不同剂量右美托咪定对视频喉镜清醒镇静插管时心血管反应的影响

目的观察不同剂量右美托咪定对视频喉镜清醒镇静插管时心血管反应的影响。方法择期气管插管全麻手术患者90例,ASAⅠ或Ⅱ级,MallampatiⅠ或Ⅱ级,随机均分为三组,D1组:右美托咪定0.8μg/kg+瑞芬太尼0.5μg/kg;D2组:右美托咪定1.0μg/kg+瑞芬太尼0.5μg/kg和D3组:右美托咪定1.2μg/kg+瑞芬太尼0.5μg/kg。插管前15min三组患者分别按上述剂量缓慢静脉泵注右美托咪定(10min泵注完毕),插管前90s快速静注瑞芬太尼,并在气管完善表面麻醉的基础上,行视频喉镜插管。记录入室后安静10min(基础值,T0)、喉镜置入前(T1)、气管插管后即刻(T2)时HR、MAP及Ramsay镇静评分;并记录插管时间、气管插管过程中躁动、呛咳、呼吸抑制、心血管不良反应的发生情况;术后随访患者对气管插管过程的知晓情况。结果 T1时三组HR明显慢于、MAP明显低于T0时(P0.05);T2时D1组HR明显快于、MAP明显高于D2、D3组(P0.05)。T1、T2时D1组Ramsay镇静评分明显低于D2、D3组(P0.05)。D1组高血压、心动过速、躁动、呛咳等不良反应的发生率明显高于D2、D3组(P0.05)。D3组心动过缓、呼吸抑制发生率明显高于D1、D2组(P0.05)。结论在完善的气道表面麻醉基础上,右美托咪定1μg/kg复合瑞芬太尼0.5μg/kg可以明显抑制视频喉镜清醒镇静插管时的心血管反应,并且不良反应少,是较为合理的临床用药剂量。     

Assessment of the test–retest reliability of a foot placement accuracy protocol in assisted-living older adults

IntroductionThis study assessed the test–retest reliability of a foot placement accuracy protocol in a population of assisted-living elderly. The goal was to evaluate the execution of foot placement performance with increasing complexity of the walking condition.MethodsTwenty-five elderly participants (5 males, 20 females, 80.4 ± 8.6 years) were assessed by one observer in two sessions with 48 h between the measurements. Participants walked at self-selected pace along a pathway with three different walking conditions composed of two rectangular foam target locations and an obstacle on the walking surface. The main outcome measures were foot placement distance error, intra-class correlation coefficients (ICC), and the smallest detectable difference (SDD).ResultsMean absolute values of the foot placement distance errors were 14.0 ± 4.5 mm for medio-lateral deviation and 27.2 ± 2.1 mm for anterior–posterior deviation, respectively. ICC values for test–retest reliability showed ‘fair to good’ to ‘excellent’ reliability across all conditions with values ranging from 0.63 to 0.94. SDD values were between 3.6 and 37.3 mm.ConclusionThe protocol showed good reliability for test–retest measurements of foot placement accuracy, thus making this protocol a reliable and location-independent tool to assess performance of foot placement in elderly in assisted-living settings. In the future, measurements with elderly fallers and non-fallers should be conducted to assess validity of the protocol.     

内窥镜鱼尾纹除皱术的颞额区应用解剖学

目的在开展内窥镜眼角鱼尾纹除皱术中减少面神经颞支损伤的概率。方法在３６侧成人头部标本上，探讨颞额区层次特点及其面神经颞支的定位。结果面神经颞支位于颞浅筋膜和额肌的深层，通常有１～４分支，第１支先位于关节结节前方８．１±２．１ｍｍ，然后向内上方行走进入额肌或眼轮匝肌上部，位于骨性眼外眦上方３３．８±４．９ｍｍ。由关节结节至骨性眼外眦向上４０ｍｍ处画一连线，该线以下的区域为颞支分布区。结论颞区切口或额部至耳前辅助切口应位于该线以上的区域     

Techniques in facial identification: Computer-aided facial reconstruction using a laser scanner and video superimposition

A facial image was reconstructed from the skull, part of a complete skeleton found in woodland, of a male person who had hanged himself from a tree. In addition, video superimposition was carried out with antemortem photographs of a person suspected of being the victim, and a good match was obtained. In a further case, a cheaper video-transparency superimposition was carried out, with identity later being confirmed on the basis of dental records. The techniques and the problems encountered are discussed. According to our experience, 3D computer reconstruction and video superimposition have a useful role in the process of identification, particularly in the early stages of an investigation and when other more definitive methods may not be available.     

18F－FDGPET／CT显像对颞叶癫痫灶定位的价值

目的探讨以18氟-2-脱氧葡萄糖为显影剂的正电子发射断层扫描／计算机断层成像（18F-FDGPET／CT）对颞叶癫痫（TLE）灶的定位价值。方法本研究回顾分析被确诊为TLE的24例患者的临床资料,将术前18F-FDGPET／CT、MRI、视频脑电图（VEEG）与术中颅内电极脑电图和术后病理学检查结果进行对比研究。结果24例TLE患者中,18F-FDGPET／CT准确定位致痫灶21例,MRI准确定位10例,VEEG准确定位10例。18F-FDGPET／CT对TLE致痫灶的敏感性为87．5％（21／24）,其中对内侧颢叶癫痫（MTLE）致痫灶为88．9％（16／18）,对外侧颞叶癫痫（LTLE）致痫灶为83．3％（5／6）。MRI对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为55．5％（10／18）,对LTLE致痫灶为0。VEEG对TLE致痫灶的敏感性为41．7％（10／24）,其中对MTLE致痫灶为50．5％（9／18）,对LTLE致痫灶为16．7（1／6）。18F-FDGPET／CT对TLE（包括MTLE和LTME）致痫灶的敏感性均显著高于MRI和VEEG（P〈0．05）,而MRI和VEEG对TLE致痫灶的敏感性无显著差异（P〉0．05）。结论18F-FDGPET／CT对于TLE致痫灶定位具有独特的优势。     

Using Video Game Telemetry Data to Research Motor Chunking,Action Latencies,and Complex Cognitive-Motor Skill Learning

Many theories of complex cognitive-motor skill learning are built on the notion that basic cognitive processes group actions into easy-to-perform sequences. The present work examines predictions derived from laboratory-based studies of motor chunking and motor preparation using data collected from the real-time strategy video game StarCraft 2. We examined 996,163 action sequences in the telemetry data of 3,317 players across seven levels of skill. As predicted, the latency to the first action (thought to be the beginning of a chunked sequence) is delayed relative to the other actions in the group. Other predictions, inspired by the memory drum theory of Henry and Rogers, received only weak support.     

Game-XP: Action Games as Experimental Paradigms for Cognitive Science

Why games? How could anyone consider action games an experimental paradigm for Cognitive Science? In 1973, as one of three strategies he proposed for advancing Cognitive Science, Allen Newell exhorted us to “accept a single complex task and do all of it.” More specifically, he told us that rather than taking an “experimental psychology as usual approach,” we should “focus on a series of experimental and theoretical studies around a single complex task” so as to demonstrate that our theories of human cognition were powerful enough to explain “a genuine slab of human behavior” with the studies fitting into a detailed theoretical picture. Action games represent the type of experimental paradigm that Newell was advocating and the current state of programming expertise and laboratory equipment, along with the emergence of Big Data and naturally occurring datasets, provide the technologies and data needed to realize his vision. Action games enable us to escape from our field's regrettable focus on novice performance to develop theories that account for the full range of expertise through a twin focus on expertise sampling (across individuals) and longitudinal studies (within individuals) of simple and complex tasks.     

前庭性偏头痛的眼震视图表现及诊断价值

目的比较前庭性偏头痛(VM)和健康受试者的眼震视图(VNG)表现,明确VNG检查在VM中的诊断价值.方法前瞻性连续纳入2018年8月至2019年8月在新乡医学院附属人民医院神经内科就诊的VM患者55例和体检中心健康受试者45例,所有患者及健康受试者在条件允许下行VNG检查,包括视动性试验(扫视试验、平稳跟踪试验、视动性试验)、前庭功能试验(温度试验、摇头眼震)、自发性眼震、诱发性眼震检查(静态位置性试验).采用χ^2检验比较两组之间VNG结果的差异.结果VM组与健康受试者组之间人口统计学差异无统计学意义(均P>0.05).扫视试验:VM组有17例(30.9%)异常,健康受试者组异常例数3例(6.7%;χ^2=9.091,P<0.05);平稳跟踪实验:VM组异常20例(36.4%),健康受试者组异常5例(11.1%;χ^2=8.418,P<0.05);视动性眼震检查:VM组异常例数24例(43.6%),健康受试者组异常例数6例(13.3%;χ^2=10.823,P<0.05);温度试验:VM组有13例(23.6%)异常,健康受试者组中异常2例(3.6%;χ^2=7.150,P<0.05);摇头眼震:VM组有11例(20.0%)异常,健康受试者组异常2例(3.6%;χ^2=5.295,P<0.05);自发性眼震检查:VM组中异常10例(18.2%),健康受试者组异常4例(8.9%;χ^2=1.775,P>0.05);静态位置性眼震检查:VM组共有22例(40.0%)异常,健康受试者组中共有7例异常(16.5%;χ^2=7.183,P<0.05).结论VM组的总VNG检查异常率高于健康受试者组,说明VNG检查有助于VM的诊断,且其表现提示VM患者中枢及外周均有损害的迹象.     

颞叶癫痫发作间期PET-CT与VEEG检查对致癫灶的诊断价值比较

目的 比较分析颞叶癫痫发作间期正电子发射计算机断层显像（PET-CT）和视频脑电图（VEEG）检查对致癫灶的诊断价值。方法 回顾性分析2016年3月至2018年3月手术治疗的80例单侧颞叶癫痫的临床资料。另选取同期健康体检者30例作为对照。术前进行PET-CT和VEEG监测定位致痫灶,以术中监测结果为定位致痫灶的金标准。利用受试者工作特征（ROC）曲线评价PET-CT放射性分布不对称指数（AI）对颞叶癫痫致癫灶的诊断价值。结果 PET-CT、VEEG确定致癫灶的灵敏度分别为88.73%、47.89%,特异度分别为88.89%、66.67%。颞叶癫痫发作间期病灶侧AI显著高于非病灶侧（P<0.05）,同时也显著高于健康体检者颞叶内侧AI（P<0.05）及颞叶外侧AI（P<0.05）。ROC曲线分析结果显示,AI=0.153诊断颞叶癫痫致癫灶的曲线下面积为0.730,95%置信区间在0.544~0.916。结论 颞叶癫痫发作间期PET-CT脑显像定位准确率优于VEEG,对手术治疗准确定位有很高的应用价值,且AI为0.153时诊断癫痫灶的效果最好。