<0.05)。结论:强制性运动疗法在脑卒中偏瘫上肢功能障碍患者康复治疗中的临床疗效较常规康复疗法好。     

依达拉奉辅助治疗急性脑梗死对其早期神经功能缺损康复的影响

目的观察依达拉奉辅助治疗急性脑梗死患者对其早期神经功能缺损康复的影响。方法将符合条件的96例首发脑梗死患者按入院次序随机分为两组,每组48例。采用单盲法分别给予基础治疗及基础治疗加用依达拉奉治疗14d。所有患者出院后均随访至治疗后90d。脑卒中患者临床神经功能缺损评分标准(CSS)于治疗前、治疗后d14、d28、d90,各评定1次,Barthel指数(BI)于治疗后d28、d90各评定1次。结果治疗前两组间CSS评分差异无显著性(CSS:18.52±6.43vs17.22±8.14,t=0.562,P=0.546>0.05),治疗后d14、d28、d90两组间评分差异有显著性意义(CSS:9.25±5.37,6.28±5.56,4.33±2.85vs12.27±8.04,10.03±7.45,7.12±5.26,t=2.468,3.446,3.325,P均<0.05),治疗组均低于对照组,治疗后d28及治疗后d90的BI在依达拉奉组优于对照组,(BI:75.32±27.01,83.20±24.48vs64.05±21.08,72.04±23.85,t=3.426,2.188,P均<0.05),两组急性脑梗死患者用药后综合疗效分析依达拉奉组明显优于对照组(总有效率:93.5%vs79.5%,基本控制率:32.6%vs20.5%,χ2=9.804,P=0.021<0.05)。结论依达拉奉辅助治疗有利于急性脑梗死患者早期神经功能缺损的康复,并能提高患者生活质量,改善预后。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.