负重对帕金森病患者上肢肌群表面肌电信号的影响

目的：观察帕金森病（PD ）患者上肢无负重和负重情况下上肢肌群表面肌电信号变化特征。方法：26例帕金森病患者为PD组,28例正常人作对照组,在坐位上肢屈肘无负重和负重1．5kg的静态运动负荷下,采用表面肌电对肱二头肌及屈腕肌群进行线性时、频分析。结果：PD组中位频率（MF）和平均功率频率（MPF）均值高于对照组（P＜0．01）,而平均肌电值（AEMG）值显著低于对照组（P＜0．01）。PD组的肱二头肌MF值、MPF值均小于屈腕肌群（P＜0．05,0．01）;PD组无负重的MF和MPF均值均大于负重时（P＜0．05,0．01）,而无负重时的AEMG小于负重时（P＜0．01）;无负重时肱二头肌的MF均值、MPF均值均小于屈腕肌群（P＜0．05,0．01）。结论：帕金森病患者上肢肌群运动单位募集过度,肌力下降,其中以前臂肌群或上肢无负重时最明显,表面肌电信号可以反映帕金森病患者的肌肉功能。     

肌肉评定和训练系统测定健康成人上肢远端肌力的重测信度研究

目的评估肌肉评定和训练系统对健康成人上肢远端肌力的重测信度。方法采用上海理工大学和华山医院康复科合作研发的肌肉评定和训练系统对30 名健康成人进行测试,由1 名评估者分别对受试者双侧屈腕肌群、指浅屈肌、指深屈肌、指伸肌、伸腕肌群进行肌力测试,并测定每组肌群的峰力矩、峰力矩体重比、最大单次做功量、最大单次做功量体重比、平均力矩、平均功率各项参数。测试共进行2 次,分别在第1 天和1 周后进行。结果肌肉评定和训练系统对健康成人的指浅屈肌峰力矩(ICC: 0.814~0.870)、指深屈肌峰力矩(ICC: 0.811~0.848)、屈腕肌群峰力矩(ICC: 0.871~0.808)、伸腕肌群的峰力矩(ICC: 0.778~0.873)有好的重测信度;对健康成人的指伸肌峰力矩有中等至好的重测信度(ICC: 0.302~0.803)。此外,肌肉评定和训练系统对健康成人的各项肌群的平均功率有中等至好的重测信度。结论肌肉评定和训练系统在健康成人上肢远端肌力观测指标中的峰力矩和平均功率有较好的重测信度。     

肌电生物反馈治疗中枢神经系统损伤所致腕、踝关节异常运动模式的临床研究

目的：通过EMG生物反馈仪提供的肌电信号，确定中枢神经系统损伤后造成腕、踝关节异常运动模式的肌肉原因，制定适宜的治疗方案，观察EMG生物反馈对该异常关节运动的治疗效果。方法：对异常运动模式的29个腕、踝关节进行一个疗程的(15次，每次50min)EMG生物反馈治疗。比较分析治疗前后腕伸肌、腕屈肌，胫前肌、腓肠肌两组拮抗肌的肌电信号、肌力，以及治疗前后的关节运动情况。结果：治疗前后腕关节背伸与掌屈，踝关节背屈与跖屈的肌电信号、肌力和关节异常运动模式均得到明显改善。结论：通过EMG生物反馈能够准确了解导致关节异常运动的肌肉原因，并有效治疗该异常运动模式。     

肌电生物反馈疗法治疗脑瘫患儿腕背屈功能障碍疗效观察

目的观察肌电生物反馈疗法治疗脑瘫患儿腕背屈功能障碍的疗效。方法20例脑瘫患儿随机分为治疗组和对照组,每组10例,所有患儿均接受Bobath技术、作业治疗、ADL功能训练。治疗组在此基础上应用AM800型神经功能重建仪,对患侧上肢腕伸肌群进行20min/d肌电触发的神经肌肉电刺激。每次治疗前后均进行测评并记录。在疗程开始与结束时,应用Fugl-Mey-er上肢运动功能评定法(FMA)等评定上肢运动功能。结果治疗后,两组患儿的观察指标均有不同程度改善(P<0.05～0.01),但治疗组的疗效优于对照组(P<0.05～0.01)。结论肌电生物反馈神经肌肉电刺治疗能明显提高脑瘫患儿的伸腕功能和肌电信号,改善其上肢运动功能。     

超声弹性成像在脑卒中后前臂屈肌痉挛定量评价中的应用

目的探讨应用超声弹性成像技术定量评价脑卒中后前臂屈肌痉挛的可行性及其特点。方法2019年1月至10月,脑卒中后屈腕和屈指肌痉挛的住院患者30例,采用超声弹性成像测量前臂屈肌群桡侧腕屈肌(FCR)、尺侧腕屈肌(FCU)、指浅屈肌(FDS)和指深屈肌(FDP)剪切波速度(SWV),采用改良Ashworth量表(MAS)评定屈腕和屈指肌张力。结果患侧和健侧各肌肉SWV在牵伸位时均显著高于放松位(|Z|>3.844,P<0.001);牵伸位时,患侧各肌肉SWV显著高于健侧(|Z|>3.593,P<0.001);牵伸位与放松位SWV差值比较,患侧各肌肉明显高于健侧(t>3.199,P<0.01);各肌肉牵伸位平均SWV与屈腕MAS评分显著相关(r=0.605,P<0.001);指浅屈肌和与指深屈肌牵伸位平均SWV与屈指MAS评分明显相关(r=0.540,P<0.01)。结论超声弹性成像可以定量评价脑卒中后前臂屈肌群内不同肌肉的痉挛程度。     

腕关节等张屈伸训练的交叉迁移效果研究

目的:观察腕关节等张屈伸训练是否会增长肌肉力量并产生交叉迁移的效果,为进一步临床康复应用提供科学依据。方法:22名右利手男性志愿者,随机分成两组,首先对两组受试者进行等张肌力评定,然后训练组受试者进行右腕关节屈伸等张肌肉力量训练,对照组保持日常活动不进行训练;6周后再次评定等张肌力。结果:训练组右侧腕屈肌肌力、左侧腕屈肌肌力、左侧腕伸肌肌力分别增加了19%、12%和41%,与对照组相比(右侧腕屈肌肌力减少0.6%,左侧腕屈、伸肌肌力增加0.6%和4%)差异有显著性意义(分别为P0.05,P0.05和P0.01);而右侧腕伸肌肌力虽增加了32%,但与对照组相比(右侧腕伸肌肌力也增加了11%)差异无显著性意义(P=0.059)。结论:本研究证实了6周单侧腕关节屈伸等张训练方案在右利手青年男性受试者交叉迁移效果良好,为临床康复实践提供了可能的新途径。     

动态腕手矫形器应用于慢性期脑卒中患者上肢及手功能康复的疗效

目的应用一种动态腕手矫形器(Saebo Glove康复手套)辅助慢性期脑卒中患者上肢及手的抓握、伸展训练。方法 2018年10月至2019年1月,脑卒中慢性期上肢及手功能障碍患者11例,在常规康复训练的基础上佩戴动态腕手矫形器后进行抓握、伸展训练,共3周。比较训练前后腕背伸肌、腕掌屈肌肌电值;采用FuglMeyer评定量表上肢部分(FMA-UE)、手臂动作调查测试(ARAT)、屈腕肌改良Ashworth量表(MAS)、改良Tardieu量表(MTS)和三倍痉挛量表(TSS)进行评定;测量握力,主动屈、伸腕关节,屈掌指关节活动度。结果治疗后,患者FMA-UE和ARAT评分、主动腕背屈活动度增大,腕屈肌TSS评分下降(t 2.739, P 0.05)。结论动态腕手矫形器辅助下抓握、伸展训练可提高慢性脑卒中患者上肢和手的运动功能,降低屈腕肌痉挛。     

体外冲击波治疗对脑卒中患者上肢肌张力及运动神经元兴奋性影响的临床研究

目的：明确体外冲击波治疗(extracorporeal shockwave therapy,ESWT)对脑卒中患者上肢肌肉张力的作用,并通过超声弹性成像和神经电生理检测探讨其作用机制。方法：选择46例符合入排标准的脑卒中患者,随机分为对照组和干预组,每组23例,对照组接受常规康复治疗,每周治疗6天,共2周;干预组在常规治疗的基础上增加ESWT,每周3次,隔日1次,连续2周。分别在治疗前和治疗后采用改良Ashworth量表(modified Ashworth scale,MAS)、超声弹性成像测量剪切波速度(shear wave velocity,SWV)评估肌张力及肌肉硬度,采用正中神经F波检测评估运动神经元兴奋性。结果：(1)MAS变化：治疗后干预组腕屈肌、指屈肌和旋前肌群MAS评分较治疗前均降低(P<0.01),组间比较,治疗后干预组腕屈肌MAS评分显著低于对照组(P<0.05)。(2)SWV变化：治疗后干预组指浅屈肌、指深屈肌、桡侧腕屈肌、掌长肌和旋前圆肌的SWV较治疗前均显著降低(P<0.05),干预组指浅屈肌、桡侧腕屈肌、掌长肌和旋前圆肌的SWV显著低于对照...     

计算机运动反馈训练对脑卒中患者手功能康复的疗效观察

目的:探讨计算机运动反馈训练对脑卒中偏瘫患者手功能康复的疗效。方法:采用随机数字法将46例脑卒中患者分为对照组(n=23)和试验组(n=23)。在接受基础常规康复训练的基础上,试验组采用计算机运动反馈训练治疗,对照组采用常规手功能康复治疗,每天1次,每次30min,每周5次,共4周。治疗前后采集患侧手部的表面肌电值,同时采用Fugl-Meyer评定量表(FMA)、改良Ashworth分级评价量表(MAS)和改良Barthel指数(MBI)来评估患者的功能。结果:共43例患者完成试验。治疗后,对照组FMA、MBI评分以及腕屈肌、腕伸肌、指伸肌、拇短展肌表面肌电积分肌电值(iEMG)、均方根值(RMS)均较治疗前提高(P0.05);试验组FMA、MAS、MBI评分以及腕屈肌、腕伸肌、指伸肌、拇短展肌表面肌电iEMG、RMS均较治疗前提高(P0.05);治疗后试验组的FMA总分及手部分评分、MBI评分、腕伸肌RMS、指伸肌iEMG改善优于对照组(P0.05)。结论:计算机运动反馈训练可有效促进脑卒中患者手功能的康复及日常生活活动能力的恢复。     

脑卒中后腕屈肌痉挛的神经与外周因素的分型量化评估

目的:本研究旨在探索量化区分痉挛状态的神经及外周因素的可行性,了解痉挛肌肉的生物力学特性变化。方法:纳入脑卒中后痉挛性偏瘫患者40例,Neuro Flexor比较双侧腕屈肌被动牵伸时的神经成分阻力(neural component,NC)、肌肉弹性成分阻力(elasticity component,EC)和粘性成分阻力(viscosity component,VC),Myotonometer比较双侧桡侧腕屈肌的肌肉硬度(stiffness,S)及张力(frequency,F)。用改良Ashworth量表(modified Ashworth scale,MAS)评估患侧痉挛程度。不同方法测量的参数及其与MAS之间进行相关性分析。结果:Neuro Flexor测量的脑卒中患者的痉挛状态腕屈肌的NC、EC和VC均较健侧明显升高(P0.05)。Myotonometer测量的痉挛状态腕屈肌的S和F都高于健侧(P0.001)。相关性分析发现患侧EC与S(P=0.035)和F(P=0.007)呈弱到中等强度正相关,MAS与NC(P0.001)、S(P=0.001)和F(P=0.006)均呈中等强度正相关。结论:脑卒中后痉挛状态腕屈肌的肌肉张力、硬度及粘性等生物力学特征变大,Neuro Flexor和Myotonometer测量的参数与MAS呈正相关,提示二者用于量化评估脑卒中后痉挛状态腕屈肌的神经和外周因素具有临床可行性。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.