A型肉毒毒素对脑性瘫痪患儿腘绳肌痉挛的疗效

目的观察A型肉毒毒素(BTX-A)注射缓解脑瘫患儿腘绳肌痉挛的疗效。方法39 例存在腘绳肌痉挛的脑瘫患儿分为对照组(n=20)和观察组(n=19),对照组采用常规康复训练,观察组在常规康复训练的基础上予BTX-A局部注射。治疗前后采用改良Ashworth 量表(MAS)、粗大运动功能测试(GMFM-88)、膝关节屈曲角度进行评定。结果治疗6 周后,观察组患儿腘绳肌MAS评分、膝关节屈曲角度、GMFM-88 评分均较治疗前改善(P<0.05),且均优于对照组(P<0.05);对照组GMFM-88 较治疗前改善(P<0.05)。结论BTX-A注射可以有效缓解脑瘫患儿腘绳肌痉挛,有助于纠正异常步态,提高患儿运动功能。     

外周神经电刺激引导下A型肉毒毒素注射治疗面肌痉挛57例观察

目的探讨在外周神经电刺激引导下A型肉毒毒素(BTX-A)局部注射治疗面肌痉挛的疗效。方法 2012年1月~2015年6月,57例面肌痉挛患者在外周神经电刺激引导下采用BTX-A局部多点注射。治疗前、治疗后72 h和6个月,进行面肌痉挛强度评级,根据面肌痉挛强度评级进行疗效评定。随访3~9个月。结果患者治疗后面肌痉挛强度均较治疗前改善。治疗72 h后有效率为98.25%,治疗6个月后有效率为91.23%(χ~2=4.946,P0.05);疗效平均维持(23.1±2.3)周。结论外周神经电刺激引导下BTX-A局部多点注射治疗面肌痉挛疗效显著且持久。     

超声引导下注射A型肉毒毒素联合康复训练治疗尖足畸形脑瘫患儿下肢痉挛的疗效观察

目的观察超声引导下注射A型肉毒毒素（BTX-A）联合康复训练治疗尖足畸形脑瘫患儿下肢痉挛的疗效。 方法选取因下肢痉挛导致尖足的脑瘫患儿47例,按照随机数字表法将其分为注射组（24例）和对照组（23例）,2组均给予康复训练,注射组在此基础上辅以超声引导下BTX-A注射。治疗前及治疗2周后、1个月后、3个月后、6个月后分别采用改良Ashworth量表（MAS）、踝关节被动活动度(PROM)和粗大运动功能测试量表-88（GMFM-88）对患儿下肢痉挛程度进行综合评定。 结果治疗前,注射组患儿MAS评分［（3.31±0.76）分］、PROM值［（108.27±11.38）°］、GMFM-88评分［（54.31±10.31）分］与对照组患儿MAS评分［（3.40±0.65）分］、PROM值［（106.10±11.44）°］、GMFM-88评分［（55.62±10.22）分］比较,差异均无统计学意义（P&rt;0.05）。注射组治疗2周后、1个月后、3个月后、6个月后各指标与治疗前比较,差异均有统计学意义（P<0.05）。对照组除治疗2周后外,剩余时间点各指标与治疗前比较,差异有统计学意义（P<0.05）,与注射组同时间点比较,对照组各指标差异均有统计学意义（P<0.05）。 结论超声引导下注射BTX-A联合康复训练可快速改善尖足畸形脑瘫患儿的下肢痉挛,值得临床应用、推广。     

肉毒毒素结合康复训练治疗痉挛型脑瘫

目的:观察局部肌肉注射A型肉毒毒素(BTX-A)治疗痉挛型脑瘫的疗效。方法:83例痉挛型脑瘫患儿分为观察组53例和对照组30例,均采用BTX-A局部肌肉注射和推拿治疗;观察组同时结合系统的康复训练等。治疗前后均以改良阿氏量表(MAS)评分肌张力,运动评价量表(PRS)评定运动功能。结果:治疗3个月后与治疗前比较2组MAS评分均明显下降,PRS评分明显升高(均P<0.05);与对照组比较观察组表现更明显(P<0.05)。结论:局部肌肉注射BTX-A结合系统康复训练能有效缓解痉挛型脑瘫患儿的肌张力,改善步态、提高行走能力。     

A型肉毒毒素配合药浴对脑性瘫痪患儿痉挛的疗效

目的探讨A型肉毒毒素注射与康复训练和药浴相结合治疗脑瘫患儿痉挛的效果。方法80 例痉挛型和混合型脑瘫患儿分为两组,每组40 例。对照组采用运动疗法;观察组采用A型肉毒毒素注射后进行康复训练和药浴。治疗前后采用改良Ashworth评定量表(MAS)、粗大运动功能测试量表(GMFM-88)进行评定。结果治疗3 个月后,两组患儿MAS评分、GMFM评分均优于治疗前(P<0.05),观察组疗效优于对照组(P<0.05)。结论A型肉毒毒素注射配合康复训练和药浴能降低肌张力,有效提高痉挛型和混合型脑瘫患儿的粗大运动功能。     

A型肉毒毒素注射配合功能训练对痉挛型脑瘫尖足畸形及粗大运动功能发育的影响

目的探讨A型肉毒毒素(BTX-A)注射配合功能训练对痉挛型脑瘫患儿尖足畸形及粗大运动功能发育的影响。方法对60例痉挛型脑瘫患儿进行BTX-A注射,再配合功能训练;对照组46例仅进行功能训练。两组分别于注射治疗前及注射后1周、3个月采用综合痉挛评分量表(CSS)、踝关节被动背屈角度(PROM)测量及粗大运动功能量表(GMFM-88)之D区(站立)、E区(走跑跳)进行评估。结果 BTX-A起效时间为注射后24～72h,到达高峰时间为1～2周,疗效维持3个月,不良反应极少。治疗组1周后、3个月后下肢CSS评分及3个月后踝关节PROM、GMFM之D区和E区评分均比对照组明显改善(P0.01),尖足消失。结论 BTX-A注射配合功能训练可快速缓解脑瘫患儿下肢肌肉痉挛,纠正尖足畸形,扩大踝关节活动范围,促进粗大运动功能发育,提高疗效。     

中药气泡浴对痉挛型双瘫脑性瘫痪患儿的疗效

目的观察中药气泡浴对痉挛型双瘫脑瘫患儿的疗效。方法痉挛型双瘫脑瘫患儿在常规康复的基础上,对照组13例患儿行单纯气泡浴;实验组14 例行中药气泡浴。治疗前和治疗10 周后,使用粗大运动功能测试量表(GMFM-66)和改良Ashworth量表(MAS)分别评定患儿的运动功能和小腿三头肌肌张力。结果治疗后,两组GMFM-66 总分均较治疗前显著增加(P<0.001),MAS 评分均较治疗前明显下降(P<0.01);实验组GMFM-66 的B、D、E 区评分高于治疗前(P<0.05),对照组无显著性差异(P>0.05)。组间比较,治疗后实验组MAS评分低于对照组(P<0.05)。结论中药气泡浴能改善痉挛型双瘫脑瘫患儿粗大运动功能,降低小腿三头肌肌张力。     

A型肉毒毒素缓解脑瘫痉挛的适宜剂量与相关因素的研究

目的探讨A型肉毒毒素(BTX-A)缓解脑瘫痉挛的适宜剂量与程度及与其他因素的关系。方法对39例脑瘫患儿采用BTX-A局部注射缓解痉挛。结果23例患儿治疗后效果良好,其中男性15例、女性8例,年龄33～145个月,平均(60.7±26.9)个月。BTX-A的适宜剂量与患儿的性别、年龄、体重、诊断分型、粗大运动功能分级(GMFCS)、致病因素、注射点数目无相关性,与术前改良Ashworth量表(MAS)评分呈线性正相关。结论BTX-A可缓解脑瘫患儿的痉挛,注射剂量与MAS评分呈正相关。     

管型石膏结合BTX-A治疗痉挛型脑性瘫痪的临床研究

目的:观察A型肉毒毒素(BTX-A)结合管型石膏固定对痉挛型脑瘫(CP)患儿坐、站、走功能及肌肉痉挛程度的影响,为痉挛型CP的治疗提供更多依据。方法:120例痉挛型CP患儿为研究对象,将其随机分为观察组和对照组各60例,对照组采用BTX-A注射治疗后行物理治疗及家庭康复指导,观察组在对照组治疗基础上予以管型石膏固定,在治疗前、治疗后1、3及6个月时分别用粗大运动功能测试量表88项(GMFM-88)和改良Tardieu量表(MTS)参数(X)对患儿进行评定。结果:除对照组在治疗6个月后GMFM-88的D区评分较治疗前差异无统计学意义外,2组在治疗1、3及6个月后,GMFM-88各区评分均较治疗前明显提高(均P<0.05),且观察组治疗6个月后GMFM-88各区评分较对照组均明显提高(均P<0.05);治疗1、3及6个月后,2组小腿三头肌和腘绳肌的MTS参数(X)评分均较治疗前明显降低(均P<0.05),且观察组在治疗6个月后较对照组同时间点比较均更低(均P<0.05)。结论:BTX-A结合物理治疗可明显改善CP患儿的肌肉痉挛程度及提高粗大运动功能,在此基础上结合管型石膏固定可延长远期疗效。     

功能性电刺激联合Vojta反射性翻身疗法对痉挛型脑瘫患儿翻身发育的影响

目的观察功能性电刺激联合Vojta反射性翻身疗法对痉挛型脑瘫患儿翻身发育的影响。方法选取年龄6月至8月的痉挛型脑瘫患儿80例, 按随机数字表法将其分成对照组和治疗组, 每组患儿40例。对照组采用单纯的Vojta反射性翻身疗法进行治疗, 治疗组在Vojta反射性翻身治疗的基础上增加胸廓主诱发带区域和腹肌区域的功能性电刺激治疗。功能性电刺激治疗每日1次, 每次20 min, 每周治疗5 d, 连续治疗6周。于治疗前和治疗6周后(治疗后)采用粗大运动评价量表(GMFM-88)A区评估2组患儿的粗大运动功能, 同时采用改良Ashworth肌张力评估量表(MAS)评估2组患儿上、下肢的肌张力。结果治疗后, 2组患儿的GMFM-88量表A区评分、上肢MAS评分和下肢MAS评分较组内治疗前均显著改善(P<0.05), 且治疗组患儿治疗后的GMFM-88量表A区评分、上肢MAS评分和下肢MAS评分分别为(39.45±4.91)分、(2.63±0.74)分和(2.67±0.66)分, 均显著优于对照组治疗后, 差异均有统计学意义(P<0.05)。结论在Vojta反射性翻身疗法的基础上增加功能...     

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.