核心肌群训练联合平衡罐疗法在慢性非特异性下腰痛患者中的应用

目的探讨核心肌群训练联合平衡罐疗法在慢性非特异性下腰痛患者中的应用效果。方法采用便利抽样法,于2017年1月—2019年12月选择广东省佛山市中医院的130例慢性非特异性下腰痛患者,依据随机数字表法分为核心肌群组和联合治疗组,每组各65例。核心肌群组予以瑞士球按端坐、双桥、屈膝双桥、反桥和俯卧撑的顺序进行核心肌群训练,联合治疗组在核心肌群训练基础上予以平衡罐按照闪罐、走罐、坐罐进行治疗。干预4周后,比较两组患者的腰痛视觉模拟量表(VAS)评分、Roland-Morris功能障碍问卷调查表(RMDQ)评分、指地距离(FFD)、静态及动态肌耐力时间、治疗总有效率。结果干预后,联合治疗组的VAS评分、RMDQ评分及FFD低于核心肌群组,差异有统计学意义(P<0.01);联合治疗组的静态肌、动态肌耐力时间均高于核心肌群组,差异有统计学意义(P<0.01)。联合治疗组的总有效率为90.77%(59/65),高于核心肌群组的76.92%(50/65),差异有统计学意义(P<0.05)。结论核心肌群训练联合平衡罐疗法能减轻慢性非特异性下腰痛患者的腰痛程度,改善腰部功能障碍,提高腰部柔韧性及肌耐力,临床疗效较好。     

经筋埋线疗法结合核心稳定性训练对部队官兵慢性非特异性下腰痛的干预效果观察

目的对应用经筋埋线疗法结合核心稳定性训练治疗部队官兵慢性非特异性下腰痛的干预效果进行评价,探寻实用有效的治疗方案。方法选取符合诊断标准的患者共计84例,应用随机数字表分为观察组(经筋埋线+核心稳定性训练)和对照组(核心稳定性训练),每组各42例,共治疗4周,干预前后分别对两组采用疼痛视觉模拟量表(vasual anlalogue scale,VAS)及腰椎Oswestry功能障碍指数(ODI)评分进行测评,以评定其临床疗效,采用指地距离(FFD)及腰部屈肌、伸肌耐力测试对患者进行肌肉柔韧性及耐力测评。结果干预后,观察组总有效率为97.6%,对照组总有效率为85.7%,组间差异具有统计学意义(P0.05),观察组疗效优于对照组。观察组与对照组VAS评分、ODI评分均低于干预前,差异具有高度统计学意义(均P0.01),观察组优于对照组,组间差异具有统计学意义。干预后,观察组与对照组FFD值均小于干预前(均P0.01),两组腰部屈肌耐力测试时间、腰部伸肌耐力测试时间,均长于干预前(均P0.05),组间差异无统计学意义(P0.05)。结论经筋埋线疗法结合核心稳定性训练对部队官兵慢性非特异性下腰痛具有良好的临床疗效,本综合疗法可作为实用有效的治疗方案进行推广应用。     

Thera-Band渐进抗阻系统结合针刺、推拿治疗慢性非特异性腰痛的疗效观察

目的:探讨Thera-Band渐进抗阻系统核心肌群稳定训练结合针刺、推拿治疗腰痛的疗效。方法:100例慢性非特异性腰痛患者随机分为对照组、治疗组,两组患者均接受常规针刺、推拿治疗,治疗组同时接受Thera-Band渐进抗阻系统核心肌群稳定训练治疗。两组患者均治疗3周,随访半年。治疗前后对两组患者均进行视觉模拟评分(VAS)和JOA下腰痛评价表评定。结果:治疗3周后,两组患者的VAS和JOA下腰痛评价表差异较治疗前均有显著性意义(P<0.05),但治疗组效果较对照组更加显著(P<0.05),随访半年,治疗组VAS和JOA下腰痛评分明显优于对照组(P<0.05)。结论:Thera-Band渐进抗阻系统核心肌群稳定训练结合针刺、推拿对慢性腰痛患者的恢复有较好的长期疗效和预防作用。     

腰椎稳定性训练结合肌内效贴治疗慢性非特异性腰背痛的临床疗效观察

目的:观察腰椎稳定性训练结合肌内效贴治疗慢性非特异性腰背痛的临床疗效。方法:将38例慢性非特异性腰背痛患者随机分为对照组和观察组各19例。对照组患者接受常规康复治疗,观察组患者在常规康复治疗的同时接受家庭腰椎稳定性训练和肌内效贴治疗。在康复治疗前、后用目测类比评分法(VAS),腰痛障碍指数(ODI)对患者进行评定。结果:经过4周的治疗,2组VAS及ODI评分均较治疗前明显下降(均P0.05);且观察组患者VAS及ODI评分均明显低于对照组(均P0.05)。结论:慢性非特异性腰背痛患者在接受常规康复治疗的同时,进行家庭腰椎稳定性训练联合肌内效贴治疗能有效地缓解腰痛,改善功能,值得临床上应用、推广。     

八段锦联合物理疗法治疗慢性腰痛的疗效观察

目的：观察八段锦联合物理疗法治疗慢性腰痛的临床疗效及对竖脊肌表面肌电信号的影响。方法：将84例慢性腰痛患者随机分为观察组和对照组各42例。对照组采用常规物理治疗，观察组在对照组基础上行八段锦训练，共治疗4周。分别于治疗前、治疗后和随访6个月时记录2组患者疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI），表面肌电仪分别采集腰部前屈、后伸及最大屈曲状态下竖脊肌平均肌电值信号并计算屈曲-放松比（FRR）。结果：治疗4周后，2组患者VAS评分及ODI值均较治疗前显著降低（均P<0.01），屈曲与后伸过程中平均肌电值（FLEXAEMG、EXEAEMG）及相应FRR值均显著升高（均P<0.01），最大屈曲状态肌电值（MVFAEMG）显著降低（P<0.01），且观察组优于对照组（P<0.05）；随访6个月时，对照组VAS评分及ODI值较治疗后均升高（均P<0.05），FLEXAEMG、EXEAEMG、FRR降低（P<0.05），MVFAEMG升高（P<0.05）；观察组VAS评分及ODI值与治疗后比较无显著性差异，FLEXAEMG、EXEAEMG、FRR降低（均P<0.05），MVFAEMG升高（P<0.05），组间比较，观察组均优于对照组（均P<0.05）。结论：八段锦训练能够有效缓解慢性腰痛的临床症状且远期疗效更佳，这可能与八段锦训练提高竖脊肌收缩和放松能力并增强腰椎稳定性有关。     

神经肌肉激活技术治疗非特异性下腰痛患者的临床效果

目的 研究神经肌肉激活技术(NFRT)治疗非特异性下腰痛(NLBP)的临床效果。方法 将50例NLBP患者随机分为研究组和对照组，各25例，分别在常规物理因子治疗的基础上进行NFRT和常规核心稳定训练(CSE)治疗。比较2组治疗前后的疼痛程度[用视觉模拟评分(VAS)和Oswestry功能障碍指数问卷表(ODI)评估]、多裂肌表面肌电均方根值(RMS)和静息状态下多裂肌厚度。结果 治疗后，2组VAS评分、ODI评分、多裂肌表面肌电RMS和多裂肌厚度均显著改善(P<0.05),且研究组的上述指标均显著优于对照组(P<0.05)。结论与传统治疗相比，NFRT能更有效地提高腰椎深层稳定肌纤维募集，改善肌肉收缩功能，缓解下腰痛。     

持续性康复训练联合核心肌群训练对腰椎骨折患者的疗效分析

目的探究持续性康复训练联合核心肌群训练对腰椎骨折患者的疗效,分析对Oswestry功能障碍指数问卷表(ODI)和日本骨科协会评估治疗分数(JOA)评分的影响。方法选取2016年8月～2019年3月我院收治的腰椎骨折患者50例,按随机数字表法分为对照组和观察组各25例。对照组给予持续性康复训练,观察组在对照组的基础上给予核心肌群训练治疗,比较两组患者视觉模拟评分法(VAS)评分、ODI评分和JOA评分。结果观察组干预后VAS、ODI评分均低于对照组,JOA评分高于对照组,差异均有统计学意义(P<0.05)。结论持续性康复训练联合核心肌群训练可改善腰椎骨折患者腰椎功能,降低VAS评分和ODI评分,改善患者病情。     

腰部核心肌群训练联合骶管注射治疗腰椎间盘突出症的疗效观察

目的 探讨腰部核心肌群训练联合骶管注射对腰椎间盘突出症患者背伸肌群生物学特性的影响。 方法 采用随机数字表法将在我院治疗的80例腰椎间盘突出症患者分为观察组及对照组,每组40例。2组患者均给予常规治疗及心理辅导,对照组在此基础上辅以骶管药物注射,观察组则辅以腰部核心肌群训练及骶管注射联合治疗。于入选时及治疗4周后观察2组患者背伸肌群生物学特性,并分别采用日本矫形外科协会(JOA)评分、腰椎功能障碍指数(ODI)评分和疼痛视觉模拟评分(VAS)对2组患者进行疗效评定。 结果 治疗前2组患者腰背伸状态下峰力矩、平均功率、腰背屈/伸比值、腰背伸肌群平均功率频率、积分肌电值、JOA、ODI及疼痛VAS评分组间差异均无统计学意义(P>0.05)。与对照组比较,治疗后观察组腰背伸状态下峰力矩、平均功率、腰背伸肌群平均功率频率、积分肌电值、JOA评分均显著升高(P<0.05),腰背屈/伸比值、ODI评分及疼痛VAS评分均显著降低(P<0.05)。 结论 腰部核心肌群训练联合骶管注射可有效改善腰椎间盘突出症患者背伸肌群生物学特性,改善临床症状,提高腰椎功能,该联合疗法值得临床推广、应用。     

美式整脊技术对非特异性腰痛的疗效

目的探讨美式整脊技术对非特异性腰痛的疗效。方法 2016年7月至2018年1月,选取90例非特异性腰痛患者,随机分为对照组(n=45)和观察组(n=45)。两组均给予核心稳定性训练和常规物理治疗,观察组在此基础上辅以美式整脊技术,治疗4周,随访半年。治疗前,治疗2周、4周后和随访半年后分别采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、腹背肌耐力测试、腰部主动关节活动度(AROM)进行评价。结果治疗2周、4周时,两组VAS评分,ODI评分,腹、背肌耐力测试和腰部AROM均较治疗前改善(P 0.05)。观察组在治疗2周、4周时,所有指标均较对照组显著改善(t 0.263, P 0.001)。半年后随访,两组VAS、ODI均较治疗前改善(P 0.05),且观察组较对照组显著改善(t 5.911, P 0.001)。结论核心稳定性训练和常规物理治疗配合美式整脊技术可以更有效减轻非特异性腰痛患者痛疼程度,改善功能障碍,同时提高脊柱稳定性,对患者的恢复有较好的长期疗效和预防作用。     

麦肯基疗法联合腰部核心肌力训练治疗腰椎间盘突出症的疗效观察

目的:观察麦肯基疗法联合腰部核心肌力训练治疗腰椎间盘突出症(LDH)的临床疗效。方法:80例LDH患者随机分为对照组与观察组各40例,2组患者均给予常规康复治疗,包括牵引、超短波治疗等;观察组增加麦肯基疗法与腰部核心肌力训练,均接受4周治疗,并分别于治疗前后选用Oswestry下腰背功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)及临床疗效进行评定。结果:治疗4周后,2组患者ODI及VAS评分较治疗前均有降低(P<0.05),且观察组较对照组评分更低(P<0.05);治疗后2组临床疗效比较,观察组总有效率明显优于对照组(92.50%,77.50%,P<0.05)。结论:麦肯基疗法联合腰部核心肌力训练治疗腰椎间盘突出症有更好的疗效,治疗周期短且见效快,值得临床推广应用。     

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.