强化躯干训练配合蹲起训练对脑卒中偏瘫患者平衡及步行能力的影响

目的观察强化躯干训练配合蹲起训练对脑卒中偏瘫患者平衡及步行能力的影响。方法将60例偏瘫患者随机分为躯干强化训练组（观察组）与常规康复治疗组（对照组），每组30例。2组均接受常规药物与康复治疗，观察组同时给予强化躯干训练配合蹲起训练。患者平衡功能的评定采用平衡障碍严重程度分级和Fugl-Meyer平衡功能评定量表，步行能力的评定采用Holden功能步行分级。结果治疗后，观察组患者的平衡功能和步行能力均明显优于对照组，二者比较差异有统计学意义（P〈0．01）。结论躯干强化训练配合蹲起训练可明显改善脑卒中偏瘫患者的平衡功能和步行能力。     

躯干控制能力训练对偏瘫患者平衡和下肢功能的影响

目的：探讨躯干控制能力训练对脑卒中偏瘫患者平衡和下肢功能的影响。方法：96例偏瘫患者随机分成治疗组和对照组各48例。两组采用常规康复治疗方法。治疗组同时强调躯干控制能力训练，治疗后两组患者分别采用躯干控制能力（Shekih）评分、FMA平衡功能评分和下肢FMA评分进行比较，比较两组治疗效果。结果：两组治疗前后比较和组间比较差异均有显著性意义（P〈0．05）；两组变化均数比较治疗组优于对照组（P〈0．001）。躯干控制能力分别与平衡功能和下肢功能呈正相关，相关系数值分别是0．783和0．746（P〈0．01）。结论：躯干控制能力训练对偏瘫患者平衡和下肢功能有良好的促进作用。     

偏瘫患者躯干控制能力训练对平衡及下肢功能的影响

目的探讨脑卒中偏瘫患者躯干控制能力训练对其平衡功能和下肢功能的影响。方法将80例偏瘫患者随机分为治疗组和对照组,每组40例。治疗组在采用常规康复治疗的同时进行躯干控制能力训练,对照组采用常规康复治疗方法。治疗后2组患者分别采用躯干控制能力（Sheikh）评分、FMA平衡功能评分和下肢FMA评分进行比较。结果2组治疗前后比较和组间比较差异均有显著意义（p〈0.05）;2组变化均数比较,治疗组优于对照组（p〈0．001）。躯干控制能力分别与平衡功能和下肢功能成正相关。结论躯干控制能力训练对偏瘫患者平衡和下肢功能有良好的促进作用。     

早期强化躯干与骨盆控制能力训练对脑卒中患者运动功能的影响

目的观察早期强化躯干与骨盆控制能力训练对脑卒中患者运动功能的影响。方法将56例脑卒中偏瘫患者随机分为治疗组和对照组，各28例。两组患者均接受常规药物治疗并配合常规康复训练，45min／次，2次／d，治疗组患者在此基础上增加强化躯干与骨盆控制能力训练，20min／次，2次／d。治疗前后分别对两组患者采用Fugl—Meyer运动功能评定（FMA）、Barthel指数（BI）、功能性步行分级（FAC）等评定。结果治疗2个月后，两组患者的FMA、BI、FAC和偏瘫步态分析评定均较治疗前提高（P〈0．05～0．01），但治疗组疗效优于对照组（P〈0．05）。结论早期强化躯干与骨盆控制能力训练结合常规康复治疗对提高脑卒中患者的运动功能有明显疗效。     

骨盆运动训练对偏瘫患者平衡及运动功能的影响

目的：观察强化骨盆运动训练对脑出血偏瘫患者平衡功能、下肢运动功能的影响。方法：脑出血偏瘫恢复期患者72例,随机分成观察组和对照组各36例。2组均进行常规康复训练,观察组增加骨盆运动训练。结果：治疗2周后,2组平衡功能评分均较治疗前明显提高（P〈0．01）,2组间比较差异无统计学意义;治疗4周后观察组平衡功能评分显著高于对照组（P〈0．01）,2组下肢运动功能评分均明显高于治疗前（P〈0．01）,且观察组高于对照组（P〈0．05）;治疗8周后,观察组下肢运动功能评分显著高于对照组（P〈0．01）,2组功能性步行分级均较治疗前明显提高（P〈0．01）,且观察组功能性步行分级≥3级的患者较对照组明显增加（P〈0．05）。结论：强化骨盆运动训练在改善脑出血偏瘫患者平衡功能和下肢运动功能方面具有较好的疗效。     

核心力量训练对脑卒中患者运动功能和平衡的影响

80例偏瘫患者随机分成治疗组和对照组各40例,两组患者采用常规康复治疗方法,治疗组增加核心力量训练。治疗前后两组患者采用Fugl-Meyer运动功能评定(FMA)、躯干控制能力(Sheikh)评定量表、Berg平衡功能量表(BBS)、改良Barthel指数(MBI)、功能性步行分级(FAC)进行评定,比较两组治疗效果。两组患者治疗后运动功能、躯干控制能力、平衡功能、日常生活能力、步行能力评分与治疗前比较有显著改善(P0.01),且治疗组优于对照组(P0.05),核心力量训练分别与运动功能、躯干控制能力、平衡功能、日常生活能力、步行能力呈正相关(P0.05)。核心力量训练对提高偏瘫患者运动功能和平衡有良好的促进作用。     

弹力带在偏瘫患者步态矫正训练中的临床应用

目的：探讨运用弹力带训练方式对偏瘫患者异常步态改善的临床疗效。方法：选择符合治疗条件的48例偏瘫患者随机分为观察组和对照组各24例,均进行以Bobath技术、运动再学习为主的治疗,观察组加以弹力带抗阻、环绕式扭曲法进行步态矫正训练。训练前后分别对患侧下肢股四头肌、小腿三头肌肌张力进行改良Ashworth评分及下肢FMA评分,躯干骨盆控制能力、患腿负重能力及步行能力进行评定和比较分析。结果：连续训练6周后,观察组患者股四头肌、小腿三头肌Ashworth评分明显低于对照组,下肢FMA评分和患肢负重能力较对照组明显提高（均P〈0．05）;躯干骨盆控制能力和步行速度也明显高于对照组（P〈0．01）。结论：偏瘫患者康复过程中加用弹力带抗阻、环绕式扭曲法训练可显著矫正异常步态,提高步行能力。     

四肢联动功能训练对脑卒中患者躯干控制能力及平衡功能的影响

目的观察四肢联动功能训练对脑卒中患者躯干控制能力及平衡功能的影响。 方法选取脑卒中后偏瘫患者56例,采用随机数字表法将其随机分为治疗组和对照组,每组患者28例。2组患者均接受常规康复治疗,治疗组患者在常规治疗方案的基础上增加四肢联动功能训练。于治疗前、治疗3周和6周后采用躯干控制测试(TCT)、Berg平衡量表(BBS)、Holden步行功能分级(FAC)和改良的Barthel指数（MBI）分别评估2组患者的躯干控制能力、平衡功能、步行功能和日常生活活动（ADL）能力。 结果治疗3周和6周后,2组患者的TCT、BBS、MBI、FAC评分较组内治疗前均显著改善,差异有统计学意义（P<0.05）;且治疗3周后,治疗组的TCT评分为（37.09±10.99）分,显著优于对照组治疗3周后的（26.83±10.78）分,差异有统计学意义（P<0.05）;而治疗6周后,治疗组的TCT、BBS、MBI、FAC评分均显著优于对照组治疗6周后,差异均有统计学意义（P<0.05）。 结论四肢联动功能训练联合常规康复训练可显著改善脑卒中后偏瘫患者躯干控制能力、平衡功能、步行能力和ADL能力。     

减重步行训练对脑卒中早期偏瘫患者步行能力恢复的影响

目的探讨减重步行训练对脑卒中早期患者步行能力恢复的影响。方法将60例脑卒中偏瘫患者随机分成2组，减重组30例，行减重步行训练加常规康复治疗；对照组30例，仅行常规康复训练。用Fugl—Meyer下肢运动功能评分、Fugl-Meyer平衡功能评分、改良Ashworth法肌张力评级和Holder步行功能分级进行训练前、后评定。结果经过4周治疗后。2组患者Fugl—Meyer下肢运动功能评分、Fugl-Meyer平衡功能评分、肌张力评级和步行功能分级较治疗前明显改善（P〈0．01），但减重组Fugl—Meyer下肢运动功能评分、肌张力评级、步行功能分级改善均明显优于对照组（P〈0．05）。结论减重步行训练加常规康复治疗对脑卒中早期患者步行功能恢复具有明显促进作用。     

核心肌训练对脑卒中偏瘫患者平衡功能的影响

目的 观察核心肌训练对脑卒中偏瘫患者平衡功能的影响。 方法 采用随机数字表法将60例脑卒中偏瘫患者分为观察组和对照组，每组30例。观察组患者予常规康复治疗结合核心肌训练，对照组患者予常规康复治疗结合躯干控制训练。2组患者均于治疗前和治疗8周后（治疗后）分别采用躯干控制能力评定Sheikh评分（TCT）、Berg平衡功能量表（BBS)、Fugl-Meyer平衡功能量表(FM-B)进行平衡功能评定。 结果 治疗后，2组患者TCT、BBS和FM-B评分较组内治疗前均有明显改善，差异均有统计学意义（P<0.05）；且治疗后观察组TCT、BBS和FM-B评分分别为（93.55±3.45）分、（50.21±3.83）分和（11.51±2.18）分，与对照组治疗后比较，差异亦均有统计学意义（P<0.05）。 结论 在常规康复治疗基础上对脑卒中偏瘫患者进行核心肌训练可显著改善脑卒中后偏瘫患者的平衡能力。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."