图片交换沟通系统护理对孤独症儿童沟通能力的影响

目的观察图片交换沟通系统(PECS)护理对孤独症儿童沟通能力的影响。方法选取孤独症儿童76例作为研究对象,随机分为观察组与对照组各38例,对照组予以基础护理,观察组基于此予以图片交换沟通系统(PECS)护理,对比2组儿童的沟通能力。结果干预后,2组儿童的面部表情、情绪情境的图片配对正确得分显著高于干预前(P0.05),且观察组儿童面部表情、情绪情境的图片配对正确得分显著高于对照组(P0.05);干预后,2组儿童的沟通能力、行为模式评分显著高于干预前(P0.05),且观察组的沟通能力、行为模式评分显著高于对照组(P0.05);干预后,2组儿童对他人反应、引发沟通、交谈技巧评分显著高于干预前(P0.05),且观察组儿童对他人反应、引发沟通、交谈技巧评分显著高于对照组(P0.05);观察组家长对护理模式的满意度显著高于对照组(P0.05)。结论图片交换沟通系统护理能够有效改善孤独症儿童的情绪认知能力以及情感表达能力,并提高其沟通能力及社会交际能力,促进其社会性发展,家属满意度高,可在临床推广使用。     

孤独症谱系障碍患儿脑白质异常的弥散张量成像观察

目的探讨孤独症谱系障碍(ASD)患儿与正常儿童脑白质连接的差异。方法 2017年9月至2018年7月,选取ASD患儿10例(ASD组)和正常儿童10例(对照组)。ASD组采用Gesell发展量表(GDS)评定发育商,并采用孤独症儿童心理教育评核第3版(PEP-3)进行评定。所有儿童均行MRI弥散张量成像(DTI)扫描,比较两组各向异性分数(FA)、轴向弥散系数(AD)、径向弥散系数(RD)和平均弥散系数(MD)差异;以及ASD组临床量表评分与DTI各参数行相关性分析。结果与对照组相比,ASD组左侧小脑中脚、左侧胼胝体体部、左侧内囊后肢、双侧放射冠和双侧上纵束FA降低,左侧小脑中脚、左侧胼胝体体部及压部、双侧放射冠和双侧上纵束RD增高。智龄与左侧小脑中脚FA呈正相关(r=0.686, P 0.05),发育商与左侧放射冠(r=0.720, P 0.05)和左侧胼胝体压部(r=0.744,P 0.05) FA呈正相关,语言表达(r=0.711, P 0.05)和语言理解(r=0.754, P 0.05)与左侧胼胝体体部FA呈正相关,精细运动与左侧小脑中脚FA呈正相关(r=0.723, P 0.05),情感表达与左侧胼胝体体部RD呈负相关(r=-0.902, P 0.05)。结论 ASD患儿脑白质发育异常,且与智力、发育和临床表现相关。     

针刺改善孤独症谱系障碍患儿核心症状的临床观察

目的:探讨针刺改善儿童孤独症谱系障碍(ASD)核心症状的临床效果。方法:选取2016年7月—2018年8月我院收治的86例ASD患儿,采取简单随机数字表法将其随机分成观察组(n=43)与对照组(n=43)。对照组采取常规康复训练,而观察组在对照组基础上加用针刺疗法治疗,所有患儿均治疗6个月。比较两组临床疗效,治疗前后分别对两组患儿进行孤独症儿童行为量表(ABC)、儿童孤独症评定量表(CARS)、孤独症疗效评估量表(ATEC)、孤独症儿童心理教育评核(第三版)(PEP-3)及韦氏学龄前及初小儿童智力量表(WPPSI)测评,并统计针刺相关副反应发生情况。结果:观察组总有效率为88.37%(38/43),与对照组的67.44%(29/43)相比显著上升(P0.05)。两组治疗后ABC和CARS评分均较治疗前显著降低(P0.05),但观察组下降更显著(P0.05);两组治疗后ATEC中各分量表(言语、感知觉、社交、行为)评分及其总分均较治疗前显著降低(P0.05),但观察组下降更显著(P0.05)。两组治疗后PEP-3中各部分包括认知(语言/语前)、语言理解、语言表达、小肌肉等10个部分评分均显著高于治疗前(P0.05),且观察组升高更显著(P0.05)。观察组治疗后WPPSI中各方面(言语理解、视觉空间、推理等)评分均较治疗前有显著增加(P0.05),且显著高于对照组治疗后(P0.05)。而对照组治疗后WPPSI中言语理解及总智商评分较治疗前有显著增高(P0.05),但在视觉空间、推理、工作记忆、加工速度评分方面的改善效果均不明显(P0.05)。同时观察组患儿因针刺所致的副作用较少且轻微。结论:针刺治疗儿童ASD不仅能有效改善核心症状,而且能促进患儿语言、认知、行为功能障碍的恢复,提高其智力水平,且患儿耐受性较好。     

功能性构音障碍患儿语音均衡式识别能力评估

目的:评估功能性构音障碍(FAD)患儿的语音均衡式识别能力,为其发病机制研究提供新的依据。方法:FAD患者68例(FAD组),另选择健康体检正常儿童50例为对照组。采用儿童语音均衡式识别能力评估表(孙喜斌词表)对2组进行声母和韵母识别能力评估。结果:FAD组患儿声母及韵母识别能力均显著低于对照组(P<0.05),且中重度FAD患儿声母韵母识别能力均明显低于轻度FAD患儿(P<0.05)。结论:FAD患儿语音均衡式识别能力明显落后于正常儿童,语音均衡式识别能力落后可能是FAD的病因之一。     

高功能孤独症儿童情绪理解能力干预的个案研究

目的:探讨高功能孤独症(HFA)儿童情绪理解干预的方法和技术手段。方法:对3例HFA儿童,以表情照片、视频动画和情境故事等视频材料为主体,以讨论式教授方式为主,对其情绪理解中的表情识别和命名、情绪归因进行全面的干预,并进行评测。结果:干预6周及12周后,3例患儿视频评测成绩、情绪词汇理解能力均明显提高。3例患儿形成性评测成绩总体呈上升趋势,并且在干预12周后趋于平稳。结论:以表情照片、视频动画和情境故事等视觉材料为主体的情绪理解中的干预能够提高高功能孤独症儿童的情绪理解能力。     

儿童孤独症谱系障碍的早期筛查

目的分析2013~2015年儿童保健门诊确诊为孤独症谱系障碍(ASD)的6岁以下儿童的筛查量表及发育商,实现ASD患儿的早期诊断、早期干预。方法对91例符合美国精神障碍诊断与统计手册第五版(DSM-Ⅴ)诊断标准的ASD儿童(ASD组),及年龄、性别匹配的70例心理行为发育正常儿童(对照组),运用DSM-Ⅴ、孤独症行为量表(ABC)、改良婴幼儿孤独症量表(M-CHAT)及Gesell发育量表对被试儿童进行临床评估。结果 M-CHAT阳性筛查结果与临床诊断标准一致性较好,差异无统计学意义(P0.1)。ASD组适应性、精细动作、大运动、语言、个人-社交5个能区的发育商较对照组降低,差异有统计学意义(P0.001)。ASD组1~3岁与3~6岁比较,随年龄增长,语言、个人-社交发育商差异无统计学意义(P0.05)。结论 ASD患儿社会沟通、社会交往能力缺陷,行为发育偏离,使用临床量表早期筛查,辅助ASD的临床诊断,实现早期干预,可改善预后,促进患儿早期回归社会。     

超声心动图诊断完全性肺静脉畸形引流的敏感指标

目的明确超声心动图诊断完全性肺静脉畸形引流(TAPVC)的敏感指标。方法分析TAPVC患儿(T组)44例,单纯性房间隔缺损(ASD)患儿(ASD组)20例及正常对照组20例的超声心动图图像,重点对三组患儿的左房、右室大小及肺动脉压(PAP)进行测量分析,并比较T组与ASD组房缺大小。结果左房大小:ASD组对照组T组,对照组与ASD组间差异无统计学意义(P0.05);右室大小:T组ASD组对照组;PAP:T组ASD组对照组;T组与ASD组房缺大小:T组ASD组,差异均有统计学意义(P0.05)。结论 TAPVC患儿左房减小,右室增大,PAP显著增高,并且一般合并较大房间隔缺损。因此房缺大小、左房、右室内径以及PAP可以成为判断TAPVC的敏感指标。     

重复经颅磁刺激在治疗孤独症谱系障碍儿童康复中的应用

目的：探讨重复经颅磁刺激（r TMS）在孤独症谱系障碍（ASD）儿童康复中的应用价值。方法：按信封法将2021年1月至2022年12月漯河医学高等专科学校第三附属医院诊治的82例ASD患儿分为对照组与研究组,各41例。对照组给予常规康复训练,研究组在对照组基础上给予r TMS治疗。对比两组核心症状改善情况、情绪识别能力及治疗前后孤独症行为[孤独症行为检查量表（ABC）]、孤独症严重程度[儿童孤独症量表（CARS）]、睡眠状况[儿童睡眠习惯问卷表（CSHQ）]、认知功能相关指标[同型半胱氨酸（Hcy）、脑源性神经营养因子（BDNF）]。结果：研究组核心症状改善率（95.12%）高于对照组（78.05%）,差异有统计学意义（P<0.05）;研究组对下半张面孔、上半张面孔、倒置及正立表情的情绪识别能力准确率高于对照组（P<0.05）;治疗8周后研究组ABC评分、CARS评分、CSHQ评分及Hcy水平均低于对照组,BDNF水平高于对照组（P<0.05）。结论：对ASD患儿进行r TMS治疗可显著缓解其核心症状,提高情绪识别能力,减轻病情,改善睡眠状况及认知功能。     

基于PECS的听觉统合训练对孤独症谱系障碍患儿发展能力、发育水平及沟通能力的影响

目的:探讨应用图片交换沟通系统(PECS)联合听觉统合训练(AIT)对孤独症谱系障碍(ASD)患儿沟通能力、发育水平及发展能力的影响。方法:选取医院2018年9月—2020年9月115例ASD患儿作为研究对象,采用随机数字表法进行分组,对照组57例,给予PECS干预,观察组58例,在PECS干预基础上联合AIT,对比两组患儿发展能力、发育水平及沟通能力。结果:干预3个月后,观察组患儿认知表达、手眼协调、模仿、认知理解、知觉、大肌肉、小肌肉及总分均明显高于对照组(P<0.05);观察组患儿粗大运动、适应能力、精细运动、语言、社会行为及发育商评分均明显高于对照组(P<0.05);观察组患儿引发沟通、交谈技巧及对他人反应评分均明显高于对照组(P<0.05)。结论:针对ASD患儿应用PECS联合AIT干预效果明显,能够明显提高患儿发育水平,增强其沟通能力,并促进发展能力的改善。     

孤独症谱系障碍儿童家庭功能与养育者育儿自我效能感的相关性

目的分析孤独症谱系障碍(ASD)儿童家庭功能与养育者育儿自我效能感(PSE)的相关性。方法采用队列研究方法,2015年8月至2016年2月本院ASD儿童(n=142)的养育者入研究组(n=173),同期正常健康儿童(n=131)养育者入对照组(n=131),使用家庭功能评定量表(FAD)、育儿自我效能感测评工具(TOPSE)对两组进行问卷调查。结果两组FAD及TOPSE得分有显著性差异(P0.05)。高收入、城镇ASD儿童家庭功能优于低收入、农村ASD儿童家庭(P0.05)。研究组FAD得分与TOPSE得分呈负相关(r=-0.152~-0.257,P0.05)。结论 ASD儿童家庭功能健康状况和养育者PSE水平明显低于正常儿童家庭,且家庭功能越差,养育者PSE水平越低。应针对ASD养育者的特点制定个体化的、以家庭为中心的干预策略,为患儿的康复提供良好的家庭环境。     

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.     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.