糖尿病周围神经病的单纤维肌电图研究

目的 探讨单纤维肌电图（ＳＦＥＭＧ）在糖尿病周围神经病（ＤＰＮ）中的应用。方法 Ⅱ型糖尿病患３６例,采用ＶｉｋｉｎｇⅣ肌电图仪,测定指总伸肌的颤抖和纤维密度 （ＦＤ）,同时进行常规神经传导检测（ＮＣＳ）并测定空腹血糖和糖化血红蛋白（ＨｂＡ１ｃ０。结果 颤抖和ＦＤ具有相关性,且均与ＨｂＡ１ｃ呈正相关,１８例ＮＣＳ异常,库抖值均超出正常范围（１１例伴阻滞）,１４例ＦＤ增加;１８例ＮＣＳ正常,７例颤抖值增大（３例伴阻滞）,５例ＦＤ增加。结论 颤抖和ＦＤ所反映的失神经－神经再支配与代谢状况相关联;ＳＦＥＮＧ是ＤＰＮ早期诊断的敏感手段。可发现亚临床神经病。     

Paraspinal electromyography that compares concentric with monopolar needles: a blinded study

OBJECTIVE: To establish interrater reliability for paraspinal muscle needle electromyography study with both monopolar and concentric needles in symptomatic and asymptomatic persons and to further establish normative data for paraspinal needle study. DESIGN: At a university spine center, participants with and without radiating low back pain were evaluated with the mini-paraspinal mapping paraspinal needle technique by an unblinded and a blinded electromyographer. RESULTS: In the symptomatic group, the intraclass correlation coefficient between concentric and monopolar needles was 0.793; between monopolar needles, it was 0.876; and between concentric needles, it was 0.966. In the asymptomatic group, the mean total score was 0.25. CONCLUSIONS: The good interrater reliability with the same needle type helps support the validity of the needle electromyography study of the paraspinal muscles. The good correlation between the concentric and monopolar needles shows the data published using monopolar needle data also apply to studies using paraspinal needle electromyography with concentric needles. The low score with the asymptomatic group reaffirms that using a cutoff score of >2 as abnormal has a false-positive rate of <5%.     

Electrical stimulation of pulp nerves--comparison of monopolar and bipolar electrode coupling

In the present study monopolar and bipolar electrode couplings were compared in electrical stimulation of intradental nerves. In experiments on cats the threshold current values of A- and C-fibres and the jaw-opening reflex were measured with both techniques using different durations of current pulses (0.2-50 msec). In human studies the perception and pain thresholds were determined in the same manner. In experiments on anaesthetized cats 170 intradental nerve units were recorded. Of these 118 were A-fibres (conduction velocity (CV) greater than 2 m/sec) and 52 C-fibres (CV less than or equal to 2 m/sec). The threshold current values (pulse duration 10 msec) of A-fibres were almost 2-fold (12.2 microA, S.D. = 7.9) and of C-fibres over 2-fold (91.3 microA, S.D. = 52.3) with bipolar stimulation compared to monopolar (6.9 microA, S.D. = 7.3 and 42.5 microA, S.D. = 21.5 respectively). The mean threshold of the jaw-opening reflex obtained with bipolar electrode coupling was about twice the value obtained with monopolar (8.2 microA, S.D. = 3.7 and 3.4 microA, S.D. = 0.7 respectively). In human experiments the mean perception threshold was 11.7 microA (S.D. = 6.7) with bipolar and 7.2 microA (S.D. = 3.2) with monopolar stimulation. The mean pain threshold was also higher with bipolar than with monopolar stimulation, 16.0 microA (S.D. = 8.8) and 10.3 microA (S.D. = 4.5) respectively. The subjective sensations were different with these two electrode couplings; the pain (at pain threshold level) induced by bipolar stimulation was experienced as sharp or cutting and with monopolar stimulation as dull or more indefinite. It is concluded that there is a marked difference in the electrical threshold values of pulpal nerves and perception threshold of individual human teeth between monopolar and bipolar tooth stimulation. The thresholds of the A-fibres measured from the cat canine tooth closely correspond to the perception thresholds of the human tooth, but the threshold values of the pulpal C-fibres were significantly higher.     

电极法与标准实验法测定电解质和代谢物的比较

目的通过比较电极法和标准化学法对电解质和代谢物的测定,评价两种方法的相关性。方法用NOVA CCX电解质测定仪测定动脉全血钾、钠、氯等电解质和葡萄糖、肌酐、尿素氮等代谢物的含量,同时用日立7020全自动生化分析仪检测同份样本血浆中的相同成分的含量,用统计学方法比较两种方法的相关性。结果电极法的不精确度范围批内小于2.5％和日间小于3．3％,除肌酐外,其余均符合要求,两种方法有较好的相关性（r〉0．9）;经回归系数假设检验,钾和钠回归方程比较差异有统计学意义（P〈0．05）,呈直线回归关系。两种方法除肌酐外,差别均无统计学意义（P〉0.05）。结论电极法急诊全血多参数分析能快速准确提供检测结果,与标准实验方法结果有可比性。     

针电极肌电信号AR模型参数与局部肌疲劳的相关定性关系

背景：研究肌肉的疲劳行为，对于神经肌肉系统的基础研究、残疾人的康复工程、理疗效果的客观评价、运动员的科学训练和工效学等都有广泛的应用价值。 目的：利用针电极肌电信号AR模型参数来研究局部肌疲劳，试图揭示局部肌疲劳过程与针电极肌电信号AR模型系数之间存在的定性关系。 设计：以人体针电极肌电信号为观察对象，分析肌电特征参数在局部肌疲劳过程中的变化规律。 单位：中国科学技术大学NML实验室。 对象：由中国科学技术大学NML实验室研制的肌电信号采集系统获得4例针电极肌电信号，挑选的4名志愿者均为健康男性，检测部位为胫前肌。 方法：根据随机信号参数模型理论，对针电极肌电信号进行建模，选取参数，研究肌肉疲劳过程中肌电信号的α1参数随时间的变化趋势。编程采用MATLAB语言工具箱的相关程序。 主要观察指标：针电极肌电信号的α1参数随着时间（疲劳过程）的增加而变化的趋势。 结果：人体的局部肌肉疲劳与从该肌肉检测的针电极肌电信号α1参数的变化趋势之间存在着一种相关关系，即针电极肌电信号的α1参数随着时间（疲劳过程）的增加有增大的趋势。 结论：针电极肌电信号的α1参数随着时间（疲劳过程）的增加有增大的趋势，利用这种关系就能够较好的对肌肉疲劳的状态进行评价。     

针电极肌电信号AR模型参数与局部肌疲劳的相关定性关系

背景:研究肌肉的疲劳行为,对于神经肌肉系统的基础研究、残疾人的康复工程、理疗效果的客观评价、运动员的科学训练和工效学等都有广泛的应用价值。目的:利用针电极肌电信号AR模型参数来研究局部肌疲劳,试图揭示局部肌疲劳过程与针电极肌电信号AR模型系数之间存在的定性关系。设计:以人体针电极肌电信号为观察对象,分析肌电特征参数在局部肌疲劳过程中的变化规律。单位:中国科学技术大学NML实验室。对象:由中国科学技术大学NML实验室研制的肌电信号采集系统获得4例针电极肌电信号,挑选的4名志愿者均为健康男性,检测部位为胫前肌。方法:根据随机信号参数模型理论,对针电极肌电信号进行建模,选取参数,研究肌肉疲劳过程中肌电信号的α1参数随时间的变化趋势。编程采用MATLAB语言工具箱的相关程序。主要观察指标:针电极肌电信号的α1参数随着时间(疲劳过程)的增加而变化的趋势。结果:人体的局部肌肉疲劳与从该肌肉检测的针电极肌电信号α1参数的变化趋势之间存在着一种相关关系,即针电极肌电信号的α1参数随着时间(疲劳过程)的增加有增大的趋势。结论:针电极肌电信号的α1参数随着时间(疲劳过程)的增加有增大的趋势,利用这种关系就能够较好的对肌肉疲劳的状态进行评价。     

膝关节骨关节炎患者膝屈伸肌的表面肌电信号研究

目的 评价单侧膝关节骨关节炎（OA）患者在不同运动状态下的健、患侧膝屈伸肌的肌肉功能和协调活动差异，为临床制定康复方案提供依据。方法 用Noraxon Myosystem1200型表面肌电图仪对26例单侧膝关节骨关节炎患者的等长肌肉收缩功能和下蹲运动进行表面肌电信号的测试。结果 患侧股外侧肌和股二头肌在最大等长收缩和下蹲运动时的肌电振幅均值小于健侧（P〈0．05）。在最大等长收缩过程中，患侧的拮抗肌协同收缩率较健侧增高（P〈0．05）；在下蹲运动过程中，患侧的胭绳肌共同活动比率高于检测（P〈0．05）。结论 表面肌电图测试可用于量化评价膝OA患者在不同运动过程中肌肉功能。膝OA患肢在不同运动状态下均可能存在肌肉功能降低和肌力平衡异常。康复治疗不仅应重视股四头肌肌力增强而且应重视改善膝关节的肌力平衡。     

Optimization of the electrodeposition process of a polypyrrole/multi-walled carbon nanotube fiber electrode for a flexible supercapacitor

In the large-scale production of flexible supercapacitors, given the poor interface stability and the low mass loading of functional films on the fiber electrode, cyclic voltammetry (CV) and constant current (CC) electrodeposition methods were adopted to prepare polypyrrole/multi-walled carbon nanotubes (PPy/MWCNTs) on the surface of polyacrylonitrile (PAN) carbon cloth to explore the optimization process. The surface morphology and structural properties of the flexible electrode were characterized, and the electrical and electrochemical properties were studied. The research indicated that the PPy/MWCNTs were uniformly distributed on the fiber surface in the form of a linear structure and were amorphous and rich in carbon, nitrogen, and oxygen functional groups. A higher deposition current density helped improve the degree of coating of the MWCNTs with PPy and the number of oxygen-containing functional groups. The electrical and electrochemical properties of the flexible electrode prepared using the CC method were excellent; the electrochemical properties of the samples in the bent state were not significantly different from those in the straightened state. Using CC and CV methods, the conductivities of the samples were 32.4 S cm⁻¹ and 24.1 S cm⁻¹, the area-specific capacitance values were C 96.24 mF cm⁻² and 46.18 mF cm⁻² at a scan rate of 100 mV s⁻¹, the equivalent series resistance R_s values were 2.74 Ω and 4.67 Ω, the specific capacitance retention rates were 94.4% and 88.3% after 1000 cycles, and the capacitance retention rates were 89.7% and 80.6% after 5000 cycles, respectively. The differences in the performances of the flexible electrodes using the same preparation solvent and different preparation processes were due to the higher deposition current density of the CC method compared with that of CV. The former enhanced the polymerization degree of the PPy/MWCNT flexible electrode and improved the electrochemical performance. The presented research results are significant for the optimization of large-scale production processes.

The difference between the electrical and electrochemical properties of PPy/MWCNTs flexible electrodes was found to be due to the constant current method having a higher deposition current density, leading to a higher degree of polymerization.     

Electrochemical fabrication and evaluation of a self-standing carbon nanotube/carbon fiber composite electrode for lithium-ion batteries

A binder-free self-standing carbon nanotube (CNT)/carbon fiber (CF) composite electrode, which has been developed using an electrophoretic deposition approach, was utilized as a lithium-ion battery anode. The morphology of the CNT/CF composite has been examined using scanning electron microscopy, and the results indicated that a CNT layer uniformly deposited on the CFs. The thickness and density of the CNT layer increased as the electrodeposition time increased, while overdeposition caused the CNT layer to exfoliate. Electrochemical evaluation revealed that the specific capacity, cycling stability, and rate capability of the CNT/CF anode were superior to those of the CF anode. The electrochemical impedance analysis results further revealed that the solid/electrolyte interface resistance and interface resistance induced by the oxygen-containing surface functional groups of CFs dominated the impedance of the anode. However, these resistance values could be potentially reduced via CNT surface modification, which could lead to the enhanced electrochemical performance of the CNT/CF anode. Our findings should open new avenues for the potential use of the CNT/CF composite as a self-standing anode for lithium-ion battery applications.

A binder-free CNT/CF composite electrode is developed via electrophoretic deposition, offering favorable electrochemical performances and stability as a self-standing lithium-ion battery anode.     

重症肌无力患者伸指总肌的单纤维肌电图和重复电刺激检测的对比性研究

目的探讨重症肌无力（MG）患者自主收缩单纤维肌电图（SFEMG）和重复电刺激（RNS）检测结果敏感性不同的可能原因。方法选择67例MG患者，每例患者均在同一天的同一时段依次进行有侧伸指总肌的低频RNS和自主收缩SFEMG检查。结果67例MG患者SFEMG的异常率（92．5％）明显高于RNS的异常率（50．7％）（P〈0．01）。RNS波幅递减值与SFEMG中的平均颤抖（Jitter）值、异常电位对和阻滞电位对百分比均呈显著的正相关。RNS检测示波幅明显递减的34例患者中，有2例在SFEMG中未发现阻滞电位，这2例患者的波幅递减值最高达62％；而RNS检测示无波幅递减的33例患者中，传导阻滞电位对百分比最高达58％。结论在诊断MG时，同一肌肉的SFEMG检查较RNS的诊断敏感性高。RNS检测中波幅递减幅度与SFEMG中的阻滞电位对百分比并非完全对应。SFEMG检查较RNS敏感性高可能有两个方面的原因：（1）RNS检测记录的是肌肉表面肌纤维运动单位电位幅度的总和，而SFEMG记录的是肌纤维单个运动终板传递时间的延长或阻滞；（2）RNS和自主收缩SFEMG所检测的可能是不同类型的运动终板。     

神经电图-肌电图检测对多灶性运动神经病的评估作用

目的:探讨神经电图(ENG)和肌电图(EMG)检查对多灶性运动神经病(multifocalmotorneuropathy,MMN)的诊断价值及康复干预的评估作用。方法:对16例诊断为MMN的患者进行电生理检查,受试者为MMN组16例和正常组16例,分别进行运动神经传导速度(MCV)和感觉神经传导速度(SCV)检查,记录刺激引出的复合肌肉动作电位(compoundmus-cleactionpotentials,CMAP)的波幅、波宽、面积、位相、时限进行对比分析,判定是否有运动神经传导阻滞(conductionblock,CB)或暂时性离散(temporaldispersion,TD)。并有选择性地进行常规肌电图检查。结果:16例患者中均见有一根以上运动神经或至少一根运动神经的一个以上部位出现CB或TD。其中13例双上肢正中神经,尺神经出现CB,3例首发为正中神经尺神经的远端出现CB,随病情进展出现下肢腓深神经CB。仅有两例感觉神经传导速度稍有减慢,波幅略有降低。16例患者神经受累区域以下所支配肌肉肌电图检查见有运动神经源性受损改变。结论:MMN病是一种以远端神经受累为主的不对称性周围神经病,神经电生理检查对诊断和鉴别诊断MMN起重要作用,CB是MMN特征性表现。     

Manual acupuncture for analgesia during electromyography: a pilot study

OBJECTIVES: To evaluate the analgesic effect of acupuncture for needle electromyography and to validate a sham acupuncture needle. DESIGN: Randomized, double-blinded, controlled study. SETTING: University-based electrodiagnostics laboratory. PARTICIPANTS: Fifty-one subjects referred for electrodiagnostic evaluation. INTERVENTIONS: Before the electromyography examination, either real acupuncture needles or telescopic sham needles were applied. MAIN OUTCOME MEASURES: Visual analog scale of pain and unpleasantness after 3 muscles were examined with electromyography. Pretest pain was subtracted to give a measurement of pain attributable to the electromyography. Subjects were asked which needle they thought they had received. RESULTS: Twenty-six subjects were randomized to the treatment group and 25 to the sham group. Pain in the treatment group (-.96) was less than in the control group (9.68), but it was not statistically significant (P=.13). Post hoc analysis, excluding 5 subjects known to have been treated by the novice acupuncturist, showed a significant difference of 14.4mm (P=.02). The proportion of subjects who thought they received real needles in the acupuncture group (69%) did not differ from the proportion in the control group (48%) (P=.13). CONCLUSIONS: Acupuncture may represent an effective form of analgesia for electromyography. This is the first study to suggest independently the telescopic sham acupuncture needle as an effective control.     

日立7170生化分析仪离子选择电极内标液的研制与应用

目的探讨自配离子选择电极（ISE）内标液试剂能否应用于7170A生化分析仪的ISE模块测定。方法取自配ISE内标液,参照有关文件的内容,测定其理化参数,并评估精密度、准确度和线性范围,并与原装内标液同时检测45份患者样本,统计相关数据。结果自配内标液与原装内标液的主要理化参数[pH值、电导率、渗透压、无机离子浓度（K＋、Na＋、Cl^-）]基本一致。2种内标液测定K＋、Na＋、Cl^-（高、低值质控品）的精密度及准确度均无差异（P均〉0.05）。线性方程为K＋（1-10 mmol/L）：Y=0.997 5X＋0.021,r=0.999;Na＋（80-180 mmol/L）：Y=0.999 7X＋0.15,r=0.999;Cl^-（60-160 mmol/L）：Y=1.015 4X-2.51,r=0.989。自配内标液用于测定常规样本的结果与原装内标液的检测结果基本一致（P〉0.05）。结论自配的ISE内标液可替代原装试剂用于7170A生化分析仪ISE模块测定。     

神经危重症患者床旁肌电图检查的应用价值

目的探讨神经危重症患者床旁肌电图检查对患者诊断及预后判断的意义。 方法对2016年11月至2017年4月在南方医科大学南方医院神经危重症病房（NCU）住院、且住NCU时间超过3 d的58例神经危重症患者进行床旁肌电图检查。检查项目包括运动神经传导、感觉神经传导、直接肌肉刺激。对超过两个肢体共计3条及以上运动和/或感觉神经传导出现异常定义为多发神经传导异常,并进行分组后病因分析、临床特点和电生理特点的比较。 结果48.3%（28/58）患者呈多发神经传导异常,为多发神经传导异常组,其余30例患者为对照组。与对照组比较,多发神经传导异常组的急性病生理学和长期健康评价（APACHE）Ⅱ评分[（12 ± 5）分vs.（16 ± 6）分]、在院最高脓毒症相关器官衰竭评分（SOFA）分值[4（3,6）分vs. 7（4,11）分]、脓毒症[11/30 vs. 21/28]及多器官功能障碍综合征（MODS）发生率[2/30 vs. 10/28]均更高,预后情况中机械通气时间[0（0,4）d vs. 6（0,16）d]、ICU住院时间[8（5,13）d vs. 14（7,20）d]均更长,出院后30 d [4（3,4）分vs. 5（5,6）分]及90 d [3.0（2.0,4.0）分vs. 6.0（4.2,6.0）分]的改良Rankin评分（mRS）分值、30 d（2/30 vs. 12/28）及90 d（4/30 vs. 15/28）病死情况均更高（P均< 0.05）。多因素Logistic回归分析发现,多发神经传导异常是出院后30 d及90 d病死情况的独立危险因素（P均< 0.05）。多发神经传导异常患者电生理特点显示与其他病因组（14例）比较,危重病性神经肌病（CIPNM）组（14例）运动神经传导未引出复合肌肉动作电位（CMAP）波形的比例更高（6/90 vs. 15/87）,而感觉神经传导异常占比均更低（58/83 vs. 28/81、29/37 vs. 14/37、29/44 vs. 14/44;P均< 0.05）。 结论神经危重症患者常存在周围神经肌肉病变,且病因复杂多样,床旁肌电图检查对神经危重症患者的病因鉴别具有重要意义,且对神经危重症患者预后判断具有重要价值。