早期脑卒中偏瘫的康复护理训练与自我锻炼的效果对比

目的：探讨早期脑卒中偏瘫的康复护理的疗效。方法：将134例脑卒中偏瘫患分为两组，67例采用药物与康复训练同步进行为康复组，67例采用单纯药物治疗及未经指导的自我锻炼为对照组，采用简式Fugl-Meyer运动功能评分，改良Barthel指数为初期，末期评定，结果：7周后两组进行评评，康复组患肢运动，日常生活能力比对照组明显提高，结论：早期康复护理训练可促进患肢功能恢复，降低致残率。     

高血压脑出血术后偏瘫肢体的早期康复训练

目的：探讨高血压脑出血术后病人偏瘫肢体进行早期康复训练的效果。方法：随机将60例高血压脑出血术后病人分为康复组和对照组。康复组采用常规治疗辅以康复训练。对照组采用常规治疗和护理。治疗前后运用Brunnstrom法评定偏瘫肢体运动功能。结果：康复组患偏瘫肢体运动功能明显优于对照组。结论：早期康复训练对高血压脑出血术后患偏瘫肢体的功能恢复有显作用。     

早期脑卒中偏瘫的康复护理训练与自我锻炼的效果对比

目的探讨早期脑卒中偏瘫的康复护理的疗效。方法将134例脑卒中偏瘫患者分为两组,67例采用药物与康复训练同步进行为康复组,67例采用单纯药物治疗及未经指导的自我锻炼为对照组。采用简式Fugl-Meyer运动功能评分,改良Barthel指数为初期、末期评定。结果7周后两组进行评价,康复组患肢运动、日常生活能力比对照组明显提高。结论早期康复护理训练可促进患肢功能恢复,降低致残率。     

急性脑梗死患者的早期运动功能康复

目的 20例急性脑梗死患早期运动功能康复疗效的观测。方法 通过床上锻炼,起坐训练,站立训练,行走训练等康复训练步骤进行早期运动功能康复。结果 康复组运动功能恢复程度明显高于对照组（P＜0.01)。结论 急性脑梗死患早期实施运动功能康复训练,能够有效的恢复其肢体功能。     

人工股骨头置换术后早期康复训练对患肢功能恢复的影响

目的：探讨早期康复训练对人工股骨头置换术后患肢功能恢复的影响。方法：将85例人工股骨头置换术后患者随机分为康复组43例和对照组42例。康复组术前重视心理护理并进行简要康复锻炼指导，术后3h开始康复训练，详细指导患者早期进行功能锻炼。对照组行常规康复护理。结果：两组术后2周并发症发生率及术后6个月髋关节功能恢复优良率比较均有显著性差异（P〈0．05）。结论：术后早期康复训练可减少人工股骨头置换术患者并发症发生率，促进患肢功能恢复。     

脑卒中后偏瘫患者的康复训练

目的：探讨康复训练对脑卒中偏瘫患运动功能及ADL的影响。方法：选择107例首发脑卒中偏瘫患分为康复组和对照组,康复组在学龄同药物治疗基础上加用Bobath法和Brunnstrom技术进行训练,对照组只常规治疗。结果：经45．2d的治疗后,两组比较运动功能差异显（P＜0．05）,ADL差异也是P＜0．01,说明康复组明显优于对照组。结论康复训练能促进偏瘫患运动功能的恢复,提高生活自理能力。     

早期康复训练对臀肌挛缩症患者术后的效果

目的观察早期康复训练对臀肌挛缩患者术后功能恢复的疗效。方法58例患者分为康复组32例与对照组26例，对照组术后只给予外科常规护理；康复组术后给予常规外科护理外，配合康复训练。结果康复组患者髋关节功能及步态的恢复优于对照组（P〈0．05）。结论早期康复训练能促进臀肌挛缩患者术后功能恢复。     

早期膀胱康复训练对脊髓损伤性截瘫患者排尿功能恢复的影响

目的探讨早期膀胱康复训练对脊髓损伤性截瘫患者膀胱功能恢复的效果。方法选择66例脊髓损伤合并截瘫患者,随机分为康复组和对照组各33例。对照组：膀胱训练和尿管护理方法按常规进行;康复组：进行早期膀胱康复训练。比较2组排尿功能恢复的情况。结果临床膀胱功能恢复情况康复组明显优于对照组。结论对脊髓损伤性截瘫患者进行早期膀胱康复训练,可以促使患者早日脱离尿管,建立规律性排尿习惯,减少并发症。     

促通技术加主动性康复训练对脑出血患者上肢、手功能及步行能力的作用

目的 观察促通技术加早期主动性康复训练对脑出血瘫患上肢、手功能和步行能力恢复的影响。方法 应用促通技术和主动性康复训练对68例脑出血患（康复组）进行训练及观察，并与对照组比较。结果 康复组上肢和手Fugl-Meyer评分明显好于对照组（P＜0．05），步行能力训练后明显提高。结论 促通技术加主动康复训练可使正常的运动模式在没有异常运动模式的干扰下建立和发展。     

早期康复训练对脑血管病偏瘫肩关节半脱位功能恢复的影响

目的探讨早期康复训练对脑血管病偏瘫肩关节半脱位及上肢功能恢复的影响.方法选择急性脑血管病偏瘫合并肩并节半脱位80例,分成康复组与对照组(各40例),康复组按常规药物治疗和护理的同时在病后第3天给予康复指导;对照组行常规药物治疗护理及随意自我锻炼.两组治疗前及治疗4周后,进行肩关节半脱位测量及上肢运动功能评价比较.结果治疗4周后,上肢运动功能达Brunnstrom Ⅳ级以上者,康复组55%,对照组25%,两组上肢运动功能差异显著(P<0.01);患侧肩峰与肱骨头之间间隙小于14 mm康复组80%,对照组42.5%,两组相比差异显著(P<0.01).结论早期康复训练可明显改善肩关节半脱位,促进患侧上肢功能的恢复.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。