本体感觉反射手法治疗颈胸综合征的效果

目的观察本体感觉反射疗法对颈胸综合征的临床疗效。方法将入选的60例患者按随机数字法分为本体感觉反射疗法组和澳式手法组,观察两组颈椎关节活动度、视觉模拟疼痛评分(VAS)、痛域及耐痛域。结果两种治疗方法均可改善颈胸交界区综合征的临床症状,治疗后,治疗组颈椎右侧屈活动度[(44.67±2.43)°]、左旋活动度[(68.33±5.56)°]分别优于对照组[右侧屈(42.37±3.08)°、左旋(64.67±7.13)°],差异有统计学意义(均P0.05)。随访时,颈椎关节右侧屈范围疗效治疗组[(44.85±2.43)°]优于对照组[(43.21±3.08)°],差异有统计学意义(P0.05)。结论本体感觉反射疗法对治疗颈胸综合征有效。     

不同体位下颈椎拔伸旋转手法治疗神经根型颈椎病的疗效对比研究

摘要 目的：观察患者颈椎处于前屈、中立、后伸3种不同体位下拔伸旋转手法治疗神经根型颈椎病的临床疗效。 方法：将240例神经根型颈椎病患者随机分成3组,均采用坐位拔伸旋转手法治疗。前屈位组、中立位组、后伸位组患者各80例,手法治疗时患者颈椎依次处于前屈位、中立位及后伸位。观察3组临床疗效、治疗前后总积分、主观感觉积分,体征积分和颈部残障指数（NDI）评分。 结果：3组间总有效率、总积分、主观感觉和客观体征比较差异均存在显著性,后伸位组优于中立位组和前屈位组（P<0.01）;治疗后NDI评分后伸位组（0.192±0.091）低于中立位组（0.221±0.071）和前屈位组（0.251±0.065）（P=0.000）。 结论：在施行颈椎旋转拔伸手法治疗神经根型颈椎病时,20°范围内,患者后伸位的临床疗效优于中立位和前屈位。     

McKenzie诊疗法在颈椎病患者中的应用

目的：探讨Mckenzie疗法在颈椎病患者中的临床应用及其治疗效果。方法：将82例颈椎病患者随机分为Mckenzie疗法组（治疗组）和对照组，治疗组按颈椎Mckenzie疗法进行治疗，并结合牵引，手法整复或加用物理因子等常规疗法，对照组仅用常规疗法进行治疗，治疗前后评定患者的临床疗效。项目有VAS、Mckenzie运动功能缺失度等。结果：两组临床治愈率都高，疼痛明显减轻（P＜0．001），颈椎活动范围明显增加（P＜0．05）。治疗组效果优于对照组，两组比较差异有非常显著性（P＜0．01），结论：Mckenzie疗法对现患者在临床症状改善，疼痛减轻和颈椎活动度增加方面，有较好的临床治疗效果，并适用于神经根型和椎动脉型颈椎病患者，有较好的依从性。     

手法旋转复位治疗颈椎小关节紊乱84例疗效观察

目的观察手法旋转复位治疗颈椎小关节紊乱型颈椎病的疗效。方法将84例颈椎小关节紊乱型颈椎病患者随机分为复位组42例,综合组42例,经两个疗程疗效观察,进行疗效对比。结果复位组比综合组疗效显著（P〈0.025）。结论复位组治疗颈椎小关节紊乱型颈椎病,疗效优于综合组,提示手法旋转复位治疗颈椎小关节紊乱型颈椎病能缩短疗程。     

整脊手法配合加味葛根汤治疗神经根型颈椎病疗效观察

目的：观察整脊手法与加味葛根汤联合治疗神经根型颈椎病的临床效果。方法：将60例神经根型颈椎病患者随机分为治疗组和对照组各30例。治疗组采用整脊手法配合加味葛根汤治疗,对照组采用整脊手法治疗。比较两组临床疗效及疼痛评分。结果：治疗组治疗总有效率为96.7%,高于对照组的73.3%,差异具有统计学意义（P＜0.05）。两组治疗前疼痛评分比较无显著性差异（P＞0.05）;治疗组治疗后疼痛评分低于对照组,差异具有统计学意义（P＜0.05）。结论：整脊手法配合加味葛根汤治疗神经根型颈椎病能有效改善患者颈椎失稳的病况,有效恢复颈椎生理曲度,同时缓解颈部周围组织对神经根部的压迫,改善临床症状。     

推拿疗法对神经根型颈椎病的疗效及疼痛的影响

目的：探究推拿手法治疗神经根型颈椎病的临床效果。方法：回顾性收集2019年1月~2020年1月收治的60例神经根型颈椎病患者临床资料,根据患者治疗方法不同分为参照组（理疗）与研究组（理疗联合推拿治疗）,每组30例,比较两组治疗总有效率、治疗前后关节活动度、临床症状消失时间。结果：研究组治疗总有效率高于参照组（P＜0.05）。两组治疗前关节活动度比较,差异无统计学意义（P＞0.05）;研究组治疗后关节活动度大于参照组,差异有统计学意义（P＜0.05）。研究组临床症状消失时间短于参照组（P＜0.05）。结论：采用推拿手法治疗神经根型颈椎病可显著改善患者神经根受压情况,有效缓解临床症状,提高关节活动度。     

智能脉冲枪整脊技术联合关节松动术治疗神经根型颈椎病的疗效观察

目的：观察智能脉冲枪整脊治疗联合麦特兰德关节松动术治疗神经根型颈椎病的临床疗效。方法：将94例神经根型颈椎病患者随机分为观察组和对照组各47例,2组患者均给予常规康复治疗和麦特兰德关节松动术,观察组在此基础上给予智能脉冲枪整脊治疗。治疗前和治疗3周后分别采用视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)对患者进行评定以及观察患者的临床疗效。结果：治疗3周后,2组患者VAS及NDI评分均较治疗前明显降低（均P<0.05）,且观察组2项评分均明显低于对照组（均P<0.05）。治疗3周后,观察组总有效率明显高于对照组（P＜0.05）。结论：智能脉冲枪整脊治疗联合麦特兰德关节松动术能显著改善神经根型颈椎病患者疼痛症状及颈椎功能,提高生活质量,值得临床推广应用。     

动态干扰电疗法结合牵引对神经根型颈椎病的疗效观察

目的：观察动态干扰电疗法结合牵引治疗神经根型颈椎病的疗效。方法：对265例神经根型颈椎病患者随机分为动态干扰电结合牵引（治疗组）133例和单纯牵引治疗（对照组）132例，治疗20天后进行颈椎活动度评定和疗效评价。结果：2组间的颈椎活动度改变差异无显著性意义，治疗组明显改善率（临床治愈＋显效）78．2％优于对照组57．6％（P＜0．01）。结论：动态干扰电疗法结合牵引治疗能提高神经根型颈椎病的疗效。     

单次手法和物理治疗颈型颈椎病:疼痛和关节活动的即刻及短期效果比较

背景:大量研究表明,手法治疗和物理治疗均可显著改善颈型颈椎病患者的疼痛和关节活动度,但两种治疗方式对颈型颈椎病的即刻和短期疗效比较鲜有报道.目的:比较单次手法治疗和物理治疗对颈型颈椎病患者疼痛和活动的即刻和短期疗效.方法:颈型颈椎病患者随机分成2组,手法治疗组和物理治疗组,各接受1次治疗.采用疼痛目测类比评分法、压力疼痛阈值和关节活动范围评定患者治疗前、后10 min(即刻疗效)和治疗后第2天(短期疗效)的情况.结果与结论:手法治疗组患者在单次治疗后的10 min和第2天疼痛目测类比评分较治疗前下降,压力疼痛阈值增加,颈椎各方向关节活动范围均增加(P＜0.05);物理治疗组患者在单次治疗后的10 min和第2天疼痛目测类比评分较治疗前均下降(P＜0.05),在治疗后第2天,颈椎左/右侧屈关节活动范围较治疗前增加(P＜0.05);在治疗后的10 min和第2天,手法治疗组患者的疼痛目测类比评分均低于物理治疗组,压力疼痛阈值均高于物理治疗组,颈椎前屈/后伸,左/右侧屈关节活动范围均大于物理治疗组(P＜ 0.05).结果表明单次手法治疗对改善慢性颈痛患者疼痛目测类比评分,压力疼痛阈值和关节活动范围的即刻效果和短期效果均优于物理治疗.     

旋转手法治疗神经根型颈椎病的机制及特点

目的：分析旋转手法治疗神经根型颈椎病的机制和特点。 资料来源：应用计算机检索Medline数据库1994-01／2006-05有关神经根型颈椎病方面的文献，检索词“cervical spondylotic radiculopathy，rotary manipulation”，限定文章语言种类为English。同时计算机检索清华同方CNKI中国期刊全文数据库1994—01／2006—05有关神经根型颈椎病方面的文献，检索词“神经根型颈椎病，旋转手法”，限定文章语言种类为中文。 资料选择：对资料进行初审，选取包括神经根型颈椎病基础和临床研究的相关文献，开始查找全文。纳入标准：①神经根型颈椎病基础和临床研究。②旋转手法治疗。排除标准：①颈椎骨折及良恶性肿瘤。②综述类文献，重复的同一研究，Meta分析类文章。 资料提炼：共检索到关于神经根型颈椎病基础和临床研究及旋转手法治疗的文献32篇，24篇文献符合纳入标准。 资料综合：神经根型颈椎病是临床常见病，因颈椎间盘退行性变致椎间盘高度降低、前位钩椎关节及后位关节突关节退行性变等合并因素所致脊神经根管狭窄并压迫神经根是其最常见的原因。旋转手法是治疗神经根型颈椎病的独特疗法，其主要治疗机制是松解神经根及其周围软组织粘连；改变椎间孔大小，调整钩椎关节位置关系；缓解肌肉痉挛，解除滑膜嵌顿；调整颈椎各组织应力分布，增强颈椎稳定性；重建颈曲，恢复颈椎正常的生理弧度。 结论：旋转手法是治疗神经根型颈椎病独特的方法，是安全有效的，但手法的操作需要进一步规范和统一。     

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.     

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.     

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.     

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.