脑卒中偏瘫患者步行时足底压力中心的特点

目的探讨脑卒中偏瘫患者步行时足底压力中心（COP）相关参数的特点及其与步速、不对称性的相关性。 方法选取60例能够独立步行的脑卒中偏瘫患者（偏瘫组）及健康中老年人（对照组），每组30例，2组受试者均以自我选择的步速进行步态测试，提取并计算步速及两侧下肢的单支撑时间、双支撑时间、单支撑期COP在前后方向的位移（AP-COPDS）及其速度(AP-COPVS)、双支撑期COP在前后方向的位移（AP-COPDD）及其速度（AP-COPVD），以及单支撑时间对称性比等参数，并分析和比较COP相关参数及其与步速、不对称性的相关程度。 结果对照组和偏瘫组的步速分别为（73.60±9.66）和（37.88±16.01）cm/s，偏瘫组步速较对照组明显下降（P<0.01）。偏瘫侧单支撑时间［（0.39±0.07）s］较对照组［（0.44±0.04）s］明显缩短（P<0.01）；非偏瘫侧的单支撑时间［（0.53±0.12）s］及两侧双支撑时间［（0.36±0.15）s、（0.36±0.21）s］均较对照组［（0.44±0.04）s及（0.15±0.03）s］延长（P<0.01）；偏瘫组患者两侧下肢所有COP相关参数均较对照组减小，且差异均有统计学意义（P<0.01）。偏瘫组两侧下肢所有COP相关参数均与步速呈高度正相关（r=0.765～0.967，P<0.01）；所有COP相关参数与单支撑时间对称性比呈不同程度正相关（r=0.505～0.764，P<0.01）。 结论脑卒中偏瘫患者步行时，足底负重在前后方向转移的能力下降，且与步速、单支撑时间对称性比呈正相关。     

踝足矫形器对脑卒中偏瘫患者步行时足底压力及步行能力的影响

目的:探讨踝足矫形器(AFO)对脑卒中偏瘫患者步行时单支撑期足底压力峰值及步行功能的影响。方法:选取脑卒中偏瘫患者38例作为研究对象,分别在其裸足与穿戴踝足矫形器时,采用步态与平衡功能评测系统进行步态测试,观察并计算步速、双下肢摆动相时间、单支撑期双下肢足底压力峰值,以及偏瘫步态不对称指数等参数,分析单支撑期足底压力峰值与步速及偏瘫步态不对称指数的相关性。结果:穿戴AFO前后比较,患者步行速度分别为(0.47±0.05)m/s及(0.63±0.04)m/s,偏瘫步态不对称指数为(0.19±0.07)及(0.15±0.02),偏瘫侧单支撑期足底压力峰值为(1.03±0.04)及(1.07±0.02),差异均有显著性意义(P0.05)。即穿戴AFO后,患者步行速度提高,偏瘫步态不对称指数减少,偏瘫侧单支撑期足底压力峰值较前增大。穿戴AFO后,偏瘫侧单支撑期足底压力峰值与步速呈正相关(r=0.417,P0.01),与偏瘫步态不对称指数呈负相关(r=-0.748,P0.01)。结论:脑卒中偏瘫患者佩戴AFO步行时,足底压力相关参数发生改变,偏瘫侧单支撑期足底压力峰值增大,且其与步速和偏瘫步态不对称性间存在相关性。     

脑卒中偏瘫患者步态的不对称性与平衡功能的相关性研究

目的研究脑卒中偏瘫患者步态时空参数的不对称性与平衡功能之间的相关性。 方法选取可以独立步行10m以上的单侧偏瘫的脑卒中患者30例设为病例组,相匹配的健康中老年人30例设为对照组,采用步态与平衡功能训练评估系统（AL-600型）对受试对象进行步态测试,经分析评估软件提取各步态时空参数（站立期时间、摆动期时间、步长及步宽）,其步态时空参数的不对称性评估用双侧下肢步长不对称比（SLA）、摆动期时间不对称比（SWTA）和站立期时间不对称比（STA）表示。并对30例脑卒中患者进行Berg平衡量表(BBS)评分。用两独立样本t检验分析病例组与对照组的各时空参数不对称比（SLA、SWTA、STA）及步宽的差异,用Pearson相关性分析法分析SLA、SWTA和STA分别与步宽及BBS评分之间的相关程度。 结果病例组患者步行时,患侧的步长及摆动期时间均较健侧增加(P<0.05),患侧站立期时间较健侧缩短（P<0.05）;而对照组下肢步态分析,各时空参数左右侧之间差异无统计学意义（P&rt;0.05）。病例组患者的步宽及各时空参数不对称比（SLA、SWTA和STA）的比值均较对照组增大（P<0.01）。病例组患者的步宽［(15.90±2.60）cm］与BBS评分［（41.57±7.27）分］之间呈中度负相关（r=-0.564,P<0.01）,而患者的SLA与步宽呈轻度正相关（r=0.432,P<0.05）,与BBS评分呈高度负相关（r=-0.849,P<0.01）;患者SWTA与步宽呈高度正相关（r=0.726,P<0.01）,与BBS评分呈中度负相关（r=-0.630,P<0.01）;患者STA与步宽和BBS评分之间均未见明显相关性（r=0.352,r=-0.126,P&rt;0.05）。 结论脑卒中偏瘫患者步态时空参数存在不对称性,其步态的不对称程度与平衡功能之间存在一定的相关性。     

脑卒中偏瘫患者步态参数与平衡功能的关系北大核心CSCD

目的探讨脑卒中偏瘫患者步态参数与平衡功能的关系。方法2018年9月至2020年3月,北京博爱医院住院脑卒中偏瘫患者76例(BrunnstromⅣ、Ⅴ期各38例),采用平衡检测仪、星状伸展平衡测试(SEBT)进行评定,采用三维步态分析系统测量步速、步频,计算双侧步长比、支撑期时间比、摆动期时间比、髋关节最大屈曲角度比、膝关节最大屈曲角度比。步态参数和平衡功能测试结果行相关性分析。结果BrunnstromⅤ期患者平衡和步态参数均优于Ⅳ期患者(|t|>2.268,P<0.05)。所有患者步速、步频与平衡功能多数参数相关(|r|>0.335,P<0.05)。BrunnstromⅣ期患者步长比与SEBT测量结果负相关(r=-0.467~-0.613,P<0.01),BrunnstromⅤ期患者步长比与平衡仪内外稳定极限负相关(r=-0.356,P=0.028)。BrunnstromⅣ期患者摆动期时间比与平衡仪前后稳定极限(r=-0.335,P=0.040)、内/外极限比(r=0.510,P=0.001)、星状伸展平衡测试多数结果(r=-0.330~-0.445,P<0.05)相关。BrunnstromⅣ期患者髋、膝关节屈曲比与平衡功能测试结果相关(|r|>0.326,P<0.05),BrunnstromⅤ期患者膝关节屈曲比与多数平衡功能测试结果相关(r>0.329,P<0.05),髋关节屈曲比仅与平衡仪前后稳定极限相关(r=0.369,P=0.023)。结论步速和步频可较好反映脑卒中偏瘫患者的平衡功能;步态的时空对称性在功能较低的患者中与平衡功能相关。     

核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响

摘要 目的：应用步态分析,观察核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响。 方法：选取脑卒中偏瘫患者60例,按随机数字表法将其分为观察组及对照组,每组30例。两组均进行常规治疗,观察组在此基础上给予核心稳定性训练。分别于治疗前和治疗6周后使用三维步态分析仪器检测并获得两组患者的步态参数。 结果：治疗6周后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相均较治疗前明显提高（P<0.01）,步宽、步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值均较治疗前显著减小（P<0.01）。组间比较显示,观察组患者的步频、步幅、步速、步宽、步态周期、双支撑相、健侧支撑相、健侧摆动相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值改善均明显优于对照组（P<0.05或0.01）。 结论：核心稳定性训练能有效改善脑卒中偏瘫患者步态时空参数和对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。     

三维步态分析训练结合等速肌力训练对老年脑卒中后偏瘫患者膝过伸的影响

目的:探讨三维步态分析训练结合等速肌力训练对老年脑卒中后偏瘫患者膝过伸的影响。方法:按照随机数字表法将2018年3月～2019年5月收治的125例老年脑卒中后偏瘫膝过伸患者分为对照组62例和观察组63例,对照组予以等速肌力训练,观察组在对照组基础上增加三维步态分析训练,干预2个月。比较两组干预前后下肢运动功能、步态时空参数和关节运动学参数。结果:干预后观察组Fugl-Meyer运动功能量表及功能性步行量表评分高于对照组(P0.05);干预后观察组步频、步速、步幅及患侧摆动相时间均高于对照组,双支撑相时间、步行周期及患侧支撑相时间低于对照组(P0.05);干预后观察组最大屈膝角度大于对照组,最大伸膝角度小于对照组(P0.05)。结论:三维步态分析训练结合等速肌力训练可改善老年脑卒中后偏瘫膝过伸患者步态功能,提高其下肢运动能力。     

节奏性听觉刺激对脑卒中偏瘫患者步态的效果

目的探讨在患者进行步行训练时给予节奏性听觉刺激(RAS),对脑卒中偏瘫患者步态的影响。方法 2014年4月~2015年4月,11例脑卒中偏瘫患者随机分为试验组(n=6)和对照组(n=5)。在常规康复训练基础上,试验组接受RAS步行训练,对照组接受口头指令步行训练。分别于训练前及训练3周后用Brunnstrom分期、步态分析对患者进行评定。结果训练后,试验组和对照组Brunnstrom分期均无明显变化(Z1.414,P0.05);试验组跨步长、步速、步频明显提高(t4.829,P0.01),时间对称性改善(t=3.323,P0.05),对照组均无明显改变(t1.765,P0.05)。结论 RAS步行训练有助于改善脑卒中偏瘫患者步态。     

脑卒中患者步行时躯体运动的三维运动学研究

目的:通过对脑卒中患者躯体运动的三维运动学分析,比较分析偏瘫步态躯体运动变化与其步行能力(步速)之间的关系,探讨影响偏瘫患者步行能力恢复的量化指标。方法:选择首次脑卒中后可以独立步行10m以上的偏瘫患者39例,采用远红外线三维步态分析系统进行步态检测与分析,对偏瘫步态躯体的运动学参数与其步行能力(步速)进行相关分析。结果:脑卒中患者的步行能力与骨盆旋转运动之间的相关有显著性意义(r=-0.396.P<0.05);其步行能力与躯体侧方运动呈负相关,而与其躯体垂直运动呈正相关(r=-0.755,P<0.01;r=0.534,P<0.01),步行能力与Barthel指数正相关(r=0.475,P<0.01)。结论:脑卒中患者躯体和骨盆运动障碍是影响步态恢复的重要因素,提示躯体的协调性训练和骨盆的控制性训练对改善脑卒中偏瘫患者步行能力具有积极的作用。     

太极“云手”对脑卒中偏瘫患者步态影响的相关性研究

目的:观察太极"云手"对脑卒中偏瘫患者平衡及步行功能的影响,探讨时空参数与平衡功能之间的相关性。方法:将2个社区随机分为试验组和对照组,招募患者各14例及16例,在基础治疗上分别进行为期12周太极"云手"和常规平衡康复训练,于治疗前后采用Berg量表及步态分析系统进行功能评估。结果:(1)治疗前后比较,对照组仅步频患/健比增加显著(P0.05);试验组的患侧和健侧总支撑相百分比均缩短(P0.05和P0.01),患侧和健侧摆动相百分比增加显著(P0.05和P0.01);患侧和健侧的单足支撑期百分比增加显著(P0.05);健侧的双足支撑期百分比缩短显著(P0.01)。(2)治疗后两组Berg评分均提高显著(P0.01)。(3)在排除基线差异后,两组治疗后比较,各步行时空参数及Berg评分差值均无显著性差异(P0.05)。(4)两组中改善的步行时空参数与Berg评分的差值之间无显著性相关。(5)治疗前患侧、健侧的步长、跨步长、步频、步速与Berg评分存在正相关(r分别为0.60,0.67,0.65,0.66,0.60,0.60,0.38;P0.01);步宽与Berg评分存在中度负相关(r=-0.49;P0.05)。总支撑期时间的患/健侧比值,单足支撑相所占百分比的患/健侧比值与Berg评分均存在中度正相关(r分别为0.43、0.66;P0.05),而摆动相和双足支撑相所占百分比的患/健侧比值则与Berg评分存在中度(r=-0.67;P0.01)、低度负相关(r=-0.37;P0.05)。结论:太极"云手"训练与常规平衡康复训练均可明显提高脑卒中偏瘫患者平衡功能,但两种干预方法无显著性差异。太极"云手"训练有助于改善步态周期的时相百分比,提高患者的步行质量和效率,但改善的步行时空参数与平衡功能的改善无明显相关。"云手"训练作为中医康复适宜技术之一,可以在社区偏瘫障碍者中推广应用。     

脑卒中偏瘫步态分析的临床应用

目的研究脑卒中偏瘫患者的步态特点。方法 49例脑卒中偏瘫患者分成两组,其中观察组33例,不佩戴矫形器,裸足进行三维视频步态分析,与健康成年人步态参数进行比较;对照组16例,佩戴固定式踝足矫形器(AFO)进行步态分析,与观察组比较。结果与正常人相比,观察组步长、跨步长、步频明显减小,步宽增大,步速减慢;步态周期延长,其中双腿支撑期时间和所占步态周期比例明显延长,单腿支撑期所占步态周期比例明显缩短(P<0.01);偏瘫患者是否应用AFO,步态运动学参数无显著性差异(P>0.05)。结论脑卒中偏瘫患者步速慢、步态周期延长、双腿支撑期比例延长、单腿支撑期比例缩短是其主要运动学特点。     

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.