电脑控制功能性电刺激辅助截瘫病人行走系统的临床应用

本文以功能性电刺激为基础,研制了一套电脑控制的截瘫锻炼和辅助行走系统,并探索了一套康复锻炼方法,经临床应用,锻炼后瘫痪下肢的肌力、肌耐力均有明显提高。本文设计的辅助行走选用骶棘肌、臂大肌、股四头肌及下肢屈曲肌群,有效的延缓了肌疲劳的发生,增加了站立行走时间,使辅助行走过程更接近于自然行走。     

Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey

ObjectiveTo identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days.Research MethodologyWe conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics.ResultsWe received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units.ConclusionWe found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.     

Evaluating treatment of posttraumatic stress disorder with cognitive processing therapy and prolonged exposure therapy in a VHA specialty clinic

This retrospective chart review evaluates the effectiveness of manualized cognitive processing therapy (CPT) protocols (individual CPT, CPT group only, and CPT group and individual combined) and manualized prolonged exposure (PE) therapy on veterans’ posttraumatic stress disorder (PTSD) symptoms in one Veterans Health Administration (VHA) specialty clinic. A total of 517 charts were reviewed, and analyses included 178 charts for CPT and 85 charts for PE. Results demonstrated CPT and PE to significantly reduce PTSD Checklist (PCL) scores. However, PE was significantly more effective than CPT after controlling for variables of age, service era, and ethnicity. Additional findings included different outcomes among CPT formats, decreased treatment dropouts for older veterans, and no significant differences in outcome between Hispanic and White veterans. Study limitations and future research directions are discussed.     

The effects of a temporarily manipulated dental occlusion on the position of the spine: a comparison during standing and walking

Background context

The relationship between dental occlusion and body posture or even the spine position is often analyzed and confirmed. However, this relationship has not been systematically investigated for standing and walking.

Purpose

To examine whether a symmetric or asymmetric dental occlusion block, using 4 mm thick silicon panels, can significantly change the spine position (cervical, thoracic, or lumbar region) during standing and walking.

Study design

The following study is a cross-sectional study.

Patient sample

This study was carried out with 23 healthy subjects (18 women, 5 men) without discomfort in the temporomandibular system or body movement apparatus.

Outcome measures

Position changes (millimeter) of the spine (cervical, thoracic, lumbar) in frontal, sagittal, and transverse planes of motion.

Methods

The upper spine position was quantified with an ultrasonic distance measurement system (sonoSens Monitor). Every subject placed the 4 mm thick silicon panel systematically between the left/right premolars or the front teeth. Differences between the habitual and manipulated occlusion positions were determined by the Friedman test, followed by pairwise comparisons with applied Bonferroni-Holm correction.

Results

During standing and walking there were significant (p≤.05) differences between the occlusion block conditions and the habitual dental position in all body planes except in the right lumbar region during walking. In addition, differences within the manipulated occlusion position could be detected. Significant differences were also shown between the standing and walking trials in the frontal, sagittal, and transverse planes, particularly with respect to the lumbar region (p≤.001).

Conclusions

Symmetrical and asymmetrical occlusion blocks in the premolar region can be associated with changes in all three spine regions during standing and walking. The results showed highly similar reaction patterns in all spine positions, regardless of the location of the silicon panel. Between standing and walking, the main differences were in the lumbar spine. The results suggest a relationship between the chewing and the movement system. However, it must be stated that this study has no direct clinical impact. The study design cannot determine the causality of the observed associations; also the clinical significance of the small postural changes remains unknown.     

急性StanfordA型主动脉夹层孙氏手术后机械通气时间延长的危险因素分析

目的评估欧洲评分Ⅱ是否能够有效预测急性Stanford A型主动夹层孙氏术后机械通气时间,探索孙氏术后机械通气时间延长的危险因素。方法自2009年12月至2012年2月共240例急性Stanford A型主动脉夹层的患者纳入研究。术后呼吸机机械通气时间超过48 h定义为机械通气时间延长。计算所有患者的欧洲评分。欧洲评分的区分能力采用受试者工作特征（ROC）曲线评估,校正能力采用Hosmer Lemeshow拟合优度检验评估。结果急性Stanford A型主动脉夹层孙氏术后院内总体病死率为10.0%（24/240）,术后平均呼吸机机械通气时间为17.0（12.5,56.0）h。共74例患者术后机械通气时间延长。欧洲评分Ⅱ的区分能力（ROC曲线下面积=0.52）及校正能力（Hosmer Lemeshow,P〈0.05）均不佳。单因素分析结果显示年龄［比值比（OR）=2.88, P=0.00］、脑卒中病史（OR=1.04,P=0.03）、外周血白细胞计数（OR=3.19, P=0.00）、发病至手术时间小于1周（OR=3.68,P=0.001）、体外循环时间（OR=1.96,P=0.02）为术后院内死亡的危险因素。Logistic多因素分析年龄大于48.5岁（OR=3.85,P=0.00）、术前外周静脉血白细胞计数超过13.5×109/L（OR=4.05, P=0.00）、发病至手术时间小于1周（OR=3.75, P=0.002）是孙氏术后机械通气时间延长的危险因素。结论年龄、术前白细胞计数超过13.5×109/L、发病至手术时间小于1周是孙氏手术后机械通气时间延长的危险因素。欧洲评分Ⅱ不能有效预测急性Stanford A型夹层孙氏手术后机械通气时间延长。术前及术中采取措施减少外周血白细胞计数、减轻炎性反应可能是一种潜在的主动脉手术脏器保护策略。     

延长Fontan类手术患者住院时间的危险因素分析

目的分析影响延长Fontan类手术后患者恢复的危险因素。方法回顾性分析2012年1月至2013年6月阜外心血管病医院60例行Fontan类手术患者的基本资料、术前导管及超声资料,术前、术中及术后血流动力学资料和血液指标资料。根据住院时间不同,将60例患者分为两组,正常恢复组[45例,男33例,女12例;年龄（5．7±1．7）岁,住院时间〈32．5d]和延迟恢复组[15例,男10例,女5例;年龄（4．9±1．6）岁,住院时间〉32．5d,延迟恢复组指超出75％分位住院时间者]。60例患者住院时间12～53d,75％分位住院时间为32．5d。比较两组患者的临床资料,分析影响术后恢复的危险因素。结果术前脉搏血氧饱和度80．5％±7．4％,术前射血分数64．1％±6．6％,肺动脉指数（370．6±234．2）mm^2／m^2,McGoon比值2．2±0．7,术前平均肺动脉压（12．4±4．0）mmHg。Fontan类手术前行Glenn手术27例（45．0％）,行Glenn手术患者的年龄0．9～4．0岁,距离Fontan类手术1．0～5．1年。患者住院期间死亡2例（3．3％）。55例并行循环下手术体外循环时间（112．0±52．4）min;5例患者需要停循环修补心内畸形,主动脉阻断时间（44．8±9．2）min。呼吸机辅助呼吸时间（18．8±6．4）h。术后住ICU时间（5．1±2．1）d。单因素分析结果显示：术前平均肺动脉压（PAP）增高（P〈0．05）、术前射血分数低（P〈0．05）、体循环心室为右心室（P〈0．05）、分期手术（P〈0．05）、合并腔静脉异位引流（P〈0．05）、术后乳酸（Lac）增高（P〈0．05）、术后中心静脉压（CVP）高（P〈0．05）、术后当天需要大量晶胶体液维持循环稳定（P〈0．05）、术后胸腔引流时间长（P〈0．05）和术后合并感染（P〈0．05）是Fontan类手术患者术后延迟恢复的危险因素。结论Fontan类手术治疗功能性单心室已经取得了很好的近期结果,明确患者手术风险因素,并妥善处理才能缩短患者的恢复进程,使患者获益。     

Long-term dietary exposure to low concentration of dichloroacetic acid promoted longevity and attenuated cellular and functional declines in aged Drosophila melanogaster

Dichloroacetic acid (DCA), a water disinfection by-product, has attained emphasis due to its prospect for clinical use against different diseases including cancer along with negative impact on organisms. However, these reports are based on the toxicological as well clinical data using comparatively higher concentrations of DCA without much of environmental relevance. Here, we evaluate cellular as well as organismal effects of DCA at environmentally and mild clinically relevant concentrations (0.02–20.0 μg/ml) using an established model organism, Drosophila melanogaster. Flies were fed on food mixed with test concentrations of DCA for 12–48 h to examine the induction of reactive oxygen species (ROS) generation, oxidative stress (OS), heat shock genes (hsps) and cell death along with organismal responses. We also examined locomotor performance, ROS generation, glutathione (GSH) depletion, expression of GSH-synthesizing genes (gclc and gclm), and hsps at different days (0, 10, 20, 30, 40, 50) of the age in flies after prolonged DCA exposure. We observed mild OS and induction of antioxidant defense system in 20.0 μg/ml DCA-exposed organism after 24 h. After prolonged exposure to DCA, exposed organism exhibited improved survival, elevated expression of hsp27, gclc, and gclm concomitant with lower ROS generation and GSH depletion and improved locomotor performance. Conversely, hsp27 knockdown flies exhibited reversal of the above end points. The study provides evidence for the attenuation of cellular and functional decline in aged Drosophila after prolonged DCA exposure and the effect of hsp27 modulation which further incites studies towards the therapeutic application of DCA.     

Prolonged grief following the recent death of a daughter among mothers who experienced distal losses during the Khmer Rouge era: Validity of the prolonged grief construct in Cambodia

This study addressed the validity of the prolonged grief (PG) construct in a Cambodian context. Eighty mothers who lost a young adult daughter stemming from a crowd stampede incident during the annual water festival were interviewed at the six-month post-loss point along with a control group of similarly aged women who were not recently bereaved. Both groups were assessed for PG, PTSD, anxiety, and depression symptoms and well as for the number of distal losses experienced during the Khmer Rouge (KR) regime – knowing that all the women were old enough to have lived through the KR regime. Support for the discriminant validity of PG was shown in a factor analysis in which its core symptoms were distinguished from anxiety, depression, and PTSD symptoms. Also, support was found for its incremental validity as shown in the unique sensitivity of PG in distinguishing the two groups when controlling for the other symptoms. Lastly, a positive relationship was found between the number of distal deaths experienced during the KR regime and PG symptom severity among the group of recently bereaved mothers, providing support for the predictive validity of PG. Implications as well as study limitations are discussed.     

The prevalence,comorbidity and risks of prolonged grief disorder among bereaved Chinese adults

Few epidemiological studies have investigated prolonged grief disorder (PGD) in the general population of Asian countries, including China. The aim of this study was to explore the rates and risks of PGD, and the association between PGD, post-traumatic stress disorder (PTSD), depression and anxiety in bereaved Chinese adults. The PG-13, PTSD Checklist-Civilian Version (PCL-C), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) were administered to 445 subjects. Prevalence within the general population of China was 1.8% (i.e., 8/445). Among the eight subjects who met the PGD diagnosis, 75%, 87.5% and 75% scored above the cut-off point on the PCL-C, SDS and SAS, respectively, although a portion remained free from comorbidity. ANOVA, correlation analysis and stepwise multiple regression analysis demonstrated that kinship to deceased, age of the deceased, religion belief and cause of death were predictive of prolonged grief. A small proportion of bereaved persons may exhibit PGD. There is a substantial but far from complete overlap between PGD and the other three diagnoses. Bereaved parents and the widowed have high risk of PGD. These findings highlight the need for prevention, diagnosis and treatment for PGD patients.     

胸外科手术患者PACU滞留时间延长的多因素分析

目的分析胸外科手术后患者麻醉后监护室(PACU)滞留时间延长(120min)的影响因素。方法回顾性分析495例胸外科手术患者的麻醉复苏记录单,按Logistic回归分析的要求进行量化或赋值,先行单因素回归,筛选有显著差异的各个因素再做多因素非条件回归分析。结果单因素回归分析:年龄60岁(OR=2.411,95%CI 1.592~3.742),ASA分级每增加1级(OR=1.833,95%CI 1.209~2.780),尿量20ml/h(OR=0.173,95%CI 0.065~0.458),术中心血管活性药物使用(OR=1.613,95%CI 1.198~2.173)对患者PACU滞留时间有明显影响。多因素回归分析:年龄60岁(OR=2.322,95%CI 1.448~3.722),术中心血管活性药物使用(OR=1.441,95%CI 1.050~1.976),尿量≤20ml/h(OR=0.139,95%CI 0.049~0.396)为PACU滞留时间延长的独立危险因素。结论胸外科手术患者PACU滞留时间延长的相关因素有年龄60岁、尿量≤20ml/h、术中使用血管活性药物、ASA分级增加。