Needle electromyography: basic concepts and patterns of abnormalities

Needle electromyography (EMG) records electrical signals generated from muscle fibers and interprets the signals to characterize underlying pathologic changes that are occurring in motor units within muscles. Different types of spontaneously firing waveforms and motor unit potential changes occur with different neuromuscular disorders. The performance of reliable EMG studies depends on the technical skills of the physician in inserting, moving, recording with a needle electrode, and analyzing electric signals recorded from muscle. This article reviews the technique of needle EMG and recognition and interpretation of various EMG waveforms. The author presents several demonstrative videos at www.neurologic.theclinics.com.     

Synchronized release of Doxil and Nutlin-3 by remote degradation of polysaccharide matrices and its possible use in the local treatment of colorectal cancer

A novel approach to the prevention of colorectal cancer (CRC) recurrence by the local, luminal application of the combined therapies: Nutlin-3 (NUT) and the liposomal preparation of doxorubicin, Doxil^® (Doxil) is presented here. The two drug entities were loaded into calcium alginate beads, engineered to erode upon exposure to a de-crosslinking agent, to allow for the controlled, concomitant release of the two. The synchronized release-driven improved cytotoxicity of NUT and Doxil was tested in vitro in RKO (wild-type p53) and HT-29 (mutant p53) CRC cells, by measuring intracellular expression of p53, p21 and Mdm2, as well as monitoring cell proliferation and viable cell numbers. NUT treatment alone was identified to be cytotoxic exclusively towards RKO cells. However, coadministration of NUT enhanced Doxil’s anti-proliferative effects and cell death induction in a synergistic manner in both cell types. It was also identified that combinatorial treatment in a wt p53 context affected the p53 pathway by elevating the expression of p53 and its target p21. The capability of the formulation to erode in the presence of a de-crosslinking agent was demonstrated in vivo in the cecum of the anesthetized rat using indomethacin as a poorly water-soluble PK probe.     

不同通气模式对呼吸窘迫综合征早产儿心功能的影响

目的探讨早产儿在相同呼气末正压(PEEP)水平下经鼻持续呼吸道正压(N-CPAP)模式和同步间歇正压通气(SIPPV)模式对心功能的影响。方法选择本院新生儿重症监护病房2009年3月-2011年5月收治的80例早产儿进行配对分析。其中N-CPAP治疗的20例急性呼吸窘迫综合征(RDS)患儿和SIPPV治疗的20例RDS患儿作为病例组(共40例),另外40例同期住院的一般疾病患儿按胎龄和日龄与病例组配成40对,应用彩色多普勒超声心动图检测所有患儿心脏泵血功能指标及各瓣口流速指标,比较2种通气模式对早产儿心功能指标的差异及2种不同通气方式下相同PEEP水平对早产儿心功能的影响。结果 N-CPAP组患儿肺动脉瓣口峰值流速,主动脉瓣口峰值流速,二、三尖瓣E/A值,射血分数,心排出量的均值均低于其配对组患儿,但差异均无统计学意义(Pa>0.05);SIPPV组患儿以上指标均值亦低于其配对组,其中肺动脉瓣口峰值流速,二、三尖瓣E/A值差异均有统计学意义(Pa<0.05);N-CPAP组与SIPPV组比较,SIPPV组各项心功能指标均值均低于N-CPAP组,其中对于三尖瓣E/A值的影响更明显,2组比较差异有统计学意义(0.71±0.05 vs 1.85±0.64,P<0.05)。结论 N-CPAP对早产儿心功能的影响不明显;SIPPV主要影响全心舒张功能、肺动脉及主动脉瓣峰值流速;相同PEEP水平下,SIPPV与N-CPAP相比,SIPPV主要影响早产儿的三尖瓣E/A值及右心室舒张功能。     

Warfarin management after discharge from hospital: a qualitative analysis

What is Known and Objective: Warfarin is recognized as a high‐risk medication for adverse events, and the risks are particularly heightened in the period immediately following a patient’s discharge from hospital. This qualitative study aimed to explore the experiences of Australian patients and healthcare professionals of warfarin management in the post‐discharge period and identify the benefits and deficiencies of existing systems, to inform the development of a model for a new collaborative post‐discharge warfarin management service. Methods: Healthcare professionals, professional organization representatives and patients recently discharged from hospital taking warfarin (consumers) were recruited via purposive, criterion‐based sampling within two Australian states. Semi‐structured telephone interviews were conducted between August and October 2008 using standard discussion guides. Data were manually analyzed to identify emergent themes using a phenomenological approach. Results: Forty‐seven participants were involved in the telephone interviews. Three major themes emerged: (i) appropriate warfarin education is integral to effective warfarin management, (ii) problems occur in communication along the continuum of care and (iii) home‐delivered services are valuable to both patients and healthcare professionals. Discussion: Although high‐quality warfarin education and effective communication at the hospital–community interface were identified as important in post‐discharge warfarin management, deficiencies were perceived within current systems. The role of home‐delivered services in ensuring timely follow‐up and promoting continuity of care was recognized. Previous studies exploring anticoagulation management in other settings have identified similar themes. Post‐discharge management should therefore focus on providing patients with a solid foundation to minimize future problems. What is New and Conclusion: Addressing the three identified facets of care within a new, collaborative post‐discharge warfarin management service may address the perceived deficiencies in existing systems. Improvements may result in the short‐ and longer‐term health outcomes of patients discharged from hospital taking warfarin, including a reduction in their risk of adverse events.     

Agar Acts as Cathode Microskin to Extend the Cycling Life of Zn//α-MnO2 Batteries

The Zn/MnO₂ battery is a promising energy storage system, owing to its high energy density and low cost, but due to the dissolution of the cathode material, its cycle life is limited, which hinders its further development. Therefore, we introduced agar as a microskin for a MnO₂ electrode to improve its cycle life and optimize other electrochemical properties. The results showed that the agar-coating layer improved the wettability of the electrode material, thereby promoting the diffusion rate of Zn²⁺ and reducing the interface impedance of the MnO₂ electrode material. Therefore, the Zn/MnO₂ battery exhibited outstanding rate performance. In addition, the agar-coating layer promoted the reversibility of the MnO₂/Mn²⁺ reaction and acted as a colloidal physical barrier to prevent the dissolution of Mn²⁺, so that the Zn/MnO₂ battery had a high specific capacity and exhibited excellent cycle stability.     

病因治疗对卒中后继发性癫痫的治疗意义

目的：探讨病因治疗对卒中后继发性癫痫的治疗意义,以为临床提供参考。方法：对本院2008年3月-2011年4月收治的568例急性脑卒中患者的临床资料进行分析,其中卒中后继发性癫痫38例,对38例患者给予控制血糖、血脂、血压,抗血小板聚集、改善循环等病因治疗及抗癫痫治疗。结果：38例患者经过治疗后显效26例（68．4％）,有效10例（26-3％）,无效2例（5．3％）。总有效率为94．7％。结论：病因治疗可减少脑卒中患者脑组织的损害程度,减少神经细胞的异常放电,对治疗卒中后继发性癫痫有重要意义,值得推广应用。     

不同表面积和不同温度的热灸样刺激对大鼠延髓背侧网状亚核神经元的激活作用

目的:探讨热灸法的作用机制及最佳的热灸刺激参数。方法:选用SD大鼠15只,微电极胞外记录延髓背侧网状亚核(SRD)神经元活动,观察7种不同温度(40、42、44、46、48、50、52℃)和7种不同圆形面积(直径分别为1.0、1.5、2.0、2.5、3.0、3.5、4.0 cm)组成的不同组合的热刺激对SRD神经元放电活动的影响。刺激部位以"中脘"穴为中心,刺激持续时间为30 s。结果:40℃和42℃的热刺激在任何面积下对SRD神经元均无激活作用;44℃-Φ3.5 cm和44℃-Φ4.0 cm的刺激组合对SRD神经元有明显激活作用;温度达46℃以上后,热刺激面积与SRD神经元的放电活动呈线性相关;48℃-Φ3.0 cm、50℃-Φ3.5 cm、52℃-Φ3.5 cm刺激组合达到SRD神经元放电活动的平台期,在温度不变的条件下,SRD神经元放电不再随刺激面积的增大而增加。结论:伤害性范围内的热刺激可以激活SRD神经元,当热刺激达到一定参数后,SRD神经元的激活反应会出现平台期。     

Nipple discharge after nipple-sparing mastectomy: should the areola complex always be removed?

Nipple discharge (ND) is a common symptom with a reported incidence of 2% to 5% of patients referred to breast cancer clinics. Approximately 90% of ND is of benign etiology. An underlying carcinoma is present with a rate of 6% to 21%. This is more frequent if it is associated with clinical or radiologic abnormality. ND after nipple-sparing mastectomy (NSM) is a rare event as the whole retroareolar glandular tissue is usually completely removed with mastectomy. ND is otherwise possible if a small amount of tissue is accidentally left by the surgeon or with the aim of reducing the risk of the nipple-areola complex (NAC) necrosis. This condition can be of concern as it may imply a local recurrence and therefore implicate NAC removal. Herein we report a case of a ND in an NSM in which only a selective duct excision allowed NAC preservation.     

精神分裂症违法者脑电图特点分析

目的探讨暴力违法青年精神分裂症患者的脑电图特征。方法采用脑电记录仪对400例司法鉴定涉嫌暴力违法精神分裂症患者进行描记。结果暴力组脑电图异常频度显著高于对照组（P〈0.005）;暴力组癫痫样放电征在左侧、右侧与双侧的表达频度与对照组无显著差异（P〉0.05）;癫痫样放电征左侧大脑半球表达频度显著高于右侧（P〈0.005）;暴力组癫痫样放电征涉及额叶、颞叶、顶叶和枕叶频度与对照组无明显差异（P〉0.05）;癫痫样放电征多在颞叶、额叶表达;暴力组癫痫样放电征总体表达频度与对照组比较差异显著（P〈0.05）。结论精神分裂症患者的暴力违法行为可能与大脑损害及大脑癫痫样放电征有关,大脑异常放电冲动刺激可能是导致患者暴力违法的重要因素。     

剩余电压条款及测试方法的探讨

该文阐述了五种国家标准中关于剩余电压条款的不同指标要求,比较了各种测试方法的优缺点．最后提出了改进测试方法的意见。