• 【与含有pro564的HIF-1alpha的VHL介导的蛋白质破坏基序融合的procaspase-3的低氧特异性细胞毒性的机制。】 复制标题 收藏 收藏
    DOI:10.1016/j.febslet.2006.09.025 复制DOI
    作者列表:Harada H,Kizaka-Kondoh S,Hiraoka M
    BACKGROUND & AIMS: :Under normoxic conditions the alpha-subunit of hypoxia-inducible factor (HIF-1alpha) protein is targeted for degradation by the von Hippel-Lindau (VHL) tumor suppressor protein acting as an E3 ubiquitin ligase. Recently, we developed a hypoxia-targeting protein, TOP3, which consisted of procaspase-3 with the VHL-mediated protein destruction motif of HIF-1alpha. This design enables procaspase-3 to be regulated similarly with HIF-1alpha, being degraded under normoxia while stabilized under hypoxia. Furthermore, stabilized TOP3 was cleaved by the hypoxic stress-induced endogenous caspases and thus the procaspase-3 was converted to active caspase-3 specifically under hypoxic conditions. These data demonstrated that the VHL-mediated protein destruction motif of HIF-1alpha endowed procaspase-3 with hypoxia-specific cytotoxicity.
    背景与目标: : 在常氧条件下,低氧诱导因子 (HIF-1alpha) 蛋白的 α 亚基被作为E3泛素连接酶的von Hippel-Lindau (VHL) 肿瘤抑制蛋白靶向降解。最近,我们开发了一种低氧靶向蛋白TOP3,它由具有HIF-1alpha VHL介导的蛋白破坏基序的procaspase-3组成。该设计使procaspase-3能够与HIF-1alpha类似地调节,在常氧条件下降解,而在缺氧条件下稳定。此外,稳定的TOP3被低氧胁迫诱导的内源性半胱天冬酶裂解,因此procaspase-3在低氧条件下被特异性转化为活性caspase-3。这些数据表明,HIF-1alpha的VHL介导的蛋白质破坏基序赋予procaspase-3低氧特异性细胞毒性。
  • 【老年恶性胶质瘤患者短程放疗的前瞻性研究。】 复制标题 收藏 收藏
    DOI:10.1023/a:1005750111883 复制DOI
    作者列表:Hoegler DB,Davey P
    BACKGROUND & AIMS: Elderly patients with malignant glioma have a poor prognosis and the benefit of standard radical radiotherapy is equivocal. Twenty-two percent of the adult referral base with malignant glioma at our centre is of age 70 years or greater. A phase II study was undertaken to determine if a shorter course of therapy yields a comparable median survival to radical radiotherapy and thus constitutes an appropriate investigational palliative regimen. 25 patients were accrued between 1988-1995, all of whom had histologically proven malignant glioma, 23 glioblastoma multiforme and 2 anaplastic astrocytoma. The median age was 73 (range 70-78) and median Karnofsky Performance Status (KPS) was 70.40% had a stereotactic biopsy only for diagnosis. Radiotherapy was delivered to limited fields to a dose of 37.5 Gy in 15 daily fractions over 3 weeks. An intention-to-treat analysis was undertaken with survival determined from date of initial consultation. The median survival of the whole group was 8.0 months (95% CI 4.8-9.6). Patients with good performance status (KPS > 70) had a median survival of 10.4 months (95% CI 9.6-14.7). 37.5 Gy in 15 daily fractions appears to yield comparable median survival to that of other series of radical radiotherapy. A phase III study of this regimen is recommended in investigating optimal palliation of elderly malignant glioma patients.

    背景与目标: 老年恶性神经胶质瘤患者的预后较差,标准的根治性放疗的益处是模棱两可的。在我们中心,患有恶性神经胶质瘤的成人转诊基地中有22% 的年龄在70岁或以上。进行了一项II期研究,以确定较短的疗程是否可以产生与根治性放疗相当的中位生存期,从而构成适当的研究性姑息治疗方案。在1988-1995之间累积了25例患者,所有这些患者均经组织学证实为恶性神经胶质瘤,23例多形性胶质母细胞瘤和2例间变性星形细胞瘤。中位年龄为73岁 (范围70-78),中位Karnofsky表现状态 (KPS) 70.40% 仅用于诊断的立体定向活检。在3周内,将放射疗法递送到有限的区域,剂量为37.5 Gy,每天15次。进行了意向性治疗分析,从初次咨询之日起确定生存率。全组的中位生存期为8.0个月 (95% CI 4.8-9.6)。表现良好的患者 (KPS > 70) 的中位生存期为10.4个月 (95% CI 9.6-14.7)。在15个每日分数中37.5 Gy似乎产生与其他系列的根治性放疗相当的中位生存期。建议对该方案进行III期研究,以研究老年恶性神经胶质瘤患者的最佳姑息治疗。
  • 【术前罗哌卡因局部浸润可缓解腹股沟疝修补术后的疼痛。一项随机对照试验。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Johansson B,Hallerbäck B,Stubberöd A,Janbu T,Edwin B,Glise H,Solhaug JH
    BACKGROUND & AIMS: OBJECTIVE:To assess the effect of preoperative local anaesthesia with ropivacaine and find out if there was a dose-response relationship with postoperative pain after inguinal hernia repair.

    DESIGN:Randomised, double-blind, placebo-controlled trial.

    SETTING:Two Swedish and two Norwegian hospitals.

    SUBJECTS:131 Male patients undergoing elective inguinal hernia repair.

    INTERVENTION:Infiltration of the inguinal field before operation with 0.5% ropivacaine 40 ml (200 mg), 0.25% ropivacaine 40 ml (100 mg) or saline 40 ml.

    MAIN OUTCOME MEASURES:Wound pain at rest and during mobilisation, pressure exerted to reach pain threshold and maximum pain tolerance after 3, 6, 10, and 24 hours, and after 7 days; consumption of analgesics; and Quality of Life assessed by two independent questionnaires before and after operation.

    RESULTS:Pain scores after 3 hours were significantly lower in the ropivacaine groups compared with the saline group for all variables (p < 0.05). At 6 hours pain scores were significantly lower for ropivacaine 0.5% compared with saline for wound pain during mobilisation and pressure exerted to reach maximum pain tolerance. Patients given saline made their first request for analgesics significantly sooner than in the other two groups (p < 0.05), and a significantly larger percentage of them requested analgesics during the first 24 hours (p < 0.05). Evaluation of the Quality of Life questionnaires showed no significant differences between the groups.

    CONCLUSION:Ropivacaine has a significant, dose-related pain-reducing effect in the immediate postoperative period but we could find no support for the theory that preoperative infiltration analgesia reduces long term pain.

    背景与目标: 目的 : 评估罗哌卡因术前局部麻醉的效果,并找出腹股沟疝修补术后疼痛是否存在剂量反应关系。
    设计 : 随机,双盲,安慰剂对照试验。
    设置 : 两家瑞典医院和两家挪威医院。
    受试者 :131例接受选择性腹股沟疝修补术的男性患者。
    干预 : 术前用0.5% 罗哌卡因40毫升 (200 mg) 浸润腹股沟,0.25% 罗哌卡因40毫升 (100 mg) 或生理盐水40毫升。
    主要结果指标 : 休息和动员过程中的伤口疼痛,在3、6、10和24小时后施加压力达到疼痛阈值和最大疼痛耐受性,7天后; 服用镇痛药; 手术前后通过两个独立的问卷评估生活质量。
    结果 : 在所有变量中,罗哌卡因组3小时后的疼痛评分均明显低于生理盐水组 (p <0.05)。6小时时,罗哌卡因0.5% 的疼痛评分明显低于动员期间伤口疼痛的生理盐水,并施加压力以达到最大疼痛耐受性。给予生理盐水的患者首次要求镇痛药的时间明显快于其他两组 (p <0.05),并且在最初的24小时内要求镇痛药的比例明显更高 (p <0.05)。生活质量问卷的评估显示,两组之间没有显着差异。
    结论 : 罗哌卡因具有显着性,在术后即刻的剂量相关的减轻疼痛效果,但我们无法支持术前浸润镇痛可减轻长期疼痛的理论。
  • 【细胞因子刺激的骨髓的产前移植可改善耐药菌株组合中的早期嵌合,但导致长期移植不良。】 复制标题 收藏 收藏
    DOI:10.1016/j.exphem.2006.05.007 复制DOI
    作者列表:Shaaban AF,Kim HB,Gaur L,Liechty KW,Flake AW
    BACKGROUND & AIMS: OBJECTIVE:In the absence of immunodeficiency, only microchimerism (<0.1%) has been achieved in human fetal recipients or nonhuman primates following in utero hematopoietic cell transplantation (IUHCT). We hypothesized that enhanced long-term engraftment might be more reliably achieved in microchimeric systems if higher levels of chimerism existed during development of adaptive immunity. To evaluate this hypothesis, we stimulated the donor cells with vascular endothelial growth factor (VEGF) and stem cell factor (SCF) prior to IUHCT in a chimerism-resistant murine strain combination. METHODS:Donor Balb/c marrow was cultured in media with or without VEGF and SCF supplementation for 12 hours prior to IUHCT into B6 fetuses at 14 days postcoitum (dpc). Donor cell phenotype, homing, and chimerism were assessed at short and long-term time points and transplanted animals received skin allografts at 8 weeks. RESULTS:In pretreated allogeneic recipients, early chimerism rates were more than double that of controls (71% vs 33%, p = 0.01). These differences were associated with higher numbers of pretransplant donor cell colony-forming cells without change in donor cell homing. Despite prolonged skin allograft survival for pretreated recipients compared with controls (mean survival = 20.8 vs 8.2 days, p < 0.001), long-term engraftment was unchanged. CONCLUSIONS:These findings demonstrate that higher levels of early chimerism in recipients of cytokine-stimulated marrow result in improved short-term chimerism and tolerance. Future studies are needed to confirm the existence of a "threshold" level of chimerism necessary to sustain long-term engraftment.
    背景与目标:
  • 【植入结果: 采用混合方法评估成人人工耳蜗植入方案的疗效。】 复制标题 收藏 收藏
    DOI:10.3109/09638289709166533 复制DOI
    作者列表:Hogan A
    BACKGROUND & AIMS: Studies concerned with the efficacy of cochlear implants have traditionally focused on measuring enhancements in speech perception associated with implantation. This paper reports the findings of a study concerned with qualitative and quantitative measures of psychosocial benefit associated with the adult cochlear implant programme. Cochlear implants enhanced implantees' interpersonal communication skills and social confidence, and were associated with a reduction in the user's social anxiety. Broader socioeconomic gains were not achieved by implantees, mainly because of an absence of adequate employment and community education programmes associated with implant programmes.

    背景与目标: 传统上,与人工耳蜗的功效有关的研究集中在测量与植入相关的语音感知的增强。本文报告了一项研究的结果,该研究涉及与成人人工耳蜗计划相关的社会心理益处的定性和定量测量。人工耳蜗增强了植入者的人际沟通技巧和社交信心,并与减少用户的社交焦虑有关。植入者没有实现更广泛的社会经济收益,这主要是因为缺乏与植入计划相关的适当就业和社区教育计划。
  • 【急性鼠皮肤切口伤口的微循环显示出血管功能的时空变化。】 复制标题 收藏 收藏
    DOI:10.1111/j.1743-6109.2006.00142.x 复制DOI
    作者列表:Bluff JE,O'Ceallaigh S,O'Kane S,Ferguson MW,Ireland G
    BACKGROUND & AIMS: :A mouse perfusion model using fluorescently labeled dextran has been developed to investigate the functionality of blood vessels during cutaneous wound healing. By immunostaining cryostat sections of perfused wounds with antibodies that identify vessels, we were able to assess their functionality. There was an increase in the proportion of CD31(+)-perfused vessels in all wound regions with time, although the vessels of the wound margins and superficial granulation tissue (GT) took the longest to become perfused. More than 50% of the latter vessels were not perfused at 10 days postwounding. This is consistent with the growth of functional vessels from the wound base proceeding to the more superficial GT. The CD34 marker was expressed by a subpopulation of CD31(+) vessels. However, in contrast to CD31(+) vessels, the functionality of CD34(+) vessels did not change significantly with time and 50-75% of CD34(+) vessels in the GT and wound margins were nonfunctional. This might be explained either by apoptosis of the CD34(+) vessels or the loss of the marker with time. This study has important implications for assays of wound-healing angiogenesis based on histology and immunohistochemical markers for vessels, because vessel functionality differs both spatially and temporally during wound healing.
    背景与目标: : 已经开发了使用荧光标记的葡聚糖的小鼠灌注模型,以研究皮肤伤口愈合过程中血管的功能。通过用识别血管的抗体对灌注伤口的低温恒温器切片进行免疫染色,我们能够评估其功能。尽管伤口边缘和浅表肉芽组织 (GT) 的血管灌注时间最长,但所有伤口区域中CD31 () 灌注血管的比例随时间增加。超过50% 的后一种血管在伤后10天没有灌注。这与从伤口基部到更浅表的GT的功能性血管的生长是一致的。CD34标记由CD31 () 血管的亚群表达。然而,与CD31(+) 血管相反,CD34(+) 血管的功能没有随时间显着变化,并且GT和伤口边缘中的50-75% CD34(+) 血管无功能。这可以通过CD34 () 血管的凋亡或标记物随时间的丢失来解释。这项研究对基于血管的组织学和免疫组织化学标记的伤口愈合血管生成测定具有重要意义,因为在伤口愈合过程中,血管功能在空间和时间上均不同。
  • 【氨基末端脑钠肽前体: 心力衰竭的诊断,预后和管理的生物标志物。】 复制标题 收藏 收藏
    DOI:10.1586/14737159.6.5.649 复制DOI
    作者列表:Morello AM,Januzzi JL
    BACKGROUND & AIMS: :There is a substantial need for a diagnostic tool to aid in the early diagnosis of heart failure and in the recognition of those at risk for its development, as well as in guidance of therapy. Testing for amino-terminal pro-brain natriuretic peptide (NT-proBNP) has been recognized to have utility in the diagnosis, prognosis and management of heart failure. In addition, numerous other applications for NT-proBNP testing are now recognized, such as evaluation of patients with heart disease in the absence of heart failure, as well as the diagnostic and prognostic evaluation of patients with acute coronary syndromes or pulmonary thromboembolism.
    背景与目标: : 迫切需要一种诊断工具来帮助早期诊断心力衰竭,识别有发展风险的人以及指导治疗。氨基末端脑钠肽前体 (NT-proBNP) 的检测已被认为可用于心力衰竭的诊断,预后和管理。此外,NT-proBNP检测的许多其他应用现已得到认可,例如在没有心力衰竭的情况下评估心脏病患者,以及对急性冠状动脉综合征或肺血栓栓塞患者的诊断和预后评估。
  • 【Shouldice技术: 疝气修复的经典。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Bendavid R
    BACKGROUND & AIMS: Controversy exists on the merits of the various approaches to inguinal repair. Evolution of the classic open repair has culminated in the Shouldice repair. Challenges from newcomers, namely, tension-free repair and laparoscopy, are being examined. These two techniques have a number of disadvantagesthe presence of foreign bodies (prostheses) and their implication in cases of infection; the cost of prosthetic material, which is no longer negligible (particularly with expanded polytetrafluoroethylene); and problems of safety in that the laparoscopic approach is no longer a dependable asset except in the hands of a highly specialized and dextrous operator. Still, complications occur with laparoscopic repair that should not be associated with a surgical procedure that is considered benign, safe and cost-effective. Surgeons must recognize the pertinent facts and decide according to their conscience which method of repair to use.

    背景与目标: 腹股沟修复的各种方法的优点存在争议。经典开放式维修的演变最终导致了Shouldice维修。正在研究新来者的挑战,即无张力修复和腹腔镜检查。这两种技术有许多缺点: 异物 (假肢) 的存在及其在感染情况下的影响; 假体材料的成本不再可忽略不计 (特别是使用膨胀的聚四氟乙烯); 以及安全性问题,因为腹腔镜方法不再是可靠的资产,除非由高度专业和灵巧的操作员掌握。尽管如此,腹腔镜修复术仍会发生并发症,而不应与被认为是良性,安全且具有成本效益的外科手术相关联。外科医生必须认识到相关事实,并根据自己的良心决定使用哪种修复方法。
  • 【停药后跌倒风险增加药物的风险: 一项前瞻性队列研究。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2125.2006.02736.x 复制DOI
    作者列表:van der Velde N,Stricker BH,Pols HA,van der Cammen TJ
    BACKGROUND & AIMS: AIMS:Falling in older persons is a frequent and serious clinical problem. Several drugs have been associated with increased fall risk. The objective of this study was to identify differences in the incidence of falls after withdrawal (discontinuation or dose reduction) of fall-risk-increasing drugs as a single intervention in older fallers. METHODS:In a prospective cohort study of geriatric outpatients, we included 139 patients presenting with one or more falls during the previous year. Fall-risk-increasing drugs were withdrawn, if possible. The incidence of falls was assessed within 2 months of follow-up after a set 1 month period of drug withdrawal. Multivariate adjustment for potential confounders was performed with a Cox proportional hazards model. RESULTS:In 67 patients, we were able to discontinue a fall-risk-increasing drug, and in eight patients to reduce its dose. The total number of fall incidents during follow-up was significantly lower in these 75 patients, than in those who continued treatment (mean number of falls: 0.3 vs. 3.6; P value 0.025). The hazard ratio of a fall during follow-up was 0.48 (95% confidence interval (CI) 0.23, 0.99) for overall drug withdrawal, 0.35 (95% CI 0.15, 0.82) for cardiovascular drug withdrawal and 0.56 (95% CI 0.23, 1.38) for psychotropic drug withdrawal, after adjustment for age, gender, use of fall-risk-increasing drugs, baseline falls frequency, comorbidity, Mini-Mental State Examination score, and reason for referral. CONCLUSIONS:Withdrawal of fall-risk-increasing drugs appears to be effective as a single intervention for falls prevention in a geriatric outpatient setting. The effect was greatest for withdrawal of cardiovascular drugs.
    背景与目标:
  • 【I组双冠子在黏菌二钕虹膜的核糖核酸DNA中的体内迁移率。】 复制标题 收藏 收藏
    DOI:10.1046/j.1365-2958.1997.3921743.x 复制DOI
    作者列表:Johansen S,Elde M,Vader A,Haugen P,Haugli K,Haugli F
    BACKGROUND & AIMS: DiSSU1 is an optional group I twintron present in the nuclear extrachromosomal ribosomal DNA of the myxomycete Didymium iridis. DiSSU1 appears to be complex both in structure and function. At the RNA level it has a twin-ribozyme organization composed of two group I ribozymes with different functions, separated by an open reading frame. Here, we show that DiSSU1 is mobile when haploid intron-containing and intron-less amoebae are mated. The mobility process is fast, being completed in 5-10 nuclear cycles after mating in the developing zygote and plasmodia. Analyses of progeny from genetic crosses confirm intron mobility. DiSSU1 is the first example of a mobile group I twintron. The intron-encoded protein was expressed in Escherichia coli and found to be an endonuclease, I-DirI, that cleaves an intron-less ribosomal DNA allele at the intron-insertion site, and is probably involved in intron homing. The endonuclease I-DirI seems to be a rare example of a protein that is expressed from a ribozyme-processed RNA polymerase I transcript in vivo.

    背景与目标: DiSSU1是一种可选的I族双冠子,存在于粘菌素二钕虹膜的核染色体外核糖体DNA中。DiSSU1在结构和功能上似乎都很复杂。在RNA水平上,它具有一个双核酶组织,该组织由两个具有不同功能的I族核酶组成,并由开放阅读框隔开。在这里,我们表明,当单倍体内含子和无内含子的阿米巴交配时,DiSSU1是可移动的。迁移率过程很快,在发育中的合子和疟原虫交配后,在5-10个核循环中完成。对遗传杂交后代的分析证实了内含子的迁移率。DiSSU1是移动组I twintron的第一个示例。内含子编码的蛋白在大肠杆菌中表达,发现它是一种内切核酸酶I-DirI,在内含子插入位点切割无内含子核糖体DNA等位基因,并且可能参与内含子归巢。核酸内切酶I-DirI似乎是从核酶处理的RNA聚合酶I转录本体内表达的蛋白质的罕见例子。
  • 【鉴定160-kD分子作为基底膜区的组成部分和次要大疱性类天疱疮抗原。】 复制标题 收藏 收藏
    DOI:10.1111/1523-1747.ep12874675 复制DOI
    作者列表:Zhu XJ,Niimi Y,Bystryn JC
    BACKGROUND & AIMS: :The antigens in normal human skin defined by antibodies in patients with bullous pemphigoid (BP) were studied by Western immunoblots. Eighteen (90%) of 20 BP sera reacted to a 230-kD antigen. Seven (35%) of the sera reacted to a 160-kD antigen. Two of these reacted only to the 160-kD antigen and five also reacted to the 230-kD antigen. Antibodies to the 160-kD antigen were not present in 25 control sera obtained from normal individuals or patients with other bullous diseases. The 160-kD antigen was present in epidermal extracts of four different specimens of normal human skin but not in dermal extracts or extracts of control cells including melanoma, fibroblasts, lung carcinoma, and colon carcinoma. Monospecific sera with antibodies to either the 230-kD or to the 160-kD antigen reacted solely to their respective target antigens, but not to both, in extracts of epidermis that contained both antigens. The 160-kD antigen broke down to a 140-kD fragment, while the 230-kD antigen was unchanged in the absence of protease inhibitors. Western blot affinity purified antibody to the 160-kD antigen bound only to the basement membrane zone on the epidermal side of 1M NaCl split skin. These results indicate that a 160-kD antigen is a normal component of the basement membrane zone of human skin. The antigen is located on the epidermal side of skin split with 1M NaCl. It is a minor BP antigen, antibodies to which are present in some patients with BP.
    背景与目标: : 通过Western免疫印迹研究了大疱性类天疱疮 (BP) 患者中由抗体定义的正常人皮肤中的抗原。20个BP血清中的18个 (90%) 反应至230-kD抗原。七个 (35%) 的血清反应至160-kD抗原。其中两个仅对160-kD抗原反应,五个也对230-kD抗原反应。在从正常个体或其他大疱性疾病患者获得的对照血清中不存在针对160-kD抗原的抗体。160-kD抗原存在于正常人皮肤的四个不同标本的表皮提取物中,但不存在于真皮提取物或对照细胞的提取物中,包括黑色素瘤、成纤维细胞、肺癌和结肠癌。在含有两种抗原的表皮提取物中,具有针对230-kD或针对160-kD抗原的抗体的单特异性血清仅与它们各自的靶抗原反应,但不与两者反应。160-kD抗原分解为140-kD片段,而230-kD抗原在没有蛋白酶抑制剂的情况下不变。Western印迹亲和纯化的160-kD抗原抗体仅与1mnacl分裂皮肤的表皮侧的基底膜区结合。这些结果表明160-kD抗原是人皮肤基底膜区的正常成分。抗原位于1M NaCl分裂的皮肤的表皮侧。它是一种次要的BP抗原,在某些BP患者中存在抗体。
  • 【卵巢旁副肾囊肿中出现的交界性恶性浆液性囊腺瘤。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Puig F,Crespo R,Marquina I
    BACKGROUND & AIMS: BACKGROUND:Borderline parovarian tumors are found incidentally at surgery or autopsy. They are extremely rare. The majority have been reported in young women and rarely are they large enough to be clinically significant. CASE:A 53-year-old multiparous female with a symptomatic paraovarian serous borderline cystadenoma is presented. DISCUSSION:The clinical aspects and subsequent management of related cases are discussed.
    背景与目标:
  • 【对诊断不足的不良治疗状况的新看法: 不宁腿综合症。】 复制标题 收藏 收藏
    DOI:10.1016/s1479-666x(06)80009-0 复制DOI
    作者列表:Barry M,Leahy AL
    BACKGROUND & AIMS: :Restless legs syndrome (RLS) is a common condition that is difficult to diagnose. However, once correctly diagnosed, its management is straightforward and evidence-based. The purpose of this article is to familiarise clinicians with both the symptoms and diagnostic criteria for RLS and to elucidate secondary and often curable causes of this prevalent condition. There is also a concise review of its pathophysiology and current management strategies. The authors hope this article will raise awareness of this condition among clinicians and in doing so improve the quality of life for the patients affected by it.
    背景与目标: : 不宁腿综合征 (RLS) 是一种很难诊断的常见疾病。然而,一旦被正确诊断,它的管理是直接的和基于证据的。本文的目的是使临床医生熟悉RLS的症状和诊断标准,并阐明这种普遍情况的继发性和通常可治愈的原因。还简要回顾了其病理生理学和当前的管理策略。作者希望这篇文章能提高临床医生对这种疾病的认识,并以此改善受其影响的患者的生活质量。
  • 14 A novel mechatronic body weight support system. 复制标题 收藏 收藏

    【一种新型机电一体化体重支撑系统。】 复制标题 收藏 收藏
    DOI:10.1109/TNSRE.2006.881556 复制DOI
    作者列表:Frey M,Colombo G,Vaglio M,Bucher R,Jörg M,Riener R
    BACKGROUND & AIMS: :A novel mechatronic body weight support (BWS) system has been developed to provide precise body weight unloading for patients with neurological or other impairments during treadmill training. The system is composed of a passive elastic spring element to take over the main unloading force and an active closed-loop controlled electric drive to generate the exact desired force. Both force generating units, the passive spring and the active electric drive, act on the patient via a polyester rope connected to a harness worn by the patient. The length of the rope can be adjusted with an electric winch to adapt the system to different patient sizes. The system is fully computer controlled. At unloading loads of up to 60 kg and walking speeds of up to 3.2 km/h, the mean unloading error and the maximum unloading error of the presented BWS system was less than 1 and 3 kg, respectively. The performance was compared with those of two purely passive BWS systems currently being used by most other rehabilitation groups. This comprised counterweight systems and static BWS systems with fixed rope lengths. Counterweight systems reached mean and maximum unloading errors of up to 5.34 and 16.22 kg, respectively. The values for the static BWS were 11.02 kg and 27.67 kg, respectively. The novel mechatronic BWS system presented in this study adjusts desired unloading changes of up to 20 kg within less than 100 ms. Thus, not only constant BWS, but also gait cycle dependent or time variant oscillations of the desired force can be realized with high accuracy. Precise and constant unloading force is believed to be an important prerequisite for BWS gait therapy, where it is important to generate physiologically correct segmental dynamics and ground reaction forces. Thus, the novel BWS system presented in this paper is an important contribution to maximize the therapeutic outcome of human gait rehabilitation.
    背景与目标: : 已开发出一种新颖的机电一体化体重支持 (BWS) 系统,可为跑步机训练期间患有神经系统或其他障碍的患者提供精确的体重卸载。该系统由被动弹性弹簧元件组成,用于接管主卸载力,以及主动闭环控制的电驱动器,以产生精确的期望力。两个力产生单元,即被动弹簧和主动电驱动器,通过连接到患者佩戴的安全带的聚酯绳作用于患者。绳索的长度可以用电动绞盘调节,以使系统适应不同的患者尺寸。该系统完全由计算机控制。在高达60千克的卸载载荷和高达3.2千米/h的步行速度下,所提出的BWS系统的平均卸载误差和最大卸载误差分别小于1和3千克。将性能与大多数其他康复小组目前使用的两种纯被动BWS系统的性能进行了比较。这包括配重系统和具有固定绳索长度的静态BWS系统。配重系统的平均和最大卸载误差分别达到5.34和16.22千克。静态BWS的值分别为11.02千克和27.67千克。本研究中提出的新型机电BWS系统在不到100毫秒的时间内调节高达20千克的所需卸载变化。因此,不仅可以实现恒定的BWS,而且可以实现步态周期相关或所需力的时变振荡。精确且恒定的卸荷力被认为是BWS步态疗法的重要先决条件,在该疗法中,重要的是产生生理上正确的节段动力学和地面反作用力。因此,本文提出的新型BWS系统是最大程度地提高人类步态康复治疗效果的重要贡献。
  • 【通过跑步机对截瘫患者进行步行康复。】 复制标题 收藏 收藏
    DOI:10.1038/sj.sc.3100403 复制DOI
    作者列表:Felici F,Bernardi M,Radio A,Marchettoni P,Castellano V,Macaluso A
    BACKGROUND & AIMS: The present study was aimed at investigating the use of a treadmill for ambulation training of paraplegic subjects. To investigate the likely effectiveness of this modality of rehabilitation, six paraplegic patients (three male and three female) were studied, using new generation reciprocating gait orthoses (RGO and ARGO), in a treadmill training program. Oxygen consumption, heart rate, and pulmonary ventilation were measured when the subjects were walking at their most comfortable speed on the treadmill and on the open field. These measurements were carried out at the beginning of the study and after two and six months of treadmill training. The following findings were significantthe treadmill walking required 30% less energy than open field ambulation prior to training (P < 0.001) and 50% after training (P < 0.05). The most comfortable walking speed was faster on the treadmill than on the open field by 18% prior to training (P < 0.05) and 42% afterwards (P < 0.05). The energy cost was 50% less after 2 months training on the treadmill (P < 0.05) showing that treadmill training can improve the efficiency of over ground ambulation. It can be concluded that the treadmill training improves the RGO/ARGO walking capability, probably both the walking efficiency (short term adaptation) and physical fitness (long term adaptation).

    背景与目标: 本研究旨在研究跑步机用于截瘫受试者的步行训练。为了研究这种康复方式的可能有效性,在跑步机训练计划中使用新一代往复式步态矫形器 (RGO和ARGO) 研究了六名截瘫患者 (三名男性和三名女性)。当受试者以最舒适的速度在跑步机和开阔的场地上行走时,测量耗氧量,心率和肺通气。这些测量是在研究开始时以及经过两到六个月的跑步机训练后进行的。以下发现是显着的跑步机步行所需的能量比训练前 (P < 0.001) 和训练后50% (P < 0.05) 的野外步行所需的能量少30%。在跑步机上,最舒适的步行速度比在露天场地上的速度快,在训练前18% (P <0.05),之后42% (P <0.05)。在跑步机上进行2个月的训练后,能量消耗50% 较低 (P <0.05),表明跑步机训练可以提高地面移动的效率。可以得出结论,跑步机训练提高了RGO/ARGO步行能力,可能同时提高了步行效率 (短期适应) 和身体素质 (长期适应)。

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