脑卒中患者吞咽障碍及康复效果影像学研究

目的探讨电视X线透视吞咽功能检查（videofluoroscopic swallowing study,VFSS）在脑卒中患者吞咽功能评估中的应用价值,观察脑卒中后吞咽障碍发生情况,康复前后患者吞咽功能变化.方法脑卒中患者70例及健康成人80名分别作为研究组与对照组均进行VFSS,比较两组误吸等VFSS异常征象的发生情况.对发现误吸患者进行吞咽功能康复训练4周,训练后复查VFSS,比较训练前后吞咽异常的发生情况变化.结果对照组渗透或误吸、口腔滞留、咽腔滞留的发生率为5.0%,13.4%,25.3%.主要为轻度渗透及口咽腔滞留.研究组渗透或误吸、口腔滞留、咽腔滞留发生率为45.0%,46.5%,48.9%,主要为重度渗透或误吸,中重度口咽腔滞留.其中隐匿性误吸为10次（占总误吸的24.4%）.误吸患者康复治疗后渗透或误吸发生率较康复治疗前减少（P＜0.05）.结论脑卒中后吞咽障碍在康复期仍较为常见,可表现为多种影像学异常.VFSS可确切诊断吞咽异常,进行针对性康复训练,使患者吞咽功能提高.     

Toward a revision of criteria for the dementias

This article critically considers current diagnostic criteria for dementia and reports recommendations approved by at least 80% of experts attending the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD3). There was consensus that many of the features proposed as essential to a diagnosis of dementia in the 1980s no longer are relevant (for example, the requirements for memory impairment, electroencephalogram and cerebrospinal fluid studies, age-specific exclusions). In addition, other syndromes such as frontotemporal dementia have been recognized and need to inform new dementia criteria. It is also recognized that a diagnosis of depression need not exclude a dementia diagnosis. Other proposals, such as neuropathology should be considered as additional evidence and not as a gold standard or that some people with dementia have prolonged plateaus so that progressive decline need not be a criterion for Alzheimer’s disease (AD), were more controversial and did not receive similar support. Given the evidence of the last three decades, there is merit in reconsidering the criteria by which dementia and AD are diagnosed.     

Utility of Salivary sIgA as a Marker for Assessing the Stress Caused by Dental Treatment

The change in the secretory immunoglobulin A (sIgA) level in saliva has received remarkable attention in recent years as an index of mental stress. Here, we examined its utility for assessing the stress caused by dental treatment. To achieve this, we measured salivary sIgA levels in children before and after dental treatment, and assessed their levels of stress by analyzing the change in salivary sIgA following treatment. Overall, 83% of the subjects showed a decrease in their salivary sIgA after treatment. Furthermore, the overall level of sIgA decreased significantly following dental treatment (p<0.01), suggesting that the children suffered increased stress following treatment, since increased stress results in decreased salivary sIgA. The level of sIgA was significantly decreased after prolonged treatment time (=20 min; p<0.01), the use of infiltration anesthesia (p<0.01) and surgical operation (p<0.01). Moreover, the level of salivary sIgA was significantly lower in children who showed cooperative behavior during treatment (p<0.01), indicating that stress may be reduced, in part, by uncooperative behavior. These results indicate that changes in the salivary sIgA level may represent an index for monitoring the stress of dental treatment, which changes following treatment. Taken together, as a non-invasive and convenient method for evaluating the stress caused by dental treatment, the level of salivary sIgA represents a promising clinically relevant marker.