肌电触发的神经肌肉电刺激对脑卒中偏瘫早期上肢运动功能的影响

目的 探讨肌电触发的神经肌肉电刺激对脑卒中偏瘫早期上肢运动功能障碍患者的影响.方法 脑卒中早期合并上肢运动功能障碍患者30例随机分为对照组和治疗组,均采用常规康复训练,治疗组另对患侧上肢进行肌电触发的神经肌肉刺激治疗;分别于治疗前(病例纳入时)、疗程结束时(病例纳入后30天)与疗程结束后1个月(病例纳入后60天),采用Fugl-Meyer量表(FMA)评估患侧上肢运动功能.结果 疗程结束时,两组患者上肢FMA评分均较自身治疗前提高,但差异无统计学意义(均P＞0.05);疗程结束后1个月时较自身治疗前显著提高,且治疗组改善程度显著高于对照组(均P ＜0.05).结论 综合康复治疗的早期介入可有效改善脑卒中患者上肢运动功能;早期应用肌电触发的神经肌肉电刺激技术对脑卒中患者上肢运动功能的恢复在短期内未显示有明显效果,但具有远期效果.     

肌电图在平山病神经电生理诊断中的价值

目的探讨肌电图在平山病神经电生理诊断中的价值。方法对19例平山病患者进行运动及感觉传导速度及针极肌电图检测。结果针极肌电图检测表现为神经源损害。在平静状态下多出现自放电位。纤颤,正锐波。MUPS时限延长,波幅增高,多相波增多。患肢手肌100％,近端肌多正常。神经传导测定异常率患侧正中神经85％,尺神经100％。主要表现为运动神经DML延长,CMAP波幅降低。感觉神经传导速度正常。结论肌电图对诊断平山病有价值。     

体外反搏治疗进行性肌营养不良症一例报告

<正>病例:女性,31岁,1989年3月无任何诱因逐渐出现双下肢乏力,奔跑及上楼困难,半年后下蹲后起立困难,渐发展到下蹲后不能起立而于1993年3月来我院诊治.住院时体查:双下肢肌萎缩,四肢肌张力减低,双上肢肌力V°,双髋关节肌力V°,双膝关节肌力IV°,双踝关节肌力V°,双下肢肌腱反射消失,双下肢肌内侧可疑感觉减退.实验室检查:SGOT44u/L;CPK2152u/L;LDH1800u/L.肌电图:双侧肌肉呈部分肌性损害,并呈少部分神经性损害.     

慢性生活性砷中毒三例误诊报告

我科收治三名慢性砷中毒患者,在院外被长期误诊,现报道如下: 例1,周××,男,42岁,住院号1230,因双上肢疼痛,麻木,肌肉萎缩三年入院。 患者自1981年开始逐渐出现双上肢疼痛、发麻、诸关节肿痛,今年以来加重,两上肢肌肉萎缩、无力,生活不能自理。查体:右肘、腕,左腕关节肿胀,活动受限,左上肢不能伸直,肌力Ⅳ度,     

慢性职业性止己烷中毒患者神经-肌电图表现特征分析

[目的]分析职业性正己烷中毒患者神经肌电图表现的特征,明确肌电图表现改变在正己烷中毒诊断中的作用。[方法]对某电子企业2009年9名正己烷中毒患者进行深度调查,收集工人的职业吏并对接触毒物进行鉴定,所有患者进行神经专科检查和定期神经肌电图检查,观察中毒患者神经肌电表现的特征。[结果]9例患者都有确切的正己烷接触史,神经电生理检查显示肌肉自发电位增多,收缩时相位异常,神经传导速度下降（P〈0．01）．远端潜伏期延长（P〈0．01）,波幅下降（P〈0．05o经营养神经对症处理辅以运动锻炼治疗后9例患者均有好转（P〈0．05o［结论]正己烷慢性中毒患者神经肌电图表现为周围神经受损,运动神经较感觉神经严重,入院治疗后临床症状好转先于神经肌电图改变,在评价恢复程度时应更注重临床表现而不导神终肌电检查。     

脑脊液特异性腮腺炎病毒抗体升高的慢性脑脊髓膜炎

作者报告了1例由腮腺炎病毒引起的慢性脑脊髓膜炎的病例。患者系男性,31岁,平素健康。1967年2月出现发热、头痛、呕吐、感觉异常、肌无力、排尿障碍及复视。3周后下肢痉挛性麻痹,伴有感觉障碍和上肢远端麻痹。巴氏征双侧阳性,腱反射活跃,腹壁反射消失,眼球震颤阳性,病人似乎表现欣快感。2个月后下肢出现瘫痪,脑电图和颅脑CT检查正常。神经肌电图提示下肢显著的去神经样改变,类似脊髓灰质炎的前角损害。一年后患者病情好转,能够步     

磷酸三甲苯脂中毒的主要特点及实验室检查

1995年4月7日，本安市未央区谭家乡联合等五个自然村60多人暴发了以下肢弛缓性瘫痪为主要临床表现的疾病。此病有以下几个特点。l临床特点发病无任何前驱表现。其主要临床症状为小腿肌肉胀痛·2一5天后疼痛减轻·出现下肢无力，站立不稳．行走困难并逐渐加重，少数患者累及上肢手部肌肉无力，抓举东西困难。肌电图表现运动一传导延迟。2流行病学特点发病家聚性很强·18家病人家庭有8户人家1加一。发病．11户人家8（小；以上发病。发病潜伏期不明显·无前驱症状，但病人临床症状、体征相似·无性别、年龄差异。从流行病学调查中发现原因与病…     

多发性肌炎与皮肌炎患者的临床与神经电生理特征分析

目的 探讨多发性肌炎(PM)与皮肌炎(DM)患者的临床与神经电生理特征及其临床意义.方法 对62例PM和DM患者的临床表现及肌电图检测特征进行分析.结果 47例(75.8%,47/62)患者头面部、颈背部或四肢出现大片暗红色、紫红色斑块,以眼睑水肿性紫红斑出现较早且多见,有的伴有痒疹;所有患者都有不同程度的肌无力表现,53例(85.5%,53/62)患者有肌痛,主要累及四肢近端肌肉,多为对称性,表现为自发性疼痛和压痛.肌电图检查见肌源性损害54例(87.1%,54/62);5例(8.1%,5/62)患者肌源性损害的同时合并有神经源性损害;25例(40.3%,25/62)患者肌电图插入电位出现纤颤电位、正锐波和少数肌僵直电位;3例(4.8%,3/62)患者出现下肢运动神经传导速度或感觉神经传导速度减慢.结论 肌电图检查是诊断PM和DM的重要检查手段,选择肢体近端肌肉检查异常率较高,临床表现越重,肌肉损害越明显,肌电图可方便快捷地检测病情异常程度和客观地评价患者的治疗情况,辅助肌肉活检定位,提高PM和DM的诊断率.     

脉管炎的新疗法

血栓闭塞性脉管炎又称伯尔格氏病,一般认为与寒冷、潮湿、吸烟、外伤等因素有关,常见于下肢。疾病症状开始表现出因患肢供血不足而出现怕冷、无力、麻木,走路时感小腿疼痛,肌肉抽搐,迫使病人跛行或坐下休息。休息后症状消失,但再走一段路后,小腿又出现疼痛和肌肉抽搐。这种走一段路就需休息一阵的现象,称为“间歇性跛行”。随着病情加重,患肢可出     

68例甲状腺机能亢进的肌电图分析

甲状腺机能亢进常合并肌肉损伤,可伴发突眼性眼外肌麻痹,急性或慢性甲状腺中毒性肌病,周期性麻痹和重症肌无力等多种类型的肌病[1 ] 。在甲亢患者中,肌电图是检测肌肉受损的一项安全敏感的方法,尤其只对疲乏无力等自觉症状,而临床体征不明显的甲亢患者有助于诊断,也可以作为观察疗效的一项指标。现将我们对68例甲亢患者的肌电图结果分析如下。1　资料和方法1·1　一般资料　68例患者均经临床及T3 、T4检查确诊为甲亢。男2 8例,女40例,年龄18～5 2 (平均3 8)岁,病程15d至8年不等。其中,伴有肌无力等慢性肌病5 0例(73 7%) ,伴有周期性麻痹6…     

Case shifting and the Medicare Prospective Payment System.

We assessed impacts of the Medicare Prospective Payment System (PPS) during its first two years of operation (1984-85) on 467 hospitals using data from the Commission on Professional and Hospital Activities and from the American Hospital Association. Medicare discharges as a per cent of total discharges remained constant between 1983 and 1985, but the per cent of uninsured patients increased, especially at large public hospitals. The number of Medicare and total discharges per hospital declined. The number of complex diagnosis related groups (DRGs) increased, both for Medicare and non-Medicare. This trend began before the implementation of PPS and affected all types of hospitals. There was also an appreciable increase in case mix types of hospitals. There was also an appreciable increase in case mix severity within specific DRGs during 1980-85. The proportion of total patients received from or transferred to other hospitals rose after 1983, but these increases were very small. The per cent of Medicare patients admitted through the emergency room increased, especially after 1983. By contrast, the share of total non-Medicare admissions through the emergency room (ER) remained stable. Although the growth of the number of uninsured and Medicare patients admitted through the ER predate PPS, they may be influenced by it and warrant further monitoring.     

浅析肌电控制人造假肢的原理和结构

肌电假肢是一种利用生物控制的人一机系统。它实现了人和假肢之间的信息交换，从而使人可以控制假肢的动作。本文讨论了肌电假肢的原理和基本结构。     

62例肌萎缩侧索硬化的临床分析

目的探讨肌萎缩侧索硬化(Amyotrophic Lateral Sclerosis,ALS)的临床和电生理特征。方法收集2004年1月1日至2010年6月30日期间佛山市中医院神经内科收治的62例ALS患者,回顾性分析这些病人的资料并总结其临床特征。结果本组病人的主要临床特征为慢性隐袭起病,中老年发病(平均发病年龄为49.3岁),男性多发(男女比例为1.48∶1),首发症状多为单侧上肢肌无力(54.8%),可伴有肌肉萎缩,吞咽、言语困难等,电生理检查均表现为脑神经和多个脊髓节段广泛的神经源性损害。结论肌萎缩侧索硬化症是一种累及脊髓前角细胞、脑干运动神经核及锥体束,具有上下运动神经元损害并存的慢性进行性神经系统变性疾病。早期诊断是本病的难点,且容易出现误诊。肌电图对本病的诊断和鉴别诊断有重要意义。     

Cost-effectiveness of the conventional papanicolaou test with a new adjunct to cytological screening for squamous cell carcinoma of the uterine cervix and its precursors

OBJECTIVE: To estimate costs and outcomes of conventional annual Papanicolaou (Pap) test screening compared with biennial Pap test plus speculoscopy (PPS) screening for cervical neoplasms. DESIGN: A Markov model compared cost-effectiveness and outcomes of annual Pap tests with biennial PPS. The model includes direct costs of screening, diagnostic testing, and treatment for squamous intraepitheial lesions and invasive cancers; indirect costs (eg, lost productivity because of cervical cancer); and newer management practices, including human papillomavirus DNA testing. PATIENTS: Women aged 18 to 64 years. INTERVENTION: Screening for cervical neoplasms with either annual Pap smear test or biennial PPS. MAIN OUTCOME MEASURE: Marginal cost per life-year gained. RESULTS: The probability of women having squamous intraepithelial lesions, cervical cancer, or death from cervical cancer was lower among women undergoing PPS biennially. A total of 12 additional days of life per woman was gained with biennial PPS during the 47-year model period. Total average cumulative direct medical costs per patient were $1419 for biennial PPS compared with $1489 for annual Pap tests. Total costs, including direct medical costs and indirect costs, were $2185 for PPS compared with $3179 for Pap tests alone. Increased savings and patient outcomes were observed in high-risk populations. CONCLUSION: Our simulations indicate that biennial screening with PPS is expected to provide cost savings for women older than 18 years compared with annual Pap test screening, especially for those in high-risk populations.     

海南省女性围绝经期综合征现状研究

目的 探讨海南省女性围绝经期综合征（PPS）发生现状及其影响因素。 方法 单纯随机抽样方法抽取2017—2019年海南省某医院体检中心参加体检的年龄40~60岁女性为研究对象进行问卷调查,采用描述流行病学分析方法对该人群PPS发生情况及影响因素进行分析。 结果 共纳入2 055名40~60岁女性参与本调查,平均年龄（51.68 ± 4.14）岁,40~49岁占53.92%;汉族占86.08%;BMI正常占40.58%。该人群PPS发生率为21.22%。多因素logistic回归分析结果显示,年龄≤50岁（OR=0.292）、在职（OR=0.476）、知晓PPS（OR=0.493）、规律补充钙剂或食用奶制品（OR=0.243）、规律体育锻炼者（OR=0.589）发生PPS风险较低,BMI越大（OR=3.346）、文化程度越低（OR=1.863）、初潮年龄≤13岁（OR=1.699）、产次≥3次（OR=2.711）、家庭人均月收入较低者（OR=4.288）PPS发生风险越高。 结论 海南省40~60岁女性PPS发生率较高,影响PPS发生的因素较多,建议针对不同年龄、在职、PPS知晓情况、生活习惯等情况采取相应措施预防或缓解该人群PPS发生风险。     

Hospital responses to price shocks under the prospective payment system

Under the prospective payment system (PPS), hospitals receive a bundled payment for an entire episode of treatment based on diagnosis‐related groups (DRG). Although there is ample evidence regarding the impact of the introduction of the PPS, there is little research on the effects of the ensuing changes in payment levels under the PPS. In 2005, the Medicare PPS changed its definition of payment areas from the Metropolitan Statistical Areas to the Core‐Based Statistical Areas, generating substantial area‐specific price shocks. Using these exogenous price variations, this study examines hospital responses to price changes under the PPS. The results demonstrate that, while the average payment amount significantly increases in the affected areas, no parallel trend is observed in admission volume, treatment intensity, and quality of services. Conversely, hospitals facing a price increase are more liable to the perverse incentives that the PPS is known to encourage, namely, selecting or shifting patients into higher‐paying DRGs. These results suggest that paying a higher price for a given service may not induce hospitals to offer services of better quality, but can rather prompt even higher payments through other behavioral responses.     

An electromyographic study of two different types of ballpoint pens--investigation of a one hour writing operation

Recently there has been an increasing incidence of occupational cervicobrachial disorders (OCD) and writer's cramp in office workers using ballpoint pens in writing operations. For the sake of workers who use ballpoint pens, it is essential to prevent such health hazards. It has been observed that a strong gripping pressure on the ballpoint pen significantly contributes to the development of these conditions. The present authors have been developing a new ballpoint pen by altering the grip area in such a way as to reduce the gripping pressure, and thus prevent OCD. The purpose of this study is to compare our ballpoint pen (new pen) with a conventional ballpoint pen (conventional pen) for the load that they exert on the upper limb during one hour of continuous writing. Electromyograms (EMG) and upper limb pain scores are used as indicators. The conventional pen used was selected from commercially available ballpoint pens widely used in offices. The grip area is cylindrical with an 8.3 mm diameter. It is manufactured of hard plastic, which can make it feel rigid and slippery to the user. The new pen has a cylindrical grip area that flares out at the bottom, near the pen-tip, and has a diameter ranging from 11.9-13.6 mm. In addition, the grip is constructed of a 2 to 3 mm-thick silicon rubber sleeve that is softer and less slippery in comparison with the conventional pen. Twelve students (5 males and 7 females) without any preexisting cervicobrachial disorders were asked to transcribe an English text for one hour, alternately using the two kinds of pens. The EMG of the flexor pollicis brevis was measured and recorded every second, while subjective pain scores were recorded every five minutes for the thumb, forefinger, middle finger, thenar, forearm extensor (forearm) and shoulder. The EMG of the flexor pollicis brevis and the pain scores for the thumb, forefinger, middle finger, forearm and shoulder were significantly lower for the new pen than for the conventional pen. These results suggest that after an hour of continuous writing, the new pen reduces the muscle load on the upper limb, and therefore mitigates fatigue in this area.     

Medicare prospective payment and the volume and intensity of skilled nursing facility services

In 1998, Medicare adopted a per diem Prospective Payment System (PPS) for skilled nursing facility care, which was intended to deter the use of high-cost rehabilitative services. The average per diem decreased under the PPS, but because per diems increased for greater therapy minutes, the ability of the PPS to deter the use of high-intensity services was questionable. In this study, we assess how the PPS affected the volume and intensity of Medicare services. By volume we mean the product of the number of Medicare residents in a facility and the average length-of-stay, by intensity we mean the time per week devoted to rehabilitation therapy. Our results indicate that the number of Medicare residents decreased under PPS, but rehabilitative services and therapy minutes increased while length-of-stay remained relatively constant. Not surprisingly, when subsequent Medicare policy changes increased payment rates, Medicare volume far surpassed the levels seen in the pre-PPS period.     

Circulating pneumococcal specific plasma and memory B cells in the elderly two years after pneumococcal conjugate versus polysaccharide vaccination

Background

Polysaccharide conjugate vaccines prime for lasting memory responses in children and young adults. The potential value of these vaccines in the elderly is unclear.

Methods

We compared the frequency of circulating pneumococcal capsular polysaccharide (PPS) specific IgG, IgA and IgM plasma and memory cells by cultured ELISpot and supernatant screening two years after vaccination with the 7-valent pneumococcal conjugate vaccine (7vCRM) and/or the 23-valent pneumococcal polysaccharide vaccine (PPV) in 252 adults aged 50–80 years. Some individuals received a six-month boost with 7vCRM or PPV. PPS specific IgG memory detected two years post-primary vaccination was correlated with published matched serum IgG concentration pre- and up to one year post-primary vaccination.

Results

There was no difference by vaccine schedule in the quantity of plasma or memory cells detected. The concentration of in vitro PPS IgG produced by memory B cells isolated two years post-vaccination correlated with pre-vaccination serum IgG concentration and not with D28 post-vaccination responses regardless of vaccination schedule.

Conclusions

This study shows that circulating memory B cells numbers two years following immunisation with 7vCRM or PPV are best predicted by pre-vaccination serotype specific serum antibody concentration and not early post-vaccination serum antibody responses.     

系统锻炼对肩关节镜下肩袖修补术康复的影响

目的 分析系统锻炼对肩关节镜下肩袖修补术患者康复的影响.方法 随机选取医院2015年1月—2020年1月接受肩关节镜下肩袖修补术治疗患者100例,采用计算机随机数字法将其分成对照组与观察组,每组50例.对照组患者接受常规锻炼,观察组患者接受系统锻炼.比较两组患者肩袖损伤修复结局、患肢肩关节活动度、患肢肌肉力量、患肢肩关...