基于脑血氧信号近似熵的麻醉深度监测方法研究

目的在全身麻醉状态下,研究麻醉与清醒阶段人脑前额脑血氧的近似熵值,得到一种新的麻醉深度监测指标。方法基于近红外光谱技术,采集了8位病人前额的左侧与右侧、近端与远端的脑血氧中的氧合血红蛋白(HbO_2)和还原血红蛋白(Hb)信号,应用近似熵算法对信号进行处理。结果 HbO_2与Hb信号的近似熵值在麻醉维持阶段大于清醒阶段,并且在这两个阶段之间存在显著性差异,通过ROC曲线分析表明近似熵指标对麻醉与清醒的区分能力较强。通过阈值分析表明近似熵指标能够设定统一的阈值。对左侧与右侧的组合信号进行比较分析,左侧与右侧间无显著性差异。结论本文提出的基于脑血氧信号的近似熵指标具有麻醉深度监测的应用价值。     

上气道CT多呼吸时相OSAS阻塞部位定位效果

【摘要】目的：观察多呼吸时相(睡眠与清醒状态时)阻塞性睡眠呼吸暂停综合征(OSAS)患者的上气道CT阻塞部位的定位效果。方法：对2018年1~10月间本院就诊的74例OSAS患者进行清醒状态(吸气末)和睡眠状态(打鼾、血氧饱和度下降、呼吸暂停同时发生时)的上气道阻塞部位定位扫描,分析清醒和睡眠两种状态下的上气道阻塞部位定位结果、矢状面横截面积、矢状面气道最小直径、睡眠与清醒状态转换时的最狭窄部位变化情况。结果：上气道部位(软腭后区气道、悬雍垂后区气道、舌后区气道和会厌后区气道)阻塞诊断率比较,睡眠状态(75.67%、28.38%、59.46%、24.32%)均显著高于清醒状态(45.94%、8.11%、36.49%、4.05%)(P<0.05);软腭后区气道和舌后区气道的矢状面横截面积、矢状面气道最小直径比较,OSAS患者睡眠状态的测量值明显小于清醒状态;睡眠与清醒状态转换时,软腭后区气道闭塞者和舌后气道闭塞者的最狭窄部位基本一致,但当患者处于睡眠状态时的狭窄程度或闭塞范围增大。结论：与清醒状态时比较,药物诱导睡眠状态下行CT上气道阻塞部位定位效果明显较优,睡眠状态下可真实再现OSAS患者上气道阻塞部位,对OSAS临床诊治具有较高指导意义。     

基于fNIRS的情绪对工作记忆负荷影响规律研究

目的研究情绪刺激和任务负荷共同影响下的大脑皮层血氧特性响应规律。方法 20名年轻男性分别进行了负性、中性与积极3种情绪图片刺激下1~3-back认知记忆负荷任务实验,采用功能近红外谱(functional near-infrared spectroscopy,fNIRS)监测参试者脑前额叶皮层(prefrontal cortex,PFC)功能区和左右运动区的含氧血红蛋白(Hb O_2)与脱氧血红蛋白(Hbr)信号均值、斜率及近似熵(approximate entropy,ApEn)3种生理特征指标来描述其脑功能活动。结果随着任务负荷增加,均值表征的脑功能活动强度增强,PFC区域血氧供应和脑功能活动强度变化率降低且趋于稳定。近似熵用于表征的脑功能活动复杂度指标,随着任务负荷增加,中性情绪状态下复杂度降低,而在负性和积极情绪状态下复杂度上升。结论背外侧PFC区域为任务负荷敏感区域脑区;运动区域脑功能活动会受情绪状态影响。近似熵能有效地表征脑区fNIRS信号的复杂度变化,并适合描述情绪状态下大脑皮层功能活动多样性。     

用近红外功能成像技术研究语义和知觉编码过程中左前额叶的活动

目的用近红外光学功能成像技术研究语义与知觉编码过程中的左前额叶活动.方法实时记录22名青年被试者(男女各半)在语义和知觉加工过程中760 nm和850 nm两个波长近红外连续光透过额骨和左前额皮层后的漫射光强变化,并以此表征该皮层区血容(CBV)和血氧的变化.语义加工要求被试者用两个非相关的汉字词对组成一个有意义的句子;知觉加工则要求被试者判断两个词是否具有相同的结构组合以及两个词对中左右结构的差别. 结果结果显示,与知觉加工相比,语义加工时左下前额叶活动增多.该区域大致对应布德曼45、47区的一部分. 结论成功地利用近红外功能成像技术观测了语义与知觉编码过程中的左前额叶活动,获得了与fMRI和断层成象技术(PET)研究相近的结果,进一步证实了左前额叶在语义加工中的作用.     

64层螺旋CT评价阻塞性睡眠呼吸暂停低通气综合征

目的 探讨64层螺旋CT扫描在评价阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)上气道的阻塞平面和范围的诊断价值.方法 前瞻性连续纳入30例OSAHS患者和20例健康志愿者清醒状态下行上气道64层螺旋CT扫描,其中9例重度OSAHS患者在睡眠呼吸暂停时再次行上气道64层螺旋CT扫描,所有数据采用Mimics软件,测量和比较健康志愿者和OSAHS患者以及重度OSAHS患者清醒状态和睡眠呼吸暂停时上气道形态学上的差异.结果 (1)OSAHS患者清醒状态下上气道在软腭平面和舌后平面有不同程度的狭窄,与健康志愿者统计学有显著性差异(P＜0.05);(2)重度OSAHS患者清醒状态与睡眠状态的阻塞平面大致一致,然而睡眠呼吸暂停发作时软腭后区的最小截面积远小于清醒状态下的截面积或完全闭塞,二者统计学有显著性差异(P＜0.05).结论 64层螺旋CT扫描和图像后处理能够在体评价OSAHS患者上气道阻塞的平面和范围.     

128层螺旋CT三维重建对OSAHS患者上气道应用价值的研究

目的：评估128层螺旋 CT 上气道三维重建对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道阻塞部位的定位价值。方法采用128层螺旋 CT 对52例确诊的 OSAHS 患者清醒和 Muller 试验下及32例正常人清醒状态下进行上气道容积扫描,分别测量软腭后区、舌后区及会厌后区的气道体积和气道长度,并对各测量指标进行统计学分析。结果与正常对照组相比,清醒状态下 OSAHS 患者上气道长度显著增加(P <0.001)。与清醒状态下相比,OSAHS 患者 Muller 试验下软腭后区气道体积、舌后区气道体积、气道总体积显著减少(P <0.001)。OSAHS 患者上气道长度与平均血氧饱和度(MSaO2)呈负性相关(r=-0.33, P <0.05)。结论128层螺旋 CT 上气道三维重建能较好评估 OSAHS 患者上气道阻塞部位及阻塞的程度,对指导临床治疗有重要意义。     

睡眠呼吸障碍与心血管疾病

睡眠呼吸障碍是指与睡眠有关的呼吸障碍。它包括习惯性打鼾、睡眠呼吸暂停综合征、低通气综合征、慢性阻塞性肺部疾病和神经肌肉疾病引起的睡眠呼吸障碍。睡眠呼吸暂停(OSA)是指睡眠过程中口鼻呼吸气流均停止10s以上,低通气以50%气流中断和(或)动脉血氧饱和度下降>4%或惊醒为标准。睡眠呼吸暂停综合征分为阻塞型,中枢型和混合型三种,其中阻塞型睡眠呼吸暂停综合征(OSAS)最为常见,其特点为患者睡眠时呼吸道完全或不完全阻塞,呼吸气流停止,但呼吸运动仍然存在[1,2]。由于患者夜间打鼾,睡眠时呼吸暂停或憋醒,经常出现晨起头痛、白天困倦、疲…     

慢性应激对脑电Alpha波功率谱及功能对称性的影响

目的探讨慢性应激对个体脑电图Alpha波功率谱及功能对称性的影响。方法以是否从事应激环境下长期连续作业为标准,将50名受试对象分为慢性应激组和对照组,于应激组执行作业任务后1d测量创伤后应激障碍筛查量表民用版（PCL—C）、疲劳评定量表（FAI）、匹兹堡睡眠质量指数量表（PSQI）各因子得分水平,并采集静息态脑电数据,对脑电数据进行功率谱和功能对称性分析。结果与对照组相比,慢性应激组PCL—C、FAI以及PSQI量表大部分因子得分显著增高。慢性应激组项叶Alpha波功率谱下降,且呈现功能不对称性,表现为左侧功率谱优势。结论慢性应激状态下顶叶活动增强,大脑活动呈现右侧顶叶优势。     

阻塞性睡眠呼吸暂停低通气综合征的静息态功能磁共振数据处理方法研究进展

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者在睡眠期间反复发生上气道阻塞,导致通气不足或呼吸暂停,继而引起夜间间歇性低氧、呼吸紊乱及睡眠碎片化,长期低氧状态会造成大脑多个脑区或网络出现异常。近年来很多学者对脑疾病相关的静息态功能磁共振成像(rs-fMRI)开展了深入研究,从而推动了rs-fMRI数据处理方法的不断变革,如局域一致性(ReHo)、低频振幅(ALFF)、种子点相关分析、独立成分分析(ICA)、图论等。本文对不同rs-fMRI数据处理方法在OSAHS中的应用进行汇总,并分析OSASH患者某些脑区的损害、脑网络功能连接的异常以及治疗前后的改变。     

气功入静时前扣带回自发低频活动变化的fMRI研究

目的:采用功能磁共振成像技术研究在气功入静过程中大脑前扣带回的低频信号变化,探讨前扣带回在气功活动中的潜在调节机制。材料和方法:研究对象为练功20年以上,以静功为主的气功师6位。研究采用GE Signa VH/i 3.0T磁共振扫描机,EPI-BOLD序列。在入静前、入静早期、入静后期和结束入静后分4次进行静息fMRI扫描。图像处理采用AFNI软件,计算大脑前扣带回频率在0.01～0.8Hz间的低频活动功率谱的优势频率和平均振幅。对不同入静状态时这两个指标的差异进行比较和分析。结果:大脑前扣带回在入静时的优势频率(0.0167Hz)要高于入静前和结束入静后(0.0125Hz);功率谱的平均振幅在入静早期最高,而在入静后期有所下降,仍高于入静前和结束入静后。结论:前扣带回在不同入静状态时低频活动的动态变化,提示它在人静过程中起着重要的调节作用。低频活动的功率谱可以作为气功入静状态的一个潜在指标。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.