低频电刺激联合压力温度刺激训练治疗老年痴呆患者吞咽困难的疗效观察

目的:探讨低频电刺激联合压力和温度刺激促进训练治疗老年痴呆患者合并吞咽功能障碍的疗效。方法:老年痴呆合并吞咽功能障碍患者80例,随机分为观察组和对照组各40例。2组均采用常规药物治疗和吞咽康复训练,观察组在此基础上加用低频电刺激联合压力温度刺激促进训练。治疗前后采用洼田饮水试验评级和标准吞咽功能评分(SSA)对2组进行评估。结果:治疗4周后,2组洼田饮水试验评级均较治疗前明显好转(P0.05,0.01),且观察组更优于对照组(P0.05)。治疗2、3及4周时,2组SSA评分均较治疗前呈逐渐下降趋势(均P0.05),且观察组在治疗第3及4周时的SSA评分均低于同期的对照组(均P0.05),治疗2周时SSA评分2组间比较差异无统计学意义。结论:低频电刺激联合压力温度刺激促进训练较常规吞咽康复训练更有效改善老年痴呆患者的吞咽功能。     

冰棉签刺激和维生素C刺激对脑梗死后吞咽障碍患者康复训练效果的影响

目的:探讨冰棉签刺激和维生素C刺激对脑梗死后吞咽障碍患者的康复治疗效果。方法:选取阜阳市第二人民医院神经内科收治的脑梗死后吞咽障碍患者60例,随机分为观察组与对照组(每组各30例)。在常规吞咽训练的基础上,对照组采取冰棉签刺激训练,观察组采取维生素C刺激训练。治疗1周后采用洼田饮水实验评价吞咽功能,比较两组治疗效果及不良反应。结果:治疗后,观察组有效率(86.67%)明显高于对照组(56.67%,P0.05)。观察组洼田饮水试验评分低于对照组(P0.05)。观察组恶心、呛咳的发生率均低于对照组(P0.05)。结论:维生素C刺激训练能有效改善脑梗死后吞咽障碍患者的吞咽功能,提高康复效果,值得临床推广。     

吞咽治疗仪联合冰刺激对脑卒中吞咽障碍患者疗效的影响

目的观察Vitaistim治疗仪联合冰刺激对脑卒中吞咽障碍患者临床效果的影响。方法随机将60例脑卒中后伴有吞咽障碍的患者分为观察组和对照组,每组30例。对照组运用冰刺激治疗,观察组在对照组治疗的基础上,给予Vitaistim吞咽仪干预,分别于治疗前、治疗3周后进行洼田饮水测验、吞咽功能量表SSA评分和X线(VFSS)检查以评价效果。结果观察组洼田饮水评分、VFSS评分高于对照组,差异均具有统计学意义(P0.05);标准吞咽量表SSA评分低于对照组,差异具有统计学意义(P0.05)。结论 Vitaistim治疗仪联合冰刺激疗法可以显著改善脑卒中后患者的吞咽功能。     

肌电生物反馈联合低频电刺激和康复训练对脑卒中后吞咽功能障碍的影响

目的探讨肌电生物反馈（SEMG-BFT）联合低频电刺激和康复训练对脑卒中后吞咽功能障碍患者吞咽功能的影响,并对比不同性状食物在吞咽中的差异,以期为脑卒中后吞咽功能障碍患者选择全面的康复治疗方案提供依据。 方法选取脑卒中后吞咽功能障碍患者56例,随机分为治疗组和对照组,每组28例。对照组采用低频电刺激和康复训练治疗,治疗组患者对照组治疗方案的基础上加以SEMG-BFT治疗。于治疗前、治疗2周和治疗4周后分别采用洼田饮水试验、中文版吞咽功能评估量表(GUSS)评估患者吞咽功能,同时采用颏下肌群表面肌电（SEMG）信号检测2组患者吞咽不同性状食物时的吞咽时程和平均波幅值,并进行比较和分析。 结果治疗2周和4周后,2组患者洼田饮水实验评分、GUSS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),且治疗组治疗2周和4周后的洼田饮水实验评分、GUSS评分均优于对照组同时间点,差异均有统计学意义(P<0.05)。治疗2周和4周后,2组患者吞咽不同性状食物时的sEMG吞咽时程、平均波幅与组内治疗前比较,差异均有统计学意义(P<0.05);且治疗组治疗2周和4周后的sEMG吞咽时程、平均波幅与对照组同时间点比较,差异均有统计学意义(P<0.05)。经SNK-q检验显示,脑卒中后吞咽功能障碍患者吞咽糊状食物的吞咽时程、平均波幅分别为（1.43±0.12）s和（23.07±7.42）μV与空吞唾液和吞咽流质食物比较,差异均有统计学意义（P<0.05）。 结论SEMG-BFT联合电刺激电刺激和康复训练显著改善脑卒中后吞咽功能障碍患者的吞咽功能,而糊状食物是一种相对安全的训练工具,可用于早期吞咽功能的评定和治疗。     

脑卒中后吞咽功能障碍病人康复护理实践与研究

[目的]结合饮水试验评分评估和研究脑卒中后吞咽功能障碍病人康复护理的价值。[方法]选取住院的脑卒中后吞咽功能障碍病人68例,随机分为对照组和康复护理组,对照组给予心理疏导、进食训练和摄食管理等常规护理,康复护理组加用包括咽部冰刺激训练及吞咽功能治疗仪行神经肌肉电刺激(NMES)等康复护理干预措施,分别于治疗前及治疗2周时,以饮水试验评分对吞咽功能障碍进行评估,以治疗后饮水试验评分改善百分率评价疗效。[结果]饮水试验评分康复护理组治疗前、2周后比较,差异有统计学意义(P0.05);治疗后两组比较差异有统计学意义(P0.05)。康复护理组总有效率为94.1%,对照组总有效率为61.7%,两组间比较,差异有统计学意义(P0.01)。[结论]包括咽部冰刺激和神经肌肉电刺激在内的康复护理可有效改善脑卒中后吞咽功能障碍饮水试验评分,提高病人的生活质量。     

神经肌肉电刺激和吞咽训练对脑卒中后吞咽障碍的影响

目的探讨神经肌肉电刺激疗法与吞咽功能训练治疗脑卒中后吞咽障碍的临床疗效。方法将60例急性脑卒中吞咽障碍患者随机分为电刺激组(n=20)、吞咽训练组(n=20)和联合治疗组(n=20)。3组均在接受常规药物治疗基础上分别加用神经肌肉电刺激、吞咽功能训练或者两者的联合治疗。治疗前和治疗后2周进行洼田饮水试验和吞咽X线电视透视检查(VFSS)。结果 治疗后2周3组洼田饮水试验和VFSS评分均高于治疗前(P<0.05),联合治疗组疗效更明显(P<0.01)。结论神经肌肉电刺激和吞咽功能训练均能明显改善脑卒中后吞咽障碍患者的吞咽功能,联合治疗效果更佳。     

导管球囊扩张术联合重复经颅磁刺激治疗脑卒中后环咽肌失弛缓致吞咽功能障碍的临床观察

目的 观察导管球囊扩张技术联合经颅磁刺激治疗脑卒中后环咽肌失弛缓致吞咽功能障碍患者的临床疗效。 方法 选取脑卒中后环咽肌失弛缓所致吞咽功能障碍患者90例,按随机数字表法分为球囊扩张组、重复经颅磁刺激（rTMS）组和联合治疗组,每组30例。球囊扩张组给予导管球囊扩张技术治疗,rTMS组给予重复经颅磁刺激治疗,联合治疗组给予导管球囊扩张技术联合重复经颅磁刺激治疗,治疗周期为4周。于治疗前和治疗4周后（治疗后）采用洼田饮水试验评分和标准吞咽功能评分（SSA）评估3组患者的吞咽功能,并于治疗后采用临床疗效评定评估3组患者的临床疗效。 结果 治疗后,3组患者洼田饮水试验加权评分和SSA评分较组内治疗前均显著降低,差异均有统计学意义（P<0.05）,且联合治疗组的洼田饮水试验加权评分和SSA评分显著优于球囊扩张组和rTMS组,差异均有统计学意义（P<0.05）。治疗后,联合治疗组总有效率为96.7%,高于球囊扩张组的70.0%（χ2=7.68,P<0.01）和rTMS组的63.3%（χ2=10.42, P<0.01）。 结论 导管球囊扩张技术联合rTMS可显著改善脑卒中后环咽肌失弛缓致吞咽功能障碍患者的吞咽功能。     

K点刺激对最小意识状态患者吞咽障碍的影响

目的观察K点刺激对最小意识状态患者吞咽功能障碍的影响。 方法将30例最小意识状态患者按照随机数字表法分为实验组和对照组，每组15例。2组均进行常规综合康复治疗、吞咽功能训练及神经肌肉电刺激治疗，实验组在上述治疗基础上辅以K点刺激治疗。治疗前及治疗4周后，采用洼田饮水试验对2组患者进行吞咽功能评定。 结果治疗前，2组患者洼田饮水试验分级比较，差异无统计学意义（P>0.05）。2组患者治疗4周后洼田饮水试验分级明显改善，与组内治疗前比较，差异有统计学意义（P<0.05），且治疗4周后实验组洼田饮水试验分级优于对照组，差异有统计学意义（P<0.05）。 结论K点刺激可改善最小意识状态患者的吞咽功能，值得临床应用、推广。     

针刺联合电刺激及吞咽功能训练治疗肝豆状核变性患者咽期吞咽障碍的疗效观察

目的观察针刺联合电刺激及吞咽功能训练治疗肝豆状核变性伴咽期吞咽障碍的疗效。 方法采用随机数字表法将60例肝豆状核变性合并咽期吞咽困难患者分为针刺组、电刺激组及综合治疗组,针刺组患者给予吞咽功能训练及针刺治疗;电刺激组患者给予吞咽功能训练及吞咽神经肌肉电刺激;综合治疗组患者则给予吞咽功能训练、针刺及吞咽神经肌肉电刺激联合治疗。于治疗前、治疗4周后分别采用洼田饮水试验及标准化床边吞咽功能检查表(SSA)对各组患者吞咽功能改善情况进行评定。 结果治疗前3组患者洼田饮水试验评分及SSA评分组间差异均无统计学意义（P&rt;0.05）;分别经4周治疗后,发现3组患者洼田饮水试验评分及SSA评分均较治疗前明显改善（P<0.05）;通过组间比较发现,综合治疗组洼田饮水试验评分［（1.9±0.6）分］及SSA评分［（25.9±2.2）分］均显著优于针刺组及电刺激组（P<0.05）,针刺组与电刺激组上述指标评分组间差异仍无统计学意义（P&rt;0.05）。 结论联合采用吞咽功能训练、针刺及电刺激治疗肝豆状核变性伴咽期吞咽障碍患者具有协同疗效,能进一步改善患者咽期吞咽功能,减少误吸及感染发生,促进患者生活质量提高。     

国际功能、残疾和健康分类在脑卒中后吞咽功能障碍中的临床应用

目的观察国际功能、残疾和健康分类（ICF）60条吞咽障碍核心条目在临床脑卒中后吞咽功能障碍评定和治疗中的作用。 方法选取脑卒中后吞咽功能障碍患者60例,按随机数字表法分为ICF组和对照组,每组30例。ICF组患者于收治后即开始Threats 60条吞咽障碍核心条目评定,对照组患者则进行康复医学科常规吞咽功能障碍评定。评定结束后,2组患者均进行吞咽功能障碍常规康复治疗,ICF组患者在此基础上,依据ICF评估时发现的功能障碍给予相应的干预。2组患者均于治疗前、治疗4周和8周后进行洼田饮水试验分级评定,并于评估结束后行表面肌电图(sEMG)检查。 结果治疗4周和8周后,ICF组的洼田饮水试验分级分别为（2.56±0.76）级和（1.46±0.32）级,分别与组内治疗前和对照组治疗后同时间点比较,差异均有统计学意义P<0.05）;治疗4周和8周后,2组患者各肌群的吞咽时程和募集最大振幅较组内治疗前均显著改善（P<0.05）,且ICF组各肌群的吞咽时程和募集最大振幅均显著优于对照组同时间点,差异均有统计学意义（P<0.05）。 结论在常规吞咽功能障碍治疗的基础上,根据ICF Threats 60条吞咽障碍核心条目的评定结果对脑卒中后吞咽功能障碍患者进行有针对性的干预,可显著改善吞咽障碍患者的洼田饮水试验分级以及各肌群吞咽时程和募集最大振幅。     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.