基于“用推即是用药”理论的津沽健脾益气推拿法治疗婴儿脾虚便秘疗效观察

[目的] 观察基于“用推即是用药”理论的津沽健脾益气推拿法治疗婴儿脾虚便秘的临床疗效。[方法] 2017年1月—2018年6月天津中医药大学第一附属医院小儿推拿专病门诊86例便秘患儿，随机分为治疗组和对照组，每组各43例。两组患儿均予以纠正不良喂养习惯、加强排便训练、被动腹部运动等基础治疗。在此基础上治疗组给予津沽健脾益气推拿法治疗，对照组口服妈咪爱治疗，7 d为1个疗程，并于3个月后进行随访。分析两组患儿临床疗效、Wexner便秘评分、复发率及不良反应发生情况。[结果] 治疗组患者总有效率为97.67%，对照组为76.74%，两组差异有统计学意义（P<0.05）；治疗7 d后，两组患儿Wexner便秘评分均有所降低，治疗组明显低于对照组（P<0.01）。两组均未发生不良反应，随访3个月发现治疗组复发率明显低于对照组（P<0.05）。[结论] 津沽健脾益气推拿法治疗婴儿脾虚便秘的临床效果显著，可有效缓解婴儿脾虚便秘症状，缩短排便频率，从而改善肠动力障碍，且减少复发率，值得推广应用。     

“OSB联合PBL”的教学模式在机能学实验教学中的应用

目的探讨"以器官系统为中心"的课程模式(organ-system-based curriculum model, OSB)联合PBL(Problembased leaming)在机能学实验教学中的应用。方法选取2016级临床本科学生1~2班作为研究对象,每班30人。两个班级均经过"OSB"教学模式的理论系统学习,两组学生性别和年龄之间的差异无统计学意义(P>0.05)。1班作为对照组按照"OSB"机能实验教学方法学习,简称A组;2班作为研究组即"OSB联合PBL"教学组,简称B组,是在"OSB"机能实验教学方法基础上引入PBL教学法学习。课程结束后对两组学生进行终结性评价和形成性评价来评测教学效果。结果终结性评价结果显示:平时成绩方面,B组(17.40±1.16)分明显高于A组(16.50±1.31)分,差异有统计学意义(P<0.05);实验设计成绩B组(7.77±0.97)分也高于A组(7.10±0.99)分,差异有统计学意义(P<0.05);理论考试成绩A组(18.57±0.73)分和B组(18.60±0.81)分,比较差异无统计学意义(P>0.05);操作考试成绩同样是B组(39.90±7.13)分高于A组(38.17±5.39)分,差异有统计学意义(P<0.05);综合成绩方面,B组(83.67±7.54)分明显优于A组(80.33±5.77)分,差异有统计学意义(P<0.05)。形成性评价结果显示:B组在自我教学效果主观评价上各单项得分均高于A组,差异有统计学意义(P<0.01);总成绩B组(27.57±1.41)分明显高于A组(25.07±1.57)分,差异有统计学意义(P<0.01)。结论 "OSB联合PBL"教学模式,可以提高机能学的教学质量,是"OSB"教学模式程体系理论教学的延伸和补充,有助于促进学生实践能力和综合素质的全面提高。     

Interstitial lung diseases in children

Interstitial lung disease (ILD) in children (chILD) is a heterogeneous group of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. The pathogenesis of the various chILD is complex and the diseases share common features of inflammatory and fibrotic changes of the lung parenchyma that impair gas exchanges. The etiologies of chILD are numerous. In this review, we chose to classify them as ILD related to exposure/environment insults, ILD related to systemic and immunological diseases, ILD related to primary lung parenchyma dysfunctions and ILD specific to infancy. A growing part of the etiologic spectrum of chILD is being attributed to molecular defects. Currently, the main genetic mutations associated with chILD are identified in the surfactant genes SFTPA1, SFTPA2, SFTPB, SFTPC, ABCA3 and NKX2-1. Other genetic contributors include mutations in MARS, CSF2RA and CSF2RB in pulmonary alveolar proteinosis, and mutations in TMEM173 and COPA in specific auto-inflammatory forms of chILD. However, only few genotype-phenotype correlations could be identified so far. Herein, information is provided about the clinical presentation and the diagnosis approach of chILD. Despite improvements in patient management, the therapeutic strategies are still relying mostly on corticosteroids although specific therapies are emerging. Larger longitudinal cohorts of patients are being gathered through ongoing international collaborations to improve disease knowledge and targeted therapies. Thus, it is expected that children with ILD will be able to reach the adulthood transition in a better condition.     

The effects of knee osteoarthritis on neural activity during a motor task: A scoping systematic review

ObjectiveTo examine the evidence of neural activation with functional magnetic resonance imaging (fMRI), corticospinal excitability, and other central nervous system measurement differences during motor tasks between those with and without knee osteoarthritis (KOA).MethodsA scoping review strategy was systematically performed. We searched PubMed, CINAHL, Embase, PsychInfo, SportDiscus, SCOPUS and Web of Science from database inception to April 2021. Any study investigating central nervous system measures during a motor task for individuals with KOA with or without a healthy control group for comparison was included. Two reviewers independently screened all studies in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses extension for scoping reviews.ResultsThirteen studies met the inclusion criteria. KOA had reduced activation of the premotor cortex during a gait imagery task when examining the brain using fMRI. This hypoactivation was not significant when the task was combined with ankle movement. Individuals with KOA had decreased motor cortex activation during a force matching motor task. KOA was associated with gamma loop dysfunction of the quadriceps and increased responsiveness of the triceps surae muscles. Also, there was an increased soleus Hoffmann reflex during heel strike of gait cycle. The flexor withdrawal reflex was heighted for individuals with KOA with a lower threshold of the reflex occurring with increased joint compression, but this reflex was modulated with joint mobilizations.ConclusionIndividuals with KOA have motor deficits associated with decreased neural activation, central nervous system sensitization, decreased quadriceps muscle spindle responsiveness, and increased triceps surae muscle activity.     

Pulmonary and upper limbs function in children with early stage Duchenne muscular dystrophy compared to their healthy peers

BackgroundPulmonary and upper limbs function of children with Duchenne muscular dystrophy (DMD) are known to deteriorate throughout the disease process. However, there is a lack of information on the extent of impairments in the early stages of DMD when compared to healthy peers.ObjectiveTo investigate to what extent pulmonary and upper limbs function of children with early stage DMD are impaired.MethodsSixty-one children participated in the study: 31 with Grade 1 DMD (study group) according to the Brooke Upper and Lower Extremity Functional Classification Systems, and 30 age matched healthy peers (control group). Pulmonary function was determined with pulmonary function tests. The Performance of Upper Limb test was used to evaluate the upper limbs function.ResultsStudy and control groups were homogenous in terms of physical characteristics (p > 0.05). Pulmonary and upper limbs function of children with DMD were about 85% and 93% of healthy peers, respectively.ConclusionThis study provides evidence for deterioration of pulmonary and upper limbs function in children with early stage DMD. Better knowledge of deterioration rate over time may help therapists to better plan and update their plan of care.