手部外骨骼机器人辅助双侧对称性训练与镜像疗法对偏瘫患者手功能的康复效果比较

目的比较手部外骨骼机器人辅助双侧对称性训练与镜像疗法对脑卒中偏瘫患者手功能的康复效果。方法选取2018年6月至2019年7月在安徽医科大学第一附属医院康复医学科住院的脑卒中偏瘫患者36例,采用随机数字表法分为外骨骼组与镜像组,每组18例。外骨骼组患者利用手部外骨骼机器人进行双手同步对称性训练,镜像组给予镜像疗法。观察两组患者治疗前后手功能及日常生活活动能力的变化,比较两组患者治疗方法的疗效差异。结果治疗后,两组患者Fugl-meyer运动功能量表评分(FMA)及改良Barthel指数均较治疗前提高,差异有统计学意义(P<0.001)。治疗后,外骨骼组患者的FMA评分高于镜像组,差异有统计学意义(P=0.034)。治疗2周后,外骨骼组患者治疗有效率高于镜像组,差异有统计学意义(P=0.044),两组患者治疗显效率差异无统计学意义(P>0.05);治疗3、4周后,两组患者治疗有效率差异均无统计学意义(P>0.05),外骨骼组治疗显效率高于镜像组,差异均有统计学意义(P=0.035,P=0.022)。结论基于手部外骨骼机器人的双侧对称性训练能加速脑卒中患者手功能的恢复进程,对于手功能的改善程度优于镜像疗法。     

阿司匹林联合氯比格雷治疗进展性脑梗死的临床研究

目的 研究阿司匹林联合氯比格雷治疗进展性脑梗死患者的疗效.方法 选择我院2014年1月1日至2015年6月30日收治的进展性脑梗死患者120例,根据治疗方案分为观察组和对照组各60例,对照组单用阿司匹林治疗,观察组联用阿司匹林与氯吡格雷.对比两组患者血常规和凝血功能、NFDS评分、治疗效果与不良反应.结果 两组治疗前后血小板、凝血酶原时间和活化部分凝血激酶时间对比均无统计学差异;观察组患者治疗后不良反应的总发生率为10.00％,高于对照组,但差异无统计学意义;观察组治疗后NFDS评分为(5.6±1.3),明显低于对照组;观察组治疗后总有效率为91.67％,明显高于对照组.结论 阿司匹林联合氯比格雷治疗进展性脑梗死具有较好疗效,安全性较高,可提高患者生存质量.     

依达拉奉联合奥扎格雷钠治疗进展性脑梗死的临床分析

目的观察依达拉奉联合奥扎格雷钠治疗进展性脑梗死的疗效和安全性。方法140例进展性脑梗死患者随机分为治疗组、对照组,各70例。治疗组给予依达拉奉和奥扎格雷钠静脉点滴,对照组给予奥扎格雷钠静脉点滴,并对临床疗效、治疗前后神经功能缺损评分比较。结果依达拉奉联合奥扎格雷钠组总有效率88．6％,对照组总有效率71．4％。与对照组比较,差异有统计学意义（P〈0．01）。结论依达拉奉联合奥扎格雷钠治疗进展性脑梗死能有效地改善神经功能,安全有效,值得推崇。     

The evaluation of Chronic Progressive External Ophthalmoplegia with computerized tomography

Introduction: Chronic progressiveexternal ophthalmoplegia is characterisedby limitation of ocular motility in alldirections of gaze and ptosis.Innervational or myogenic factors wereclaimed to be responsible for thismotility disorder. The aim of thisstudy was toinvestigate the extraocular muscles inCPEO with computerized tomography in an attemptto distinguish extraocular musclemorphology caused by this disorderfrom that occurring in normal individuals.Methods: Eighteen orbits from 9patients diagnosed with CPEOwere included in the study. Axialand coronal scans were obtained for CTevaluation of extraocular muscles and thedimensions of extraocular muscles were measured.The control group consisted of40 orbits belonging to 20 individuals and,the results were compared with a student'st test.Results: The thickness (the verticaldimension of vertical recti and thehorizontal dimension of horizontal recti)of all rectus muscles wassignificantly decreased in comparison with the controlgroup, whereas the width (the horizontal dimensionof vertical recti and the verticaldimension of horizontal recti) was similar inboth the diseased and normal orbits.In all the rectus musclesof the diseased orbits,the normal fusiform shape was lost and the muscles appeared asthin bands.Discussion: The differentiation ofCPEO from other myogenic and neurogenicdisorders may present difficulty,and a cluster of criteria are required fora final diagnosis. CT has provento be a valuable tool in assessing extraocularmuscles [1, 2]. In this study, an extremeatrophy of all rectus muscles wasdemonstrated by means of CT. This diagnostic method mayconsequently contribute to a properdiagnosis of CPEO.     

渐进式平衡训练方案在全髋关节置换术后患者中的应用

目的 研究渐进式平衡训练方案在全髋关节置换术(THA)后患者干预过程中的应用.方法 将2017年5月至2020年5月于深圳市宝安区石岩人民医院接受THA治疗的89例患者纳入研究,按照随机数字表法分作A组44例和B组45例.B组开展常规干预,A组则于常规干预基础上增用渐进式平衡训练.分析两组干预前后患者平衡能力、活动状态...     

依达拉奉联合巴曲酶治疗进展性脑梗死的疗效评价

目的观察依达拉奉联合巴曲酶治疗进展性脑梗死的疗效。方法选择发病在48h内进展性脑梗死患者80例,随机分为治疗组（40例）和对照组（40例）,两组均用巴曲酶治疗,治疗组加用依达拉奉,观察治疗后神经功能改善情况及血浆纤维蛋白原（Fb）含量的变化。结果3周后治疗组有效率85%,高于对照组72.5%（P〈0.05）,两次治疗后Fb水平较治疗前明显降低（均P〈0.01）。结论依达拉奉联合巴曲酶治疗进展性脑梗死安全有效。     

带有对称误差的群体药代动力学参数的贝叶斯估计

目的:研究对称分布用于药代动力学中参数的估计是否合理。方法:在广义线性模型框架下,以贝叶斯方法推导出模型中各回归参数的后验,再用MCMC算法结合模拟得出参数的具体值。结果:对5 000次模拟的结果进行统计分析,得到各参数的点估计值和置信域及相应图表,符合模拟的预设值。对称分布与广义线性模型结合,得到了较好的参数估计值。结论:群体药物代谢动力学中可以考虑使用对称分布进行参数的估计。     

小剂量尿激酶治疗进展性脑卒中疗效观察

目的观察小剂量尿激酶治疗进展性脑卒中的疗效。方法选择60例发病时间在48h以内,病情呈进行性加重的进展性脑卒中患者,随机分为2组,分别接受小剂量尿激酶、低分子肝素治疗。观察2组治疗前后2周的神经功能缺损程度评分(SSS),并监测治疗前后血小板计数、出凝血时间。结果用药2周后,2组SSS评分较治疗前均下降,小剂量尿激酶治疗组的指标更具有显著性差异(P<0.01,P<0.05),而无出血倾向。结论小剂量尿激酶治疗进展性脑卒中临床疗效确切,安全可靠。     

Charge transfer as a mechanism for chlorophyll fluorescence concentration quenching

Highly concentrated solutions of chlorophyll display rapid fluorescence quenching. The same devastating energy loss is not seen in photosynthetic light-harvesting antenna complexes, despite the need for chromophores to be in close proximity to facilitate energy transfer. A promising, though unconfirmed mechanism for the observed quenching is energy transfer from an excited chlorophyll monomer to a closely associated chlorophyll pair that subsequently undergoes rapid nonradiative decay to the ground state via a short-lived intermediate charge-transfer state. In this work, we make use of newly emerging fast methods in quantum chemistry to assess the feasibility of this proposed mechanism. We calculate rate constants for the initial charge separation, based on Marcus free-energy surfaces extracted from molecular dynamics simulations of solvated chlorophyll pairs, demonstrating that this pathway will compete with fluorescence (i.e., drive quenching) at experimentally measured quenching concentrations. We show that the rate of charge separation is highly sensitive to interchlorophyll distance and the relative orientations of chromophores within a quenching pair. We discuss possible solvent effects on the rate of charge separation (and consequently the degree of quenching), using the light-harvesting complex II (LH2) protein from rps. acidophila as a specific example of how this process might be controlled in a protein environment. Crucially, we reveal that the LH2 antenna protein prevents quenching, even at the high chlorophyll concentrations required for efficient energy transfer, by restricting the range of orientations that neighboring chlorophyll pairs can adopt.

Chlorophyll molecules in photosynthetic light-harvesting complexes are surprisingly immune to the rapid fluorescence quenching displayed by concentrated solutions of chlorophyll in molecular solvents (1). The effect has consequently not been given much attention in studies of natural light harvesting (2). However, it highlights a fundamental role of the protein environment in tailoring the behavior of embedded chromophores for efficient energy transfer. Understanding first how this “concentration quenching” occurs and, second, how it is avoided in photosynthetic protein complexes should not be further overlooked in the context of developing new synthetic proteins (3) and biomimetic light-harvesting materials (4, 5), since protection against this unproductive quenching pathway must necessarily be a critical design consideration.Measurements of fluorescence quenching in solutions of chlorophyll in both diethyl ether and acetone, reported in ref. (1), sparked several investigations into possible quenching mechanisms. Careful experiments by Porter et al. excluded the possibility of quenching due to trap states formed by impurities; intersystem crossing to the triplet state; and multiexcitation annihilation or collisions with quenching species (6). Unlike many other porphyrin-based pigments, chlorophyll does not readily aggregate in polar organic solvents (e.g., ethanol, ether) (7), as evidenced by the lack of concentration-dependent spectral changes (6, 8), so this was also ruled out as a potential cause of quenching.The fluorescence decay kinetics of chlorophyll solutions suggest that quenching involves excitation transfer from an excited monomer to a (relatively) nonfluorescent dimer that acts as a trap (9). These nonfluorescent “dimers” are widely accepted to be statistical pairs: pairs of molecules that, in the random distribution in solution, happen to be (temporarily) within some critical distance of each other (8, 10). Beddard and Porter estimated this critical distance as 10Å by fitting experimental quenching data with Monte Carlo simulations of excitations performing random walks around randomly arranged 3D arrays of molecules (10). Their model used experimentally parameterized rates for fluorescence, intersystem crossing, and resonant energy transfer and assumed instantaneous quenching at statistical pairs.The means by which excitations are trapped and quenched at statistical pairs is still unknown. The most promising hypothesis is that the excited chlorophyll pair undergoes a charge transfer (Chl−Chl)∗→Chl+−Chl− to form an ion pair that recombines back to the ground state (2, 7, 11). Electrostatic attraction between the intermediate ions may pull them closer together, helping to stabilize the pair and make it easier to reach the ground state. However, there is not yet any experimental evidence for the existence of an ion-pair intermediate (12).An alternative possibility is that the chlorophyll molecules within a statistical pair form a temporary H-aggregate, where the lowest excited state has an oscillator strength close to zero and acts as a dark trap state (13, 14). Density functional theory calculations on chlorophyll pairs in vacuum support the idea that closely associated cofacial pairs do have a lower energy dark state (13) but the expected shift in absorption wavelength for the higher energy bright state is not observed experimentally (12). For this reason, we consider it the least likely of the two hypothesized mechanisms.Nonradiative decay via an intermediate charge-transfer state is an established quenching mechanism for other small chromophores (15), bound porphyrin-based dyads (16), and chlorophyll in combination with carotenoids (17), where there is a redox potential between the molecules in the statistical pair. It is less clear whether the same mechanism would still operate between homogeneous chlorophyll pairs, although the question of symmetric charge transfer is of great interest in the context of understanding charge separation in the special pair of the photosynthetic reaction center. Theoretical studies of the special pair in vacuum indicate that there is a charge-transfer state energetically close to the first excited state (18, 19), although this could potentially change in the reaction center protein or in solution. Charge transfer has been observed in experimental models of the special pair (covalently linked cofacial porphyrin units) (20, 21) and is known to drive quenching in side-by-side bacteriochlorin or porphyrin dyads (16, 22, 23). However, it is not known to what degree the covalent linking in these models might influence their charge-transfer properties. Charge transfer in these linked systems is more pronounced in solvents with a high dielectric constant, implying that chlorophyll concentration quenching, if it proceeds via a charge-transfer mechanism, should have a solvent dependence. This is loosely in agreement with early experimental results (1), although more data would be needed to confirm the trend.Our aim in this paper is to provide concrete evidence for the feasibility of a quenching mechanism involving charge transfer by calculating the free energy surfaces (FESs) for the photoexcited and intermediate charge-separated state in a solvent environment. We calculate the rate of charge separation at chlorophyll separations around the predicted “critical separation” and compare these to the fluorescence rate to determine the likelihood of observing significant quenching. Finally, we investigate how these surfaces change in a protein environment, revealing how photosynthetic antenna proteins may inhibit quenching to allow efficient energy transport.     

渐进式心脏运动康复护理对冠心病经皮冠状动脉介入术后患者心功能的影响

目的 探讨冠心病经皮冠状动脉介入术(PCI)治疗患者,在术后早期进行渐进式心脏运动康复护理干预对患者心功能的影响.方法 选择2017—2018年营口市中心医院收治的冠心病并行P C I患者120例,随机分为对照组和干预组各60例.对照组进行常规护理,干预组在对照组基础上在术后进行6个月的渐进式心脏运动康复护理干预,对比...