重复经颅磁刺激应用于脑卒中后认知并摄食障碍患者的疗效观察

目的:观察重复经颅磁刺激(rTMS)对脑卒中后认知并摄食障碍患者的认知及摄食功能的疗效。方法:将60例脑卒中后具有认知障碍和摄食障碍的患者随机分为对照组和观察组各30例。2组患者均给予常规药物治疗、常规认知训练及常规摄食训练，观察组另外行rTMS治疗，疗程共4周。于治疗4周前后评估患者认知及摄食功能变化情况。结果:治疗4周后，2组患者简易精神状态量表(MMSE)评分、24h摄入量均较治疗前显著提高(P<0.01),荧光透视吞咽困难量表(VDS)评分、口腔转运时间(OTT)及软腭上抬时间(SET)数值均较前治疗前显著缩短(P<0.01);治疗4周后，观察组MMSE评分、24h摄入量均较对照组升高(P<0.01),VDS评分、OTT及SET数值较对照组缩短(P<0.01)。观察组治疗后MMSE评分与24h摄入量呈显著正相关(rs=0.757,P<0.01),MMSE评分与VDS评分呈负相关(rs=-0.432,P<0.05),MMSE评分与OTT数值呈负相关(rs=-0.422,P<0.05),MMSE评分与SET数值呈负相关(rs=-0.430,...     

虚拟现实技术联合重复经颅磁刺激治疗帕金森病轻度认知障碍的临床疗效观察

目的:探讨虚拟现实技术联合重复经颅磁刺激对帕金森病患者轻度认知障碍的临床疗效。方法:将帕金森病患者64例随机分成对照组和观察组各32例，对照组予以常规认知训练和重复经颅磁刺激治疗，观察组予以虚拟现实技术联合重复经颅磁刺激治疗，并在治疗前、治疗8周后，采用蒙特利尔认知测试(MoCA)、简易精神状态检查(MMSE)、统一帕金森病评分量表第三分量表(UPDRSⅢ)、改良Barthel指数评定量表(MBI)对患者的认知功能和日常生活活动能力进行评定，并采用帕金森病生存质量问卷(PDQ-39)总评分评价临床疗效。结果:治疗8周后，2组MMSE评分较治疗前均有明显提高(P<0.01),组间MMSE评分的比较仅记忆力在治疗后观察组优于对照组(P<0.05),余亚项及总分的比较均无统计学意义；观察组视空间与执行功能、记忆评分及MoCA总评分较治疗前均明显提高(P<0.01),注意评分较治疗前提高(P<0.05),且治疗后观察组视空间与执行功能、记忆评分及MoCA总评分明显优于对照组(P<0.01),注意评分在治疗后优于对照组(P<0.05)。2组MBI评分较治疗前均...     

认知训练联合高压氧治疗脑外伤后认知障碍的临床观察

目的观察认知训练联合高压氧治疗脑外伤后认知障碍的临床效果。方法 64例脑外伤后认知障碍患者随机分为观察组和对照组各32例,两组均接受基础药物治疗、常规康复治疗和计算机辅助认知功能训练,观察组增加高压氧治疗。治疗前和治疗4周后分别进行简易精神状态量表(Mini-Mental State Examination,MMSE)和蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评定结果。治疗后对照组和观察组MMSE和MoCA评分均高于治疗前,差异有统计学意义(P0.05)。对照组和观察组比较,治疗后观察组的MMSE和MoCA评分明显高于对照组,差异有统计学意义(P0.05)。结论计算机辅助认知训练联合高压氧治疗可有效改善脑外伤患者认知功能。     

通督调神针法对中风后轻度认知障碍临床疗效观察

目的:根据神经心理学量表,观察通督调神针法治疗中风后轻度认知功能障碍的疗效。方法:通过神经心理学量表评定,将符合轻度认知功能障碍诊断的90例患者随机分为治疗组、针刺组、药物组,每组各30例。治疗组采用通督调神针刺治疗,针刺对照组采用调神通络针刺治疗,药物组采用药物治疗.均治疗4周。3组均在治疗前后进行神经心理学量表评定,并进行治疗前后及2组间对比。结果:通过MMSE与MOCA量表评分,3组治疗后均高于同组治疗前(P0.05),治疗组MMSE与MOCA积分改善优于针刺对照组及药物对照组(P0.05)。结论:通督调神针法对改善中风后轻度认知功能障碍患者的认知功能具有临床意义,是一种临床有效的治疗方法。     

高频重复经颅磁刺激对脑卒中后非痴呆型血管性认知障碍患者的疗效观察

目的:探讨高频重复经颅磁刺激(rTMS)对脑卒中后非痴呆型血管性认知障碍患者认知功能的影响。方法:入选脑卒中后非痴呆型血管性认知障碍(VCIND)患者60例,随机将其分为观察组和对照组各30例,2组患者均给予药物治疗和常规康复训练,观察组在此基础上增加高频rTMS治疗。2组患者均于治疗前、治疗6周后进行简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MOCA)和改良Barthel指数(MBI)评定。结果:治疗后,2组患者的MMSE、MOCA及MBI评分均较治疗前明显提高(P0.05),观察组上述评分较对照组提高更明显(P0.05)。结论:高频rTMS可改善脑卒中后非痴呆型血管性认知障碍患者的认知功能以及进食、个人卫生、洗澡、穿衣、如厕、上下楼梯和平地步行等日常生活自理能力。     

高压氧联合认知训练治疗脑卒中后认知障碍的疗效观察

目的:观察高压氧联合认知训练对脑卒中后认知障碍患者的疗效。方法:90例脑卒中后认知障碍患者随机分为对照组、高压氧组和联合治疗组,每组30例,各组均接受基本药物和常规康复治疗,高压氧组增加高压氧治疗,联合治疗组增加高压氧治疗和认知训练,分别于治疗开始前和治疗4周后进行简易智能状态评定表(MMSE)、蒙特利尔认知评估量表(MoCA)评定。结果:治疗后,高压氧组MMSE评分较治疗前差异不明显,MoCA评分较治疗前明显提高(P0.05);联合治疗组治疗后MMSE及MoCA评分均较治疗前明显提高(P0.05,0.01);对照组两个评分较治疗前差异均无统计学意义。治疗后,联合治疗组治疗后MoCA评分较高压氧组及对照组治疗后明显提高(P0.05),治疗后3组间MMSE评分差异无统计学意义。结论:高压氧可改善脑卒中患者认知功能,但作用有限,高压氧联合认知训练更有利于改善脑卒中后认知功能。     

重复经颅磁刺激结合计算机认知训练对脑卒中患者认知功能评估和日常生活能力分析

目的:探讨重复经颅磁刺激(rTMS)结合计算机认知训练对脑卒中患者认知功能和日常生活能力的影响。方法:脑卒中患者84例随机分为观察组与对照组各42例,2组患者均予以常规药物治疗及康复训练,观察组在此基础上增用RTMS以及计算机认知训练。分别比较2组在干预前后认知功能、日常生活能力、生活质量变化情况以及患者满意度情况等方面的差异。结果:治疗4周后,2组MMSE评分、MoCA评分、Barthel指数及SS-QOL评分均较干预前明显提高(P<0.05,0.01),且观察组各项评分均明显高于对照组(P<0.05,0.01)。治疗后,2组患者满意度比较,观察组明显优于对照组(P<0.05)。结论:rTMS结合计算机认知训练可显著改善脑卒中患者的认知功能,同时有效提高日常生活能力以及生活质量,改善患者满意度,值得临床推广应用。     

头穴丛刺法联合认知训练对脑梗死后认知功能障碍的影响

目的:观察头穴丛刺法联合认知训练治疗脑梗死后认知功能障碍的疗效。方法:脑梗死后认知功能障碍患者60例,随机分为观察组及对照组各30例。2组均给予认知训练,观察组加用头穴丛刺疗法。治疗前后评定简明精神状态量表(MMSE)、血浆皮质醇水平、事件相关电位变化。结果:治疗4周后,2组MMSE评分均较治疗前显著提高,且观察组提高更显著(均P<0.01);2组血浆皮质醇水平均较治疗前明显下降,且观察组下降更显著(均P<0.01);2组事件相关电位中的P3潜伏时均较治疗前明显缩短(P<0.01,0.05),且观察组更短于对照组(P<0.01);观察组P3波幅较治疗前显著提高(P<0.05)。结论:头穴丛刺疗法联合认知训练可更好地改善脑梗死患者认知障碍程度,值得临床推广、应用。     

虚拟现实技术联合下肢康复机器人训练对缺血性脑卒中患者下肢功能及平衡能力影响的研究

目的:探讨虚拟现实技术联合下肢康复机器人训练对缺血性脑卒中患者下肢功能及平衡能力的影响。方法:收集60例缺血性脑卒中下肢功能障碍患者,随机分为对照组和观察组各30例,对照组进行常规康复训练和Lokomat下肢机器人训练,观察组在此基础上再联合虚拟现实技术,治疗前和治疗4周后分别对2组患者进行Berg平衡量表(BBS)、Fugl-Meyer下肢运动功能量表(FMA-LE)、功能性步行量表(FAC)评定。结果:治疗4周后,2组患者BBS和FMA-LE评分较治疗前均明显提高(均P<0.01),且观察组以上评分均更高于对照组(均P<0.05);2组患者FAC分级较治疗前均明显改善(均P<0.01),且观察组分级较对照组改善更显著(P<0.05)。结论:虚拟现实技术联合下肢康复机器人训练能改善缺血性脑卒中患者的下肢功能及平衡能力。     

计算机辅助认知训练治疗卒中后认知功能障碍的多中心随机对照研究

目的 研究计算机辅助认知训练治疗卒中后认知功能障碍的临床疗效。 方法 筛选31家医院就诊的脑卒中后血管性认知功能障碍患者155例,按随机数字表法分为对照组和观察组两组,失访6例,最终对照组72例,观察组77例。对照组给予脑卒中后常规认知训练,每日训练30 min,5 d/周,共治疗2周;观察组应用计算机辅助认知训练,每日训练30 min,5 d/周,共治疗2周。分别于治疗前和治疗2周后（治疗后）,采用简易精神状态评价量表（MMSE）以及蒙特利尔认知测验(MoCA)评估2组患者的总体认知功能。 结果 ①治疗后,2组患者的MMSE评分［观察组（22.55±3.62）分;对照组（21.75±4.30）分］和MoCA评分［观察组（19.69±4.43）分;对照组（19.10±5.58）分］均较组内治疗前［MMSE总分（19.34±3.08）和（19.74±3.11）分;MoCA总分（16.79±4.58）和（17.74±5.25）分］有明显改善（P＜0.05）,但观察组治疗后的MMSE评分总分及MoCA评分总分与对照组组间比较,差异均无统计学意义（P＞0.05）。②治疗后,观察组患者MMSE量表中的即刻记忆、计算力和注意力、延迟记忆三个分项目均较对照组有明显提高,且组间差异有统计学意义（P＜0.05）。 结论 卒中后认知功能障碍的患者能够通过计算机辅助认知训练改善其整体的认知功能,达到与常规认知训练相等的治疗效果;并在提高即刻记忆、计算能力以及延迟记忆三方面认知能力方面较卒中后常规认知治疗的疗效更为突出。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.