强制性使用运动疗法对慢性期脑卒中患者上肢运动功能的康复疗效

目的 探讨强制性使用运动疗法（CIMT）对慢性期脑卒中患者上肢运动功能的康复疗效。方法 15例慢性期脑卒中偏瘫患者（平均病程13．5个月）在CIMT治疗期间健侧穿戴吊带和夹板限制肢体动作，每天清醒时固定时间不少于90％，连续12d；同时接受塑形训练，密集训练患侧肢体活动，完成日常生活动作，连续两周共10个工作日。在CIMT治疗前2周的基线期、治疗前和治疗后采用上肢功能测验（UEFT）和简易上肢机能检查（STEF）评价患者的上肢运动功能。结果 患者在CIMT治疗前2周的基线期内，UEFT和STEF显现出微小改善（ES；0．11，0．13）；接受2周CIMT治疗后，UEFT和STEF显现出较为明显的改善（ES：0．8，0．5）。结论 C1MT是改善慢性期脑卒中患者上肢运动功能的一种有效治疗方法，短期CIMT介入可以促进患侧上肢功能多方面的改善。     

强制性使用运动疗法在最低上肢运动标准慢性脑卒中偏瘫患者中的疗效

目的：探讨强制性使用运动疗法（CIMT）在最低上肢运动标准慢性脑卒中偏瘫患者中的疗效。方法：10例符合CIMT最低上肢运动标准即腕关节伸展〉10°，拇指外展〉10°，其他四指中任何两个手指伸展〉100的慢性脑卒中偏瘫患者参与此研究。在基线期接受常规康复治疗。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12天，同时接受塑形训练，密集地训练患侧肢体活动．完成日常生活中的动作，连续两周共10个工作日。在基线期与CIMT治疗前后用Fugl—Meyer评价法（FMA）和上肢动作研究量表（ARAT）来评价患者的上肢运动功能，用动作活动日志（MAL）来评价患者的上肢的使用量（AOU）和动作质量（QOM）。结果：患者在基线期，在FMA、ARAT、AOU和QOM上显现出微小改善，效应值（ES）分别为：0．15、0．24、0．07和0．05。但患者在接受CIMT治疗后，在FMA、ARAT、AOU和QOM上显现极为显著的改善，ES分别为：2．1、3．75、5．19和4．29。结论：CIMT可以改善最低上肢运动标准慢性脑卒巾偏瘫患者上肢运动功能，但CIMT在这些脑卒中患者中的长期功能效益尚需进一步明确。     

强制性使用运动疗法对亚急性期脑卒中患者上肢运动功能的影响

目的：强制性使用运动疗法是近年来针对慢性期脑卒中患者上肢功能障碍的一种新的康复训练技术，观察其对亚急性期脑卒中患者上肢运动功能恢复的影响。方法：选择2002-09/2005-04解放军总医院康复医学科收治的脑卒中偏瘫患者13例，所有患者符合以下条件：①脑卒中病程在1～6个月。②穿戴强制性装置后要有足够的平衡和安全能力。⑧手腕能主动背伸至少20&;#176;。除拇指外，至少有其他两指背伸10&;#176;。在强制性使用运动疗法治疗前的2周对患者上肢功能进行基线测量，然后进行为期2周的以患侧上肢和双上肢组合的神经发育技术为主的常规的康复训练，最后进行连续12d的强制性使用运动疗法，治疗期间要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，同时接受行为再塑的技巧训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在强制性使用运动疗法治疗前2周、治疗前和治疗12d后用上肢功能测验（满分99分，分数越高，功能越好）和简易上肢机能检查（分数越高，功能越好）来评价患者的上肢运动功能，并用效应值来比较常规康复和强制性使用运动疗法治疗前后差异的大小（0．2即表示疗效轻微，0．4～0．6为中等疗效；≥0．80为疗效显著）。结果：13例患者全部进入结果分析。①常规康复治疗前后比较：上肢功能测验平均提高（5．3&;#177;5．1）分，效应值为0．41；简易上肢机能检查平均提高（2．9&;#177;6．0）分，效应值为0．13。②强制性使用运动疗法治疗前后比较：上肢功能测验平均提高（25．3&;#177;14．0）分，效应值为1．59；简易上肢机能检查平均提高（24．3&;#177;15．6）分，效应值为1．03。结论：强制性使用运动疗法疗法是改善亚急性期脑卒中患者上肢运动功能一种有效治疗方法，短期强制性使用运动疗法疗法介入，可以显著促进患侧上肢功能多方面的改善，减缓恢复平台期的出现，效果优于常规训练。     

强制性使用运动疗法对脑卒中偏瘫患者上肢功能恢复的影响

目的观察强制性使用运动疗法（CIMT）对亚急性期脑卒中偏瘫患者上肢功能恢复的影响。 方法将60例脑卒中偏瘫患者分为治疗组（n=30）和对照组（n=30），进行6周的康复治疗。2组患者均先进行常规康复训练，每日1次，每次45~60 min，每周训练6次。4周后治疗组改用CIMT治疗2周，对照组治疗保持不变。采用Fugl-Meyer运动量表（FMA）、上肢功能测验（UEFT）、简易上肢机能检查（STEF）和改良Barthel指数（MBI），于治疗前、治疗4周和6周后，以及治疗结束后1个月和3个月评定2组患者的上肢运动功能和日常生活活动能力，并进行比较。 结果2组治疗后不同时间段的上肢、腕和手FMA、UEFT、STEF和MBI评分与治疗前比较，差异均有统计学意义（P<0.05）；治疗组治疗6周后及随访期间的UEFT、STEF和MBI评分与对照组比较，差异有统计学意义（P<0.05），提示其功能改善更显著，且疗效持续至随访期。 结论CIMT可促进亚急性期脑卒中偏瘫患者上肢功能的恢复，其疗效优于常规康复训练。     

改良强制性使用运动疗法对脑卒中偏瘫患者上肢功能影响的临床研究

目的观察改良强制性使用运动疗法（mCIMT）对脑卒中偏瘫患者上肢运动功能的康复疗效。 方法选取27例符合入选标准的脑卒中偏瘫患者，随机分为改良强制性使用运动疗法组（改良组，14例）和常规治疗组（常规组，13例）。常规组治疗以Bobath技术为主，进行上肢运动功能训练，每日2 h，每周训练5 d，连续10周。改良组采用改良强制性使用运动疗法，限制健侧肢体动作，在治疗期间要求患者穿戴吊带和夹板，每天清醒时固定时间不少于90%，训练在治疗环境中进行，每日1 h，每周3次，其它时间在日常生活活动中进行训练，时间不少于每日2 h，连续10周。治疗前、后分别采用简易上肢机能检查量表（STEF）和Wolf运动功能量表（WMFT）评价患者的上肢运动功能。 结果2组患者治疗前，STEF中的10项活动评分和WMFT评分差异均无统计学意义（P&rt;0.05）。经过治疗后，组内评分比较，差异均有统计学意义（P<0.05）；组间比较，STEF中的10项活动评分除拿大球、拿大方块和拿中方块3项差异无统计学意义（P&rt;0.05）外，其余7项差异均有统计学意义（P<0.05）；WMFT评分比较，差异有统计学意义（P<0.05）。 结论改良强制性使用运动疗法是改善脑卒中偏瘫患者上肢运动功能的有效治疗方法，与常规Bobath技术相比，可显著提高患者偏瘫侧上肢的灵活性和运动速度。     

强制性运动方案对脑卒中偏瘫上肢功能障碍患者的疗效

目的:观察强制性运动疗法在脑卒中偏瘫上肢功能障碍患者康复治疗中的疗效。方法:选取脑卒中偏瘫上肢功能障碍患者120例,随机分为观察组62例和对照组58例,对照组予常规康复疗法治疗,观察组予强制性运动疗法治疗,比较两组治疗前后简式Fugl-Meyer运动功能评价量表(FMA)、简易上肢功能检查量表(STEF)和观察改良Barthel指数(MBI)评分。结果:治疗前2组FMA、STEF、MBI评分比较,差异无统计学意义(P>0.05);治疗后,2组FMA、STEF、MBI评分高于治疗前,差异有统计学意义(P<0.05);且治疗后观察组的FMA、STEF、MBI评分高于对照组,差异有统计学意义(P<0.05)。结论:强制性运动疗法在脑卒中偏瘫上肢功能障碍患者康复治疗中的临床疗效较常规康复疗法好。     

强制性使用运动疗法对恢复期脑卒中患者上肢功能的影响

目的探讨强制性使用运动疗法(CIMT)对恢复期脑卒中患者上肢功能和日常生活活动能力的影响。 方法将符合入选条件的30例恢复期脑卒中偏瘫患者随机分为观察组和对照组,每组15例。观察组用CIMT，即用休息位夹板和吊带将健侧上肢固定，限制使用，每天在清醒时的固定时间不少于90%；每天强制性训练患者使用偏瘫侧上肢6 h（其中1 h在作业治疗室进行任务指向性塑形训练，其它5 h在家属监督下使用患手），每周6 d，持续3周。对照组用神经发育疗法(NDT)，每天在作业治疗室以运动再学习方案训练为主，训练患者使用偏瘫侧上肢1 h，每周6 d，持续3周。2组患者均同时予以常规药物治疗及其它康复治疗，治疗前、后采用Wolf运动功能评价量表（WMFT）评定偏瘫侧上肢运动功能，采用Barthel指数(BI）评定ADL能力。 结果治疗前2组患者WMFT评分和BI评分比较，差异无统计学意义（P&rt;0.05）；2组治疗前、后比较，偏瘫侧上肢运动功能和ADL能力均有提高，差异具有统计学意义(P<0.001)；治疗后2组患者WMFT评分比较，观察组优于对照组，差异具有统计学意义(P<0.05)，而BI评分比较，差异无统计学意义(P&rt;0.05)。 结论CIMT与NDT对恢复期脑卒中患者上肢功能都有促进作用，都可提高患者ADL能力，但CIMT对促进恢复期脑卒中患者的上肢功能优于NDT。     

改良强制性运动疗法对脑卒中患者上肢功能及日常生活能力的影响

目的观察改良强制性运动疗法对脑卒中患者上肢功能及日常生活活动（ADL）能力的影响。 方法选取脑卒中偏瘫患者60例,采用随机数字表法将其分为改良组和常规组,每组30例。改良组采用改良强制性运动疗法,常规组治疗以Bobath技术、运动再学习技术为主,进行上肢功能训练。治疗前、后,采用简式Fugl-Meyer上肢运动功能评价量表（FMA）、简易上肢功能检查量表（STEF）评定患者的上肢功能,采用改良Barthel指数（MBI）评定患者的ADL能力。 结果治疗前,2组患者FMA、STEF、MBI评分间比较,差异均无统计学意义（P&rt;0.05）。与组内治疗前比较,2组患者治疗8周后（治疗后）FMA、STEF、MBI评分均较高,差异有统计学意义（P<0.05）。与常规组治疗后比较,改良组治疗后FMA［（52.80±5.37）分］、STEF［（63.17±5.34）分］、MBI评分［（66.67±6.16）分］明显较高,差异有统计学意义（P<0.05）。 结论改良强制性运动疗法可显著改善脑卒中患者的上肢功能,提高患者的日常生活能力,值得临床应用、推广。     

强制性使用运动疗法在不同程度上肢功能障碍脑卒中患者中的效力

目的 探讨强制性使用运动疗法（CIMT）在不同程度上肢运动障碍的脑卒中患者中的康复效力。方法 27例脑卒中偏瘫患者（平均病程8．3个月）参与此研究。在CIMT治疗期间，要求患者健侧穿戴吊带和夹板来限制健侧肢体动作，每天清醒时固定时间不少于90％，连续12d。同时接受塑形训练，密集地训练患侧肢体活动，完成日常生活中的动作，连续两周共10个工作日。在接受CIMT治疗前和治疗后用上肢功能测验（UEFT）评价患者的上肢运动功能。根据CIMT治疗前UEFT评定结果进行上肢运动功能障碍程度分类。结果 在CIMT治疗后，上肢运动功能障碍重度组和中度组患者的UEF得分较治疗前均显著提高（P〈0．001），而且CIMT在重度组患者中比在中度组患者显现出更大的康复效力（ES分别为2．2和1．8）。在UEFT的改善值方面，重度组和中度组患者间无显著性差异（P〉0．05）。结论 CIMT可以有效地改善不同障碍程度脑卒中患者的上肢运动功能，特别是在上肢运动功能障碍严重的脑卒中患者中显现出更大的康复效力。     

强制性运动疗法用于脑卒中偏瘫康复治疗的效果

目的分析强制性运动疗法用于脑卒中偏瘫康复治疗的效果。方法选取汝阳县人民医院于2009年3月至2013年1月收治的接受强制性运动疗法的脑卒中偏瘫患者85例,将其随机分为对照组47例和治疗组38例,对照组接受患侧下肢PT训练为主的神经发育技术疗法,治疗组采用强制性运动疗法,两组患者均接受2个月的治疗。在治疗前及治疗后,计时测试“起立－行走”,对两组患者移动平衡能力进行评定,测量10m最大步行速度（MWS）,对两组患者的静态平衡功能进行评定,评定标准采用Berg,对比分析两组患者的治疗效果。结果两组患者治疗前后MWS和BI评分比较差异有统计学意义（P〈0．01）。治疗前,两组MWS和BI评分比较差异无统计学意义（P〉0．05）;治疗后,治疗组优于对照组,差异有统计学意义（P〈0．05）。结论强制性运动疗法对于治疗脑卒中偏瘫患者,对于治愈脑卒中偏瘫患者效果显著,可以有效提高患者的动态以及静态平衡,值得临床医学中推广使用。     

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.