表面肌电在肘关节骨折术后患者运动功能评估中的应用

目的 探讨肘关节术后患者在肘关节最大等长收缩和肘关节屈伸运动中肩肘肌群表面肌电(sEMG)信号的特征。方法 选择北京积水潭医院康复科2021年8月至2022年4月肘关节术后恢复期患者15例(患者组)和与之匹配的健康人11例(对照组)。分别在肘关节做最大等长收缩和肘关节屈伸活动时,记录肱二头肌、肱三头肌、肱桡肌、斜方肌上束、三角肌前束、三角肌中束以及三角肌后束的sEMG信号,计算相应肌肉的均方根值(RMS)、协同收缩率(CSR)、共激活率(CR)和屈伸活动中目标肌肉的激活百分比。结果 屈、伸肘最大等长收缩时,患者组肱二头肌和肱三头肌的最大肌力均明显小于对照组(|t|> 4.109, P <0.01);伸肘最大等长收缩时,患者组肱三头肌的RMS显著小于对照组(t=-7.695, P <0.001)。伸肘最大等长收缩时,患者组肱二头肌、肱桡肌的CR均大于对照组(t> 2.326, P <0.05);屈肘最大等长收缩时,患者组斜方肌上束CSR大于对照组(t=2.232, P <0.05)。屈肘活动时,患者组肱三头肌的激活水平大于对照组(t=3.336, P ...     

偏瘫肩痛患者肩胛肌肉的表面肌电特征研究

目的:应用表面肌电技术探讨偏瘫肩痛患者在上肢特定功能动作中肩胛肌肉的表面肌电特征。方法:选取2019年1月至2019年6月在无锡市同仁康复医院住院的脑卒中后偏瘫肩痛者21例作为偏瘫肩痛试验组(HSP组);年龄、性别以及其他因素与HSP组相匹配的健康志愿者22例为健康对照组。应用表面肌电技术记录HSP组患侧和对照组利手侧上斜方肌(upper trapezius,UT)、中斜方肌(middle trapezius,MT)、下斜方肌(lower trapezius,LT)和前锯肌(serratus anterior,SA)在最大等长收缩(MVIC)以及"够物"动作中的表面肌电信号,原始信号经处理后对比分析肌电特征,包括目标肌肉激活水平(MVIC%)和激活比率(UT/LT、UT/SA、MT/SA)。结果:(1)比较"够物"动作过程中各目标肌肉激活水平:HSP组UT激活水平(MVIC%)大于健康对照组,具有显著差异(P0.01);SA和LT激活水平明显小于对照组(P0.01);两组之间MT的MVIC%值无显著性差异(P0.05)。(2)各目标肌肉的在"够物"过程中UT/LT、UT/SA、MT/SA激活比率情况对比:HSP组的UT/LT、UT/SA、MT/SA的激活比率均高于健康对照组(P0.05)。结论:偏瘫肩痛患者在够物过程中表面肌电存在异常特征性改变。在运动学上,表面肌电用于评估该类患者肩胛骨的运动具有相当可行性,可定量评估其运动功能障碍并为临床康复治疗提供客观指导。     

表面肌电在评估偏瘫患者肘关节肌张力中的应用

目的探索肱二头肌、肱三头肌表面肌电(sEMG)特征与偏瘫患者肘关节肌张力的关系。方法同一治疗师对37 例脑损伤后偏瘫患者的患侧肘关节进行改良Ashworth 量表(MAS)评估,同时用sEMG记录被动活动时肱二头肌和肱三头肌的表面肌电信号。结果经Spearman 相关分析,被动屈肘时,肱二头肌(r=0.651)、肱三头肌(r=0.912)、肱三头肌+肱二头肌(r=0.905)、肱三头肌-肱二头肌(r=0.903)的均方根值(RMS)与MAS 相关(P<0.001);被动伸肘时,肱二头肌(r=0.848)、肱三头肌(r=0.518)、肱三头肌+肱二头肌(r=0.850)、肱二头肌-肱三头肌(r=0.711)的RMS 与MAS 相关(P<0.001)。结论sEMG 能检测主动肌和拮抗肌的肌电活动,对临床肌张力评估和痉挛的治疗提供量化的参考。     

应用表面肌电图评定乒乓球运动员的上肢肌疲劳

目的:对北京市优秀乒乓球运动员进行提拉弧圈球训练时握拍上肢主要做功肌肉表面肌电(surfaceelectromyography,sEMG)信号进行分析,利用时、频域指标的变化来评价上肢肌疲劳情况。方法:北京市乒乓球队7名男性运动员,进行乒乓球训练的主要内容为提拉弧圈球训练,采集准备活动后训练开始与训练结束前各20min的握拍上肢:肱三头肌、肱二头肌、肱桡肌、三角肌、腕屈肌和腕伸肌肌电信号,利用Megawin软件进行平均功率频率(meanpowerfrequency,MPF),中位频率(medianfrequency,MF),均方根振幅(root-mean-square,RMS)的分析,两个实验测试阶段的频域和时域值的差异性利用t检验进行统计处理。结果:第2阶段所测六块肌肉的MPF,MF均比第1阶段的明显降低(P<0.001),具有非常显著性差异;第2阶段与第1阶段的RMS值相比,所测肌肉的RMS值变化趋势不稳定。结论:频域指标MPF,MF可较敏感地反映乒乓球训练上肢肌肉功能状况,可作为评价肌肉动态负荷水平的生理学指标。     

应用表面肌电图评定优秀竞走运动员20 km训练中的肌疲劳

目的通过动态肌电分析方法对20 km定量负荷竞走运动员疲劳过程中肌肉的功能状态变化做出评价,找出该运动员的定量负荷疲劳阈值.方法北京田径队竞走运动员20 km定量负荷竞走训练,取全程的表面肌电图信号用Megawin软件进行时、频域分析.对主要做功肌肉股外侧肌和胫骨前肌的表面肌电图(surface electromyography,sEMG)信号进行全程动态分析,计算平均功率频率(mean power frequency,MPF)和平均振幅(average electromyography,AEMG)的变化.结果竞走开始时肌肉放电节奏非常有规律,竞走结束前股外侧肌与胫骨前肌的肌电活动振幅较竞走开始时明显增高;竞走至15 km时出现AEMG增高,MPF下降;频域指标MPF与竞走距离呈明显负相关(r=-0.758,P＜0.001).结论sEMG的AEMG和MPF能反映运动员20 km竞走的肌肉功能状况;定量负荷20 km竞走运动过程中,该运动员在15 km时开始出现肌肉的疲劳.     

实时剪切波弹性成像对颈肩部肌筋膜疼痛综合征阿是穴针刺疗效评估

目的 探讨实时剪切波弹性成像（SWE）对颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗后的效果评估价值。方法 应用SWE技术定量测量30例颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗前后斜方肌疼痛触发点的弹性模量值及弹性评分,并且测量患者治疗前后的疼痛视觉模拟评分（VAS）。结果 针刺治疗前患者VAS评分与斜方肌MTrPs杨氏模量值及弹性评分均呈明显正相关(r=0.572, P<0.001;r=0.474, P=0.008),经阿是穴针刺治疗后,MPS患者VAS评分较治疗前减低(t=10.02, P<0.001),斜方肌MTrPs超声弹性成像评分 (t=6.34, P<0.001)及杨氏模量值(t=33.36,P<0.001)明显降低,差异均具有统计学意义;经针刺治疗后?VAS、?杨氏模量值与?弹性评分均呈明显正相关(r=0.611, P<0.001;r=0.561, P=0.001)。 结论 实时剪切波弹性成像能客观有效评估颈肩部肌筋膜膜疼痛综合征阿是穴针刺疗效。     

不同干预方式对斜方肌在运动中激活模式的影响

目的 分析正常人斜方肌的激活特征,观察不同干预方式对斜方肌异常者激活模式恢复的作用.方法 2017年9月至10月,互联网招募肩关节正常人(正常组,n=20)和肩关节不适者(观察组,n=20),在无干预、上斜方肌(UT)静力牵拉、下斜方肌(LT)等长收缩和组合干预后,均完成直臂侧上举、坐姿划船和反向飞鸟动作.测试记录肌电...     

鼻咽癌放疗后患者吞咽时颏下肌群和舌骨下肌群表面肌电信号特征分析

目的 研究鼻咽癌（NPC）放疗后患者吞咽时颏下肌群和舌骨下肌群的表面肌电信号特征。 方法 选取经吞咽造影检查证实存在咽期吞咽障碍的NPC放疗后患者15例，设为患者组，另选取健康受试者15例设为健康组，采用表面肌电图（sEMG）进行检测，分别记录受试者干吞咽和吞咽3ml浓流质时颏下肌群和舌骨下肌群的sEMG信号，对2组受试者的肌电活动持续时间、平均振幅和峰值进行比较。 结果 患者组在干吞咽和吞咽3ml浓流质时颏下肌群和舌骨下肌群的sEMG持续时间［干吞咽时颏下肌群和舌骨下肌群的sEMG持续时间分别为（1.94±0.60）s（3.43±0.94）s；吞咽3ml浓流质时颏下肌群和舌骨下肌群的sEMG持续时间分别为（1.96±0.61）s和（3.45±0.92）s］较健康组均显著延长，组间差异均有统计学意义（P<0.05），且患者组吞咽3ml浓流质时颏下肌群和舌骨下肌群的sEMG持续时间显著长于干吞咽时，差异均有统计学意义（P<0.05）。患者组在干吞咽和吞咽3ml浓流质时颏下肌群和舌骨下肌群的sEMG峰值和平均振幅均显著高于健康组，组间差异均有统计学意义（P<0.05），且患者组吞咽3ml浓流质时颏下肌群和舌骨下肌群的sEMG峰值和平均振幅亦显著高于干吞咽时，差异均有统计学意义（P<0.05）。 结论 NPC放疗后患者吞咽时颏下肌群和舌肌下肌群表现为强化收缩，可在吞咽过程中发挥代偿作用。     

高频超声检测扩张型心肌病患者颈总动脉弹性和内中膜复合体厚度

目的探讨劲总动脉早期结构改变在扩张型心肌病(DCM)疾病诊断中的意义。方法采用高频超声检测DCM患者和正常健康人颈总动脉弹性和内中膜复合体厚度(IMT),比较两者劲总动脉弹性(Ep和β)和IMT的差异,分析IMT与Ep及β相关性。结果 DCM组和CON组研究对象收缩压、舒张压、脉压、收缩期内径和舒张期内径的差异无统计学意义(P>0.05)。DCM组Ep、β和IMT均显著高于CON组(P<0.001),而内径差也显著低于CON组(P<0.001)。DCM组和CON组研究对象中性别构成比在Ep、β和IMT的差异无统计学意义(P>0.05)。CON组中IMT与Ep(r=0.62,P=0.006)和β(r=0.65,P=0.003)分别正相关;DCM组中IMT与Ep(r=0.82,P<0.001)和β(r=0.80,P<0.001)分别正相关。结论扩张型心肌病患者劲总动脉IMT增厚,动脉弹性降低,检测上述指标对扩张型心肌病诊断具有重要意义。     

俯卧撑运动对翼状肩患者肩周肌群表面肌电信号的影响

目的 探讨在不同倾角斜面上进行俯卧撑运动对翼状肩患者上斜方肌（UT）、胸大肌（PM）及前锯肌（SA）肌电信号的影响,为翼状肩患者康复训练提供参考依据。 方法 选取16例翼状肩患者纳入实验组,同时选取性别、年龄、身高及体重与之相匹配的健康志愿者纳入对照组。2组受试者分别在0°、30°、60°、90°倾角斜面上进行俯卧撑运动,在运动过程中采集受试者UT、PM及SA肌电信号,以肌电信号最大振幅平均值与最大自主等长收缩（MVIC）时肌电值的百分比表示该肌肉活动水平;通过分析SA/UT比值以评价受试者SA与UT间的平衡程度。 结果 实验组与对照组在不同倾角斜面上进行俯卧撑时其UT肌电值组内差异均无统计学意义（P>0.05）;实验组在30°、60°倾角俯卧撑时其UT肌电值［分别为(10.67±7.20)和（9.11±7.28)］较对照组显著增大（P<0.05）。实验组在0°倾角俯卧撑时其SA肌电值（65.17±13.52）较30°、60°、90°倾角俯卧撑时显著增大（P<0.05）,在30°倾角俯卧撑时SA肌电值（49.38±17.30）较60°、90°倾角俯卧撑时显著增大（P<0.05）;对照组在0°倾角俯卧撑时其SA肌电值（73.48±13.45）较60°、90°倾角俯卧撑时显著增大（P<0.05）,在30°倾角俯卧撑时其SA肌电值（61.32±23.65）较60°倾角俯卧撑时显著增大（P<0.05）;组间比较发现实验组在不同倾角俯卧撑时其SA肌电值均明显小于对照组（P<0.05）。实验组在0°倾角俯卧撑时SA/UT比值（9.16±4.41）较30°、60°、90°倾角俯卧撑时显著增大（P<0.05）,在30°倾角俯卧撑时SA/UT比值（6.24±4.08）较90°倾角俯卧撑时显著增大（P<0.05）;对照组在不同倾角俯卧撑时其SA/UT比值均无明显变化（P>0.05）;实验组在不同倾角俯卧撑时其SA/UT比值均较对照组明显减小（P<0.05）。 结论 俯卧撑运动可显著激活翼状肩患者和正常人SA,在0°倾角进行俯卧撑训练对激活翼状肩患者SA及调节SA与UT间平衡尤为显著。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.