超声与射频消融肺静脉口对血小板活性的影响

目的对比射频与超声消融肺静脉口对GMP-140阳性表达活化血小板百分率的影响。方法分别在插管前、插管后、消融后即刻、消融后30 min及48 h抽取外周静脉血各2 ml,分离血清,用流式细胞仪检测GMP-140阳性表达活化血小板百分率的变化。结果消融后即刻、30 min及消融后48 h,射频消融组GMP-140阳性表达活化血小板百分率均高于超声消融组,差异有统计学意义（P〈0.05）。结论与射频消融相比,超声消融肺静脉口激活血小板程度低,不易形成血栓,较射频消融安全。     

Impact of Exercise on Lower Activity Levels in Children with Acute Lymphoblastic Leukemia: A Randomized Controlled Trial from Turkey

This randomized, controlled experimental study was carried out to determine the effects of an exercise program on both physical parameters and the quality of life of children with acute lymphoblastic leukemia (ALL). A total of 41 children with ALL (20 trial and 21 control cases) at two university hospitals were accepted into the study. Due to the demise of one of the children in the trial group, the study was completed with 19 trial and 21 control patients, a total of 40 children and their parents. Regular and systematic exercise regimens implemented by children with ALL have resulted in improved testing results, enhanced physical performance, and better laboratory results compared with a control group and to children's scores before the initiation of such a program.     

Intrinsic Properties of the Knee Extensor Muscles After Subacute Stroke

Horstman AM, Gerrits KH, Beltman MJ, Koppe PA, Janssen, TW, de Haan A. Intrinsic properties of the knee extensor muscles after subacute stroke.

Objective

To characterize muscle properties of paretic lower-limb (PL) and nonparetic lower-limb (NL) knee extensors in patients with subacute stroke.

Design

Case-control study.

Setting

Rehabilitation center research laboratory.

Participants

Patients with subacute stroke (n=14) and able-bodied age-matched control subjects (n=12).

Interventions

Not applicable.

Main Outcome Measures

Half relaxation times (HRTs) and maximal rates of torque development (MRTDs) were assessed as indicators of contractile speed using both voluntary and electrically evoked contractions. Moreover, changes in torque were measured during a fatigue protocol (35 electrically evoked intermittent contractions; 1.5s on, 2s off) and recovery.

Results

No differences among groups were found for normalized MRTDs during electrically evoked contractions (P=.117). However, during voluntary contractions both PLs (53% of control, P=.022) and NL (71% of control, P<.001) had significantly lower MRTD compared with control. Both PL (134% of control, P=.001) and NL (123% of control, P=.032) had significantly higher HRTs than control, indicating muscle slowing in patients with subacute stroke. PLs fatigued more and faster than control (P=.011) and both PL and NL recovered slower (P<.001).

Conclusions

The changes in HRTs and fatigue suggest adaptations in muscle properties toward slower, more fatigable muscle shortly after stroke. The inability to make use of contractile speed because of impaired neural activation seems the most limiting factor during the initial phase of torque development in PL. Thus, besides strengthening, muscle endurance and speed should also be addressed during rehabilitation.     

Tension Headache: Botulinum Toxin Paralysis of Temporal Muscles

SYNOPSIS
The pathogenetic mechanism of tension headache (TH) is still unknown. The role of pericranial muscle tension in TH is also enigmatic. To evaluate this factor in chronic TH, pericranial muscles were paralysed in 6 chronic TH patients, using botulinum toxin. All patients fulfilled the IHS criteria of chronic TH associated with involvement of the pericranial muscles, but not the current criteria for cervicogenic headache. The patients were followed-up regularly with evaluation of the paralysis, changes in pain intensity, and pressure pain threshold measurements. We primarily only injected the temporal muscle on the one side, using the other side as a control. Contralateral muscles were in some cases injected at a later stage. In our study, we did not find any significant reduction in pain intensity, as measured by the visual analogue scale, nor any changes in pressure pain threshold, as measured by an algometer. On the basis of our observations, we conclude that muscle tension in these muscles possibly plays a minor role in the genesis of chronic TH. In our study, however, we have only treated a limited number of patients, and only one pericranial muscle has been injected systematically. Further studies of various neck/posterior head muscles ought to be performed in order to further evaluate a possible effect of tension in the pericranial musculature in producing this type of pain.     

膝关节屈曲角度对主动肌和拮抗肌共同收缩和力矩的影响

目的测试股四头肌进行最大等长收缩时,不同膝关节屈曲角度对股四头肌和腘绳肌收缩时肌电活动和力矩产生的影响。方法10名健康成人在3个不同膝关节角度(分别为30°、60°、90°)下进行膝伸展的最大等长收缩,利用Cybex等速测试系统测试下肢股四头肌产生的力矩,并应用表面肌电仪测试股四头肌和腘绳肌的神经肌电活动。结果在膝关节屈曲60°时,股四头肌的力矩值比其他角度明显增大(P<0.01),但股四头肌在3个屈曲角度时的神经肌电活动差异无统计学意义;而腘绳肌的神经肌电活动在膝关节屈曲90°时最大。结论在特定膝关节角度进行股四头肌和腘绳肌最大等长收缩训练可帮助维持膝关节的稳定性。     

消除酶活性测定中基质效应影响的方法研究

该研究旨在寻找一种消除酶活性测定中基质效应影响的方法。运用标准加入法及正常人混合血清稀释法测定酶性高值标本。运用标准加入法测定接近医学决定水平的标本。实验结果表明，标准加入法及正常人混合血清稀释法能有效地克服基质效应，从而获得准确的结果，具有简便、快速、准确、经济和适用等优点。     

原发性胃结直肠癌组织中黄嘌呤氧化还原酶活性的变化

目的：通过测定胃结直肠原发性癌组织和对照组组织中的黄嘌呤氧化还原酶(xanthine oxidoreductase．XOR)活性的变化，来研究癌肿的发生和发展在胃肠道各部位所具有特殊的生物学变化，为治疗胃、结直肠癌提供理论依据。方法：连续收集中山医院手术室中速冻保存的胃肠道癌切除标本49例，分别测定癌肿组织和标本切缘相对正常组织的XOR活性，按照性别、年龄、部位、分化程度4个指标分组进行统计学分析。结果：按部位分组，结肠组内的癌组织XOR活性明显低于对照组，分别为0．8338和1．1404U，两者酶活性均数存在显著差异；其他所有分组中癌组织和对照组的酶活性均无显著差异。用广义线性模型和SNK法分别分析，正常粘膜组织按照部位分为三组的组问XOR活性均数无差异。结论：人原发性结肠癌组织在其发生和发展中具有特殊的生物学变化，可能产生抑制XOR活性的物质，其原因和机制尚待更多病例标本和实验研究。     

Influence of Altered Knee Angle on Electromyographic Activity of Hamstring Muscles Between Nordic Hamstring Exercise and Nordic Hamstring Exercise with Incline Slope Lower Leg Board

BackgroundPrevious studies have shown that performing the Nordic hamstring exercise (NHE) with different board slope angles can affect hamstring activation. However, changes in muscle length with different board slopes can alter joint angles leading to the moment arm (MA) at the knee changing during the NHE.PurposeThis study aimed to investigate the influence of changing muscle length on hamstring electromyographic activity during an isometric NHE, while maintaining an equal moment arm.Study DesignA crossover study designMethodsSixteen male volunteers performed two types of conventional NHE, one with knees on the floor (NHE) and one with the legs placed upon an incline slope of a lower leg board (NHEB). To compare between the conventional and inclined NHE, the moment arm at the knee was calculated to be equal by an examiner holding the lower legs at points marked at 77% and 94% of the length of the lower leg. The four sub-groups comprised of: 1) NHE-77%, 2) NHE-94%, 3) NHEB-77%, and 4) NHEB-94%. The hamstring EMG activity was measured at the biceps femoris long head (BFlh) and at the semitendinosus (ST) and related compensatory muscles. The RMS data were normalized as a percentage of the maximum isometric values (normalized EMG [nEMG]). Significant main effects findings were followed up with Tukey’s post-hoc test using SPSS software and statistical significance was set at the p < 0.05 level.ResultsThe BFlh EMG activity values for NHE-77% were significantly higher than those for NHE-94% (p= 0.036) and NHEB-77% (p < 0.001), respectively, while ST during NHE-77% was significantly higher only in NHEB-77% (p < 0.001). In addition, NHEB-94% was significantly greater than NHEB-77% for both BFlh (p < 0.001) and ST (p < 0.001).ConclusionThese results indicate that hamstring electromyographic activity is decreased when the hamstring muscle is lengthened during the Nordic hamstring exercise.Level of Evidence3     

Surface EMG characteristics of people with multiple sclerosis during static contractions of the knee extensors

Objectives: This study was designed to determine whether any alterations existed in surface electromyography (sEMG) in people with multiple sclerosis (MS) during isometric contractions of the knee extensors. Methods: Fifteen people with MS and 14 matched controls (mean ± SD age and body mass index 53·7 ± 10·5 versus 54·6 ± 9·6 years and 27·7 ± 6·1 versus 26·5 ± 4, respectively) completed 20%, 40%, 60% and 80% of their maximal voluntary contraction (MVC) of the knee extensors. sEMG was recorded from the vastus lateralis where muscle fibre conduction velocity (MFCV) and sEMG amplitude (RMS) were assessed. Body composition was determined using dual‐energy X‐ray absorptiometry and physical activity with the use of accelerometry. Results: People with MS showed significantly (P<0·05) faster MFCV during MVC (6·6 ± 2·7 versus 4·7 ± 1·4 m s^?1) and all submaximal contractions, while RMS was significantly (P<0·05) less (0·11 ± 0·03 versus 0·24 ± 0·06 mV) in comparison with the controls. MVC along with specific thigh lean mass to torque, rate of force development and mean physical activity were significantly (P<0·01) less in PwMS. Conclusion: People with MS have elevated MFCV alongside reduced RMS during isometric contraction. This elevation in MFCV should be accounted for when interpreting sEMG from people with MS.     

恶性血液病细胞端粒酶活性检测及其临床意义

目的　研究恶性血液病的端粒酶活性表达情况,探讨端粒酶活性检测对恶性血液病的临床意义。方 法　选取各类恶性血液病病例87例,以良性血液病和骨髓形态学正常的非血液病患者作为对照,采用改良 TRAP 银染法及亚利恩凝胶成像系统检测其骨髓标本内的端粒酶活性水平并随访。结果　良性血液病时端粒 酶阴性或低水平表达;慢性白血病慢性期、骨髓增生异常综合征(MDS)、多发性骨髓瘤(MM)骨髓端粒酶活性轻 度或中度升高,急性白血病和慢性白血病急变期端粒酶活性显著升高,完全缓解后活性水平下降,复发时端粒酶 活性又升高。同时端粒酶活性水平与预后相关,活性高者往往预后较差。结论　端粒酶活化与肿瘤的恶性转化 密切相关,可作为恶性血液病恶性克隆增殖的分子标志,有希望成为监测微量残留白血病的一个新指标。     

肌力练习对膝关节骨关节炎肌肉软弱的影响

目的 :了解肌力练习对膝关节骨关节炎患者肌肉软弱的影响。方法 :对照比较 2 6个患肢 3— 6周肌力练习前后和 19个患肢被动活动前后的等速运动肌力参数。结果 :两组均表现出不同程度的肌力增加 ,肌力练习组在减轻肌肉软弱上更为成功。结论 :肌力练习可通过募集来减轻骨关节炎患者的肌肉抑制。     

动脉硬化性闭塞症患者血液流变学和抗凝血酶Ⅲ活性的研究

目的研究动脉硬化性闭塞症患者血液流变学和抗凝血酶Ⅲ活性的变化。方法对50例动脉硬化性闭塞症患者和50例正常对照者分别进行血液流变学指标和抗凝血酶Ⅲ活性的检测。结果动脉硬化性闭塞症患者组的全血粘度、血浆粘度、血沉、全血低切还原粘度、血沉方程K值、红细胞聚集指数,全血低切相对粘度及抗凝血酶Ⅲ活性与正常组对照,均有显著性差异(P<0．01)。结论动脉硬化性闭塞症患者存在明显的血液流变学改变和微循环障碍。测定血液流变学和抗凝血酶Ⅲ活性有助于指导临床治疗。     

水中运动训练对恢复期脑卒中患者下肢肌肉力量和步行能力的影响

目的:探讨水中运动训练对恢复期脑卒中患者下肢肌肉力量、痉挛程度和步行能力的影响方法:初次发病的恢复期脑卒中患者(n=20,年龄41.5±16.5岁),随机分为两组,每组10例.一组为对照组,只进行常规康复训练,另一组为水疗组,每周进行3-4次水中运动训练,其他时间做常规康复训练.两组治疗总时间相同,观察4周,水疗共14次.于训练前后评价患侧膝和踝屈伸肌的最大等长收缩(MIVC)肌力、下肢痉挛状况、运动功能和步行能力的改变,用t检验进行分析比较.结果:经过4周训练,水疗组患者踝跖屈时腓肠肌等长收缩力矩显著提高(3.6±0.3 vs 0.6±0.2,P＜0.05),患者步行能力(3.5±1.5 vs 2.7± 1.2)、下肢运动功能(29.7±3.5 vs 27.8±2.6)及平衡功能评分(11.5±3.3 vs 9.3±2.9)显著提高(p＜0.05);在训练前后患者股直肌与腓肠肌痉挛并无显著性改变(P＞0.05).结论:短期水中运动训练可以增强恢复期脑卒中患者患侧踝跖屈肌力,且不强化痉挛,有利于提高患者下肢功能和步行能力.     

The association between muscle strength and activity limitations in patients with the hypermobility type of Ehlers–Danlos syndrome: the impact of proprioception

Purpose: The patients diagnosed with Ehlers–Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients.

Methods: Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders.

Results: Muscle strength was associated with 30CRT (r?=?0.67, p?=?<0.001), 6MWT (r?=?0.58, p?=?<0.001) and HAQ (r?=?0.63, p=?<0.001). Proprioception was associated with 30CRT (r?=?0.55, p?r?=?0.40, p?=?<0.05) and HAQ (r?=?0.46, p?Conclusions: Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT.

• Implications for rehabilitation

• Reducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients.

• Although muscle strength is the most dominant factor that is associated with activity limitations, this association is confounded by proprioception. In contrast to common belief proprioception was not directly associated with activity limitations but confounded this association. Controlling muscle strength on the bases of proprioceptive input may be more important for reducing activity limitations than just enhancing sheer muscle strength.

     

康复训练结合部分发音肌电刺激治疗脑卒中后遗症期运动性痉挛型构音障碍的疗效观察

目的：通过与康复训练治疗相比较，观察康复训练结合部分发音肌电刺激治疗脑卒中后遗疽期运动性痉挛型构音障碍的疗效。方法：2001年5月-2004年6月共选取符合入选标准并完成临床观察病例共44例，其中康复训练组22例，康复训练结合部分发膏肌电刺激组22例，病程1～3年。结果：康复训练结合部分发音肌电刺激治疗组与康复训练组治疗运动性痘孪型构音障碍疗效比较，治疗后构音障碍评分的变化有显著差异（P〈0．01），结论：康复训练与部分发问肌电刺激治疗脑率中后遗症期运动性痉挛型构音障碍的疗效优于康复训练组。     

血清C-反应蛋白测定对皮肤病及其病情活动的临床意义

作者采用琼脂糖单向免疫扩散法对200例皮肤病患者血清239人次进行了CPR的测定。结果发现病情活动与缓解两者之间的CRP值,在某些皮肤病差异高度显著性P<0.005,在SLE显著性差异P<0.05,硬皮病和皮肌炎则差异无显著性P>0.05。经治疗缓解的某些感染性皮肤病,CRP值是正常的。急性感染性疾病的CRP值是显著地增高。     

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

OBJECTIVES:

To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter.

METHOD:

Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference.

RESULTS:

The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10).

CONCLUSIONS:

The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion.