针刺运动疗法联合早期康复训练对急性踝关节扭伤患者踝关节功能、血清炎症因子和致痛物质水平的影响

摘要 目的：观察针刺运动疗法联合早期康复训练对急性踝关节扭伤患者踝关节功能、血清炎症因子和致痛物质水平的影响。方法：选取湖南中医药大学第一附属医院2019年5月~2022年1月期间收治的116例急性踝关节扭伤患者。按照随机数字表法分为对照组（早期康复训练,n=58）和研究组（针刺运动疗法联合早期康复训练,n=58）。观察两组治疗前、治疗4周后的疗效、量表评分[视觉模拟评分（VAS）、美国足与踝关节协会（AOFAS）踝-后足功能评分]、踝关节功能、血清炎症因子[白细胞介素（IL）-1β、IL-6和肿瘤坏死因子-α（TNF-α）]和致痛物质[神经肽（NPY）、P物质（SP）]水平。结果：研究组的临床总有效率为96.55%,高于对照组的77.59%,差异有统计学意义（P<0.05）。治疗4周后,研究组的AOFAS评分高于对照组（P<0.05）,VAS评分低于对照组（P<0.05）,血清IL-6、TNF-α、IL-1β水平低于对照组（P<0.05）,踝关节背伸活动度、踝关节跖屈活动度大于对照组（P<0.05）,血清NPY、SP水平低于对照组（P<0.05）。结论：急性踝关节扭伤患者经针刺运动疗法联合早期康复训练干预后,可有效降低其血清致痛物质和炎症因子水平,有利于疼痛症状的缓解及踝关节功能的恢复。     

门诊和住院运动锻炼为核心的整体管理对慢性心力衰竭患者心脏康复治疗效果影响的临床研究*

目的: 探讨门诊运动康复和住院运动康复对慢性心力衰竭（CHF）患者心脏康复治疗效果的影响。方法: 选择2015 年9 月至2018 年9 月间在北京康复医院临床诊断为CHF患者36 例,按照随机原则和患者参与意愿分为3组：对照组（n=12）：进行除运动锻炼治疗之外的常规心脏康复指导;住院运动康复组（n=12）和门诊运动康复组(n=12）：患者在我院分别住院或门诊进行运动锻炼为核心的心脏康复。根据心肺运动试验（CPET）制定个体化运动处方。功率车运动强度为无氧阈以上Δ50%功率负荷,30 min/d,每周5 d,共12 周。治疗前、后分别评估患者CPET指标、超声心动图指标、6 min步行距离（6MWD）、生活质量（QoL）评分等。结果: 所有CHF患者安全无并发症完成症状限制性CPET,运动康复组患者安全完成全程12 周运动康复。组间比较显示,治疗前,3组患者CPET指标、超声心动图指标、6MWD和QoL均无明显差异（P>0.05）。治疗后,住院和门诊运动康复组患者无氧阈（ml/min, ml/（min·kg）, %pred）、峰值摄氧量（ml/min, ml/（min·kg）, %pred）、峰值氧脉搏（ml/beat）、峰值功率（W, %pred）、左心室射血分数、6MWD较对照组升高（P<0.05）,QoL 评分较对照组降低（P<0.05）;门诊运动康复组和住院运动康复组之间比较,CPET指标、超声心动图指标、6MWD和QoL评分等均无明显差异（P>0.05）。治疗前后比较显示,对照组患者治疗后上述指标与治疗前比较,差异均无统计学意义（P>0.05）;治疗后住院运动康复组和门诊运动康复组患者无氧阈（ml/min, ml/（min·kg））、峰值摄氧量（ml/min, ml/（min·kg）, %pred）、峰值氧脉搏（ml/beat, %pred）、峰值功率（W/min、%pred）、左心室射血分数和6MWD均较治疗前升高（P<0.05）,QoL 评分较治疗前降低（P<0.05）。结论: 门诊运动康复可显著改善CHF患者心肺功能、运动耐力和生活质量,与住院运动康复效果无明显差异。门诊康复作为心脏康复一种有效的治疗模式,值得大力推广。     

不同修复措施对黄河源退化高寒草甸植物群落与土壤养分的影响

为了揭示退化高寒草甸逆向转变的驱动因子,通过野外调查和室内分析相结合的方法探究了黄河源不同修复措施(施有机肥F、免耕补播N、施有机肥+免耕补播FN)处理高寒草甸植物群落特征、土壤理化性质和两者相关性的变化规律,阐明不同修复措施对黄河源退化高寒草甸植物群落与土壤养分的影响。结果表明：免耕补播显著增加草甸物种丰富度指数(P<0.05);施有机肥+免耕补播显著增加草甸植物盖度、总生物量、Shannon Wiener多样性指数和Pielous均匀度指数(P<0.05)。不同人工修复后草甸植物功能群地上、地下生物量变化趋势基本一致(除豆科)。和对照相比,莎草科,杂类草地上和地下生物量含量在N、FN处理分别降低83.04%、73.86%、30.43%、92.37%和96.51%、84.09%、85.68%、95.36%;禾本科地上和地下生物量含量在F、N和FN处理分别增加7.29%、23.45%、17.93%和6.04%、4.03%、10.52%;豆科地上生物量含量基本保持不变,地下生物量含量在F、N和FN处理分别降低24.43%、82.19%和42.61%。F显著增加土壤有机碳含量(...     

海洋生态修复:概念、类型与实施路径选择

生态修复是我国生态文明建设的重要内容。在对生态修复相关概念梳理的基础上,从公共物品治理视角对海洋生态修复主体、修复标准、修复路径及修复措施保障等关键环节进行论述,研究表明：污染和破坏者作为赔偿型海洋生态修复的主体,可通过自行修复和委托修复等方式,将受损海洋生态修复到破坏前的基线水平;国家作为补偿型海洋生态修复的主体,依据边际成本收益分析法确定最优修复规模,通过政府市场采购和创建市场等经济激励型路径实施生态修复以增加公众福利。未来我国海洋生态修复应重点关注修复的资金保障、监督制度以及生态修复的技术研发和修复完成后的成本收益评估等。     

Evaluating effectiveness of restoration to address current stressors to riverine fish

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Effects of sitting postures on risks for deep tissue injury in the residuum of a transtibial prosthetic-user: a biomechanical case study

Transtibial amputation prosthetic-users are at risk of developing deep tissue injury (DTI) while donning their prosthesis for prolonged periods; however, no study addresses the mechanical loading of the residuum during sitting with a prosthesis. We combined MRI-based 3D finite element modelling of a residuum with an injury threshold and a muscle damage law to study risks for DTI in one sitting subject in two postures: 30°-knee-flexion vs. 90°-knee-flexion. We recorded skin-socket pressures, used as model boundary conditions. During the 90°-knee-flexion simulations, major internal muscle injuries were predicted (>1000 mm³). In contrast, the 30°-knee-flexion simulations only produced minor injury ( < 14 mm³). Predicted injury rates at 90°-knee-flexion were over one order of magnitude higher than those at 30°-knee-flexion. We concluded that in this particular subject, prolonged 90°-knee-flexion sitting theoretically endangers muscle viability in the residuum. By expanding the studies to large subject groups, this research approach can support development of guidelines for DTI prevention in prosthetic-users.     

Roads as Ecological Edges for Rehabilitating Coastal Dune Assemblages in Northern KwaZulu-Natal, South Africa

Abstract Post‐mining coastal dune rehabilitation north of Richards Bay, KwaZulu‐Natal started 20 years before field work for the present study commenced. This resulted in the development of a known age sere of coastal dune forest succession. These rehabilitating areas are fragmented by roads that may act as ecological edges. To establish whether roads affect regenerating bird, millipede, and rodent assemblages, multivariate techniques were applied to test for existence of edge and core assemblages within seral stages representative of the coastal dune forest successional sere. Edge and core assemblages were identified for both the bird and millipede communities but not for the rodent community. Low rodent numbers may have concealed edge effects, but the absence of edge and core assemblages could also be ascribed to the absence of a forest core. In the bird community species composition, richness, density, and total number of species contributed to the identification of edge and core assemblages. Within seral stages the species composition of millipedes differed between the edge and core assemblages. However, if the site was the same age the number of species in edge and core assemblages was similar. The generality of the edge concept should be approached with caution when dealing with taxa comprising species with such diverse natural histories as in the present study. It should also be kept in mind that some species require forest interiors for survival.     

Is disruption of sleep quality a consequence of severe Covid-19 infection? A case-series examination

ABSTRACT

The Covid-19 outbreak put enormous stress on the health system worldwide, and objective data to handle the emergency are still needed. We aimed to objectively assess the consequence of severe symptoms of Covid-19 infection on sleep quality through wrist actigraphy monitoring of four patients during the sub-acute recovery stage of the disease. The sleep of those patients who had experienced the most severe respiratory symptoms and who had needed prolonged intensive care unit (ICU) stay showed lower Sleep Efficiency and Immobility Time and higher Fragmentation Index compared to those patients who had experienced only mild respiratory symptoms and not requiring ICU stay. Wrist actigraphy assessment provided important clinical information about the sleep and activity levels of Covid-19 patients during the post-acute rehabilitation management.     

Shoulder joint kinetics and dynamics during underwater forward arm elevation

Aquatic exercises are widely implemented into rehabilitation programs. However, both evaluating their mechanical demands on the musculoskeletal system and designing protocols to provide progressive loading are difficult tasks. This study reports for the first time shoulder joint kinetics and dynamics during underwater forward arm elevation performed at speeds ranging from 22.5 to 90°/s. Net joint moments projected onto anatomical axes of rotation, joint power, and joint work were calculated in 18 participants through a novel approach coupling numerical fluid flow simulations and inverse dynamics. Joint dynamics was revealed from the 3D angle between the joint moment and angular velocity vectors, identifying three main functions—propulsion, stabilization, and resistance. Speeds <30°/s necessitated little to no power at all, whereas peaks about 0.20 W⋅kg⁻¹ were seen at 90°/s. As speed increased, peak moments were up to 61 × higher at 90 than at 22.5°/s, (1.82 ± 0.12%BW⋅AL vs 0.03 ± 0.01%BW⋅AL, P < 0.038). This was done at the expense of a substantial decrease in the joint moment contribution to joint stability though, which goes against the intuition that greater stabilization is required to protect the shoulder from increasing loads. Slow arm elevations (<30°/s) are advantageous for joint mobility gain at low mechanical solicitation, whereas the intensity at 90°/s is high enough to stimulate muscular endurance improvements. Simple predictive equations of shoulder mechanical loading are provided. They allow for easy design of progressive protocols, either for the postoperative shoulder or the conditioning of athlete targeting very specific intensity regions.     

Intelligent Touchscreen Joystick for Controlling Electric Wheelchair

Background

The objective of this research was to design, implement, use and evaluate a human-machine touch interface for driving an electric wheelchair. This new interface allows control of the electric wheelchair with touch screen smartphone technologies (android, IOS or Windows phone). In addition, an intelligent calibration algorithm, based on the neural network (NN), is implemented in this interface to overcome manoeuvring problems, namely the inability to move correctly in one or more directions.