CPM对骨折后肘关节功能障碍的疗效观察

目的：观察关节持续被动活动（CPM）治疗骨折后肘关节功能障碍的效果。方法：63例骨折后肘关节功能障碍患者分为CPM组33例和对照组30例,均采用常规康复治疗。CPM组加用CPM。结果：治疗2个月后,CPM组患者肘关节活动范围及有效率均明显优于对照组（P〈0.05）。结论：CPM能显著提高骨折后肘关节功能障碍的疗效。     

小儿肱骨髁上骨折克氏针交叉内固定术后CPM康复治疗

目的探讨小儿肱骨髁上骨折手术治疗后患指使用关节持续被动活动（CPM）仪进行功能锻炼的恢复效果。方法2004年1月至2007年8月，对35例肱骨髁上骨折儿童患者行克氏针交叉内固定术治疗，其中20例术后使用CPM仪进行功能锻炼，15例术后未使用CPM仪进行功能锻炼。观察肘关节功能的康复情况。结果术后患者随访6～24个月（平均12个月），CPM组最终患者肘关节屈曲平均125°；伸直差值平均24．5°；旋前平均80°；前臂旋后平均75°。活动能力（ADL）基本正常，X线检查骨折愈舍好，无骨化性肌炎，较空白对照纽好。CPM组优评率为90．0％，空白对照组优评率为33．3％。结论小儿肱骨髁上骨折术后早期系统地采用CPM康复治疗可最大限度地防止肌肉萎缩、关节粘连，促进肢体功能恢复，缩短疗程，防止关节僵硬。     

可调式肘关节固定器在骨折后肘关节功能障碍康复中的应用

目的 观察可调式肘关节固定器在骨折后肘关节功能障碍康复中的作用.方法 将31例骨折后肘关节功能障碍患者分成治疗组和对照组.治疗组17例采用关节松动术加关节活动度训练,并在训练后应用可调式肘关节固定器固定关节于最大关节活动度2 h;对照组14例采用关节松动术加关节活动度训练.2个月后2组患者进行肘关节关节活动范围(ROM)评定和Mayo肘关节评分.结果 治疗组Mayo肘关节评分、ROM明显优于对照组(P＜0.05).结论 可调式肘关节固定器在骨折后肘关节功能障碍的康复治疗中可以尽快恢复肢体功能,缩短疗程,减轻患者痛苦和经济负担.     

可调式肘关节固定器在骨折后肘关节功能障碍康复中的应用

目的 观察可调式肘关节固定器在骨折后肘关节功能障碍康复中的作用.方法 将31例骨折后肘关节功能障碍患者分成治疗组和对照组.治疗组17例采用关节松动术加关节活动度训练,并在训练后应用可调式肘关节固定器固定关节于最大关节活动度2 h;对照组14例采用关节松动术加关节活动度训练.2个月后2组患者进行肘关节关节活动范围(ROM)评定和Mayo肘关节评分.结果 治疗组Mayo肘关节评分、ROM明显优于对照组(P＜0.05).结论 可调式肘关节固定器在骨折后肘关节功能障碍的康复治疗中可以尽快恢复肢体功能,缩短疗程,减轻患者痛苦和经济负担.     

可调式肘关节固定器在骨折后肘关节功能障碍康复中的应用

目的观察可调式肘关节固定器在骨折后肘关节功能障碍康复中的作用。 方法将31例骨折后肘关节功能障碍患者分成治疗组和对照组。治疗组17例采用关节松动术加关节活动度训练,并在训练后应用可调式肘关节固定器固定关节于最大关节活动度2 h;对照组14例采用关节松动术加关节活动度训练。2个月后2组患者进行肘关节关节活动范围（ROM）评定和Mayo肘关节评分。 结果治疗组Mayo肘关节评分、ROM明显优于对照组（P<0.05）。 结论可调式肘关节固定器在骨折后肘关节功能障碍的康复治疗中可以尽快恢复肢体功能,缩短疗程,减轻患者痛苦和经济负担。     

儿童肱骨髁上骨折术后的综合康复治疗

目的：探讨综合康复治疗对儿童肱骨髁上骨折术后的效果。方法：42例肱骨髁上骨折术后患儿在石膏外固定期进行上肢各关节主动活动，去除石膏后采用物理疗法及ADL训练。结果：治疗1-3个月后肘关节屈伸活动对围较治疗前明显提高（P〈0．01）。结论：综合康复治疗能防止儿童肱骨髁上骨折术后肘关节功能障碍，且早期治疗效果更显著。     

膝关节周围骨折术后持续被动活动治疗时间窗对膝关节功能康复的影响

[目的]对比观察膝关节周围骨折术后持续被动活动（CPM）治疗时间窗对膝关节功能康复的影响。[方法]将120例膝关节周围骨折内固定术后病人随机分为3组,分别选择术后6h、72h及1周开始进行CPM治疗,配合患膝关节的主动运动,观察CPM不同治疗时机的临床效果。[结果]术后72h开始CPM治疗时膝关节功能恢复最佳,其次为6h,1周后的效果最差。[结论]膝关节周围骨折术后CPM治疗的最佳治疗时机为术后72h,有利于膝关节功能的尽快恢复。     

臂丛麻醉下肘关节僵硬松动术治疗的护理

[目的]探讨肘关节僵硬病人在臂丛麻醉下行肘关节僵硬松动术治疗的护理措施.[方法]对19例肘关节僵硬病人行肘关节松动术治疗并采取相应护理措施,随访12个月,观察病人术后肘关节Mayo功能评分情况.[结果]术后肘关节Mayo功能评分为优12例,良7例,差0例;分数由术前平均45分提高至术后89分.[结论]针对治疗特点及术后康复要求采取相应的护理措施是肘关节僵硬病人在臂丛麻醉下行肘关节僵硬松动术治疗取得成功的重要保证.     

膝关节周围骨折术后持续被动活动治疗时间窗对膝关节功能康复的影响

[目的]对比观察膝关节周围骨折术后持续被动活动(CPM)治疗时间窗对膝关节功能康复的影响。[方法]将120例膝关节周围骨折内固定术后病人随机分为3组,分别选择术后6h、72h及1周开始进行CPM治疗,配合患膝关节的主动运动,观察CPM不同治疗时机的临床效果。[结果]术后72h开始CPM治疗时膝关节功能恢复最佳,其次为6h,1周后的效果最差。[结论]膝关节周围骨折术后CPM治疗的最佳治疗时机为术后72h,有利于膝关节功能的尽快恢复。     

系统康复治疗对下肢制动后膝关节活动范围的影响

对院内康复治疗和院外锻炼对股骨干骨折术后病人及不同康复时机对下肢骨折术后病人膝关节活动范围的影响进行临床观察，结果表明：康复治疗组术后１２个月时患肢膝关节活动范围为１２９．２９°±２５．８６°，对照组为６２．１２°±４８．３９°，两组差异非常显著（Ｐ＜０．０１）；在本组病例中下肢骨折术后１２个月时膝关节活动范围的改善与术后开始康复治疗间隔时间呈显著负相关（ｒ＝－０．７３，Ｐ＜０．０１）。说明下肢骨折术后康复治疗在改善制动后膝关节功能方面明显优于自行锻炼，康复治疗得越早，效果越明显。     

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.