系统性呼吸功能训练对哮喘-慢性阻塞性肺疾病重叠综合征患者肺功能及呼吸指标的影响

目的 探讨系统性呼吸功能训练对哮喘-慢性阻塞性肺疾病重叠综合征(asthma-COPD overlap syndrome,ACOS)患者肺功能和呼吸指标的影响。方法 选择笔者所在医院2019年5月-2020年10月收治的102例ACOS患者作为研究对象,采用随机数字表法将其分为对照组和研究组,各51例。对照组行常规护理,研究组在对照组基础上融合系统性呼吸功能训练。比较2组干预前后的肺功能指标和呼吸指标。结果 干预后,研究组的肺功能各项指标均明显优于对照组(P<0.05);气道阻力各项指标显著优于对照组(P<0.05),呼吸困难程度轻于对照组(Z=-2.996,P=0.003)。结论 对ACOS患者在护理过程中融合系统性呼吸功能训练,可明显降低患者气道阻力指标,对改善肺功能、缓解患者呼吸困难具有明显效果。     

Changes in knee range of motion after large osteochondral allograft transplantations

BackgroundOur study purpose was to determine if primary osteochondral allograft (OCA) transplant surgeries for large (>4 cm²) single-surface, multisurface, or bipolar articular defects in the knee would be associated with significant gains in knee range of motion (ROM) at ≥1-year follow-up when compared to preoperative ROM.MethodsPatients were prospectively enrolled into a dedicated registry to follow outcomes after OCA with or without meniscal allograft transplantation using Missouri Osteochondral Preservation System (MOPS)-preserved allografts. Patients were included if they had surgery to repair at least one osteochondral defect, and when at least one year of ROM data and Visual Analog Scale pain scores were available. Data on complications and reoperations, patient-reported outcome measures, compliance with rehabilitation, revisions, or failures were recorded.ResultsFor patients who met inclusion criteria after OCA surgery (n = 75), overall ROM increased from 127.8 ± 17 degrees preoperatively, to 130.5 ± 14 post-operatively. Non-compliance was the largest factor contributing to postoperative ROM lag or loss. Knee manipulation/lysis of adhesion rates were comparable to rates in TKA and ACL procedures (2.96–4.54% for ACL/TKA, 4% for OCAs in the present study).ConclusionResults suggest that OCA with or without meniscal allograft transplantation in the knee using high-viability grafts, advanced graft cutting and implantation techniques, and procedure-specific rehabilitation protocols can result in consistently successful outcomes in a high percentage (92%) of selected patients. Most patients (95%) can expect to regain, or improve, to “full” functional range of motion (130°) at 1 year after surgery such that highly functional activities can be performed.Level of Evidence: Cohort study; Level III.     

Fathers of children with autism spectrum disorder: Their perceptions of paternal role a predictor of caregiving satisfaction,self-efficacy and burden

BackgroundThe positive effect of a father’s involvement in children’s upbringing is now recognised. However, research on fathers raising children with autism spectrum disorder (ASD) are still few. This study examines the relationship between the perception, fathers of children with ASD have of the importance of their role in the development of their children and the feelings (self-efficacy, caregiving burden, satisfaction) they express about their parenting experience.MethodSixty-three Swiss Italian fathers of children with ASD completed The Role of the Father Questionnaire (ROFQ), three sub-scales of the Caregiver Survey, a subtest of the Child Adjustment and Parent Efficacy Scale and a home-made questionnaire measuring Perceived Social Support.ResultsThe results from hierarchical multiple regression analyses show that the importance that fathers attach to the paternal role predicts positively their caregiving satisfaction and their feeling of self-efficacy. The children’s challenging behaviours predict positively the caregiving burden whereas the assessment of social support predicts it negatively.ConclusionsThe perception of the importance of the paternal role needs to be considered in the support offered to families with a child with ASD. A better understanding of the fathers’ feelings could be of value for the programmes.     

项目教学法在教学中的应用效果研究

目的探讨项目教学法在康复治疗学专业认知功能评定教学中的应用效果研究。方法将2018年6月—2020年6月在苏州大学附属第三医院康复医学科进行临床实习的60名康复治疗技术专业的实习生随机分为两组,每组各30名。对照组采用常规教学方法,观察组使用项目教学法,对比两组的教学效果、考核成绩、自主学习能力以及自我评价。结果观察组的实习同学对“有利于激发学习兴趣”“有利于提高沟通及协作能力”“有利于提高自主学习能力”“有利于提高综合职业能力”“有利于缩小教学与临床的距离”以及“有利于熟悉规范的认知功能评定流程及主要工作内容”等几个教学方面的肯定率高于对照组(P<0.05);同时,观察组理论考核成绩、操作技能考核成绩、实习态度成绩以及考核总分高于对照组(P<0.05);观察组在自主学习、自我管理、信息能力、合作能力等自主学习能力评分也均高于对照组(P<0.05)。结论项目教学法在康复治疗学专业认知功能评定教学中的应用效果显著,明显提高了教学效果,提升了学生的自主学习能力和学习成绩。     

Prospective case‐control study of enterovirus detection differences in children’s cerebrospinal fluid between multiplex PCR and real‐time RT‐PCR assay

BackgroundViral encephalitis is common in childhood. It is an acute brain parenchymal inflammation caused by a variety of viral infection, and enterovirus accounts for the majority. Due to atypical clinical manifestations, pathogenic testing is important for assisting clinical diagnosis. The purpose of this study was to evaluate the performance of the multiplex PCR assay compared with quantitative real‐time PCR for enterovirus detection.MethodsA prospective case‐control study was performed involving 103 pediatric patients suspected for viral encephalitis and cerebrospinal fluid (CSF) samples were collected and tested for 9 pathogens using multiplex PCR assay during April to November in 2018. In parallel, an aliquot of samples was tested for enterovirus infection by real‐time PCR assay.ResultsThere were 85.4% children were confirmed as viral encephalitis on discharge, the remaining ones were diagnosed as other CNS diseases, such as epilepsy. The specificity of the two methods was the same as that of the clinical diagnosis, but the sensitivity and consistency with clinical diagnosis of multiplex PCR were both higher than the real‐time PCR. Besides of enterovirus, multiplex PCR could also detect coinfection of enterovirus with Epstein‐Barr virus and mumps virus.ConclusionResults of multiplex PCR method are more consistent with the clinical diagnosis and are superior to real‐time PCR for detecting enterovirus in CSF.     

阿奇霉素序贯给药辅助治疗小儿大叶性肺炎的效果及对患儿血清炎症因子水平的影响

目的探讨阿奇霉素序贯给药辅助治疗小儿大叶性肺炎的效果及对患儿血清炎症因子水平的影响。方法回顾性分析我院2014年10月至2019年10月收治的120例大叶性肺炎患儿的临床资料,根据治疗方式的不同将其分为对照组(60例,阿奇霉素静脉滴注治疗)和观察组(60例,阿奇霉素序贯给药治疗)。比较两组的治疗效果、不良反应情况、血清炎症因子及肺功能指标水平。结果观察组的治疗总有效率显著高于对照组,不良反应总发生率显著低于对照组(P<0.05)。治疗后,两组的TNF-α、PCT、IFN-γ、TM水平均降低,FVC、TLC、Cdyn水平均升高,且观察组显著优于对照组(P<0.05)。结论阿奇霉素序贯给药辅助治疗小儿大叶性肺炎的效果显著,可有效改善患儿血清炎症因子水平和肺功能指标水平,降低不良反应发生率,值得临床推广应用。     

Endoscopic coblation treatment for congenital pyriform sinus fistula in children

Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.     

多学科协作模式康复护理对脑卒中吞咽功能障碍患者吞咽功能及吸入性肺炎发生的影响

目的探讨多学科协作模式康复护理对脑卒中吞咽功能障碍患者吞咽功能及吸入性肺炎发生的影响。方法选择2018年3月-2020年3月我科收治的脑卒中吞咽功能障碍患者86例,按照随机数字表法分为对照组和观察组,每组43例。对照组采取常规专科护理。观察组采取多学科协作模式康复护理,持续干预12周。比较两组护理前后心理状态、神经功能、吞咽功能及吸入性肺炎发生率。结果两组护理前焦虑自评量表(SAS)、抑郁自评量表(SDS)、美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P>0.05);观察组护理后SAS、SDS、NIHSS评分低于对照组(P<0.05);观察组吞咽功能恢复优良率为90.70%,高于对照组的74.42%,吸入性肺炎发生率为4.65%,低于对照组的20.93%(P<0.05)。结论多学科协作模式康复护理能够改善脑卒中吞咽功能障碍患者心理状态,促进神经及吞咽功能恢复,预防吸入性肺炎的发生。     

Multidisciplinary intestinal rehabilitation in acute type II intestinal failure: Results from an intestinal rehabilitation team

BackgroundType II (acute) intestinal failure (IF) is usually caused by complications of abdominal surgery resulting in enteric fistulas or proximal stomas and requires parenteral nutrition (PN) for several months. This study aimed to evaluate clinical management and outcome of type II IF patients in a single center.MethodsMedical records of patients referred to the Intestinal Rehabilitation Team (IRT) at Samsung Medical Center (Seoul, Korea) were retrospectively analyzed.ResultsFrom 2014 to 2019, 34 patients with IF were referred. 28 patients were type II IF and were included in the analysis. There were 17 males and 11 females. Mean age of patients was 56.7 years. Pathophysiology of IF were high-output stoma in 16 cases, extensive bowel resection (with bowel in continuity) in 7 cases, and enterocutaneous fistula in 5 cases. The catastrophic events necessitating abdominal surgery in the patients were adhesive ileus in 9 cases, superior mesenteric artery thrombosis in 8 cases, internal herniation of bowel in 5 cases, traumatic bowel injury in 3 cases, and ischemic enteritis in 3 cases. Following medical and surgical rehabilitation, 10 patients (35.7%) were weaned off PN and overall mortality was 28.5%. Deaths were related to progression of underlying malignancies in 4 cases, liver failure in 3 cases, and sepsis in 1 case. Thirteen patients underwent surgery to restore bowel continuity. Six postoperative complications occurred in 4 patients (30.7%) and there were no postoperative mortalities.ConclusionStandardized care including restorative surgery resulted in successful outcomes in type II IF patients in this cohort.