双侧重复经颅磁刺激联合肌电生物反馈治疗脑卒中吞咽障碍的临床研究

目的：探讨健侧低频加患侧高频重复经颅磁刺激（rTMS）联合肌电生物反馈疗法治疗脑卒中后吞咽障碍（PSD）患者的临床疗效。方法：将100例脑卒中吞咽障碍患者随机分为对照组和观察组各50例。2组均予以常规内科药物治疗和吞咽康复训练，对照组予以肌电生物反馈训练、rTMS假刺激，观察组予以肌电生物反馈训练和rTMS治疗，分别为健侧1Hz和患侧10Hz刺激。使用洼田饮水试验分级，Rosenbek渗漏-误吸评分（PAS）和功能性经口摄食分级（FOIS）评估患者的吞咽功能，采用吞咽生命质量量表（SWAL-QOL）评估病人的生活质量，并于治疗结束后评估2组的临床疗效。结果：经过2周治疗，观察组总有效率为93.88%，对照组总有效率为73.47%，观察组总有效率明显高于对照组（P＜0.05）；2组患者PAS、FOIS及SWAL-QOL评分与治疗前比较明显提高（P＜0.05），且观察组的PAS、FOIS及SWAL-QOL评分均高于对照组（P＜0.05）；治疗后洼田饮水评估比较观察组优于对照组（P＜0.05）。结论：双侧rTMS联合表面肌电生物反馈能较好地改善脑卒中患者的吞咽功能和生活质量。     

肌电生物反馈与电刺激治疗对急性出血性脑卒中后吞咽障碍患者临床疗效及吞咽功能的影响

目的探讨肌电生物反馈与电刺激治疗对急性出血性脑卒中(CVA)后吞咽障碍患者临床疗效及吞咽功能的影响。方法选取2018年2月至2022年2月我院收治的CVA后吞咽障碍患者91例,根据治疗方式不同分为对照组42例和观察组49例,对照组采取常规吞咽训练结合神经肌肉电刺激(NMES)疗法,观察组采取常规吞咽训练结合肌电生物反馈(EMGBF)疗法。比较两组治疗前后洼田饮水试验分级、临床疗效、表面肌电图(sEMG)检测结果、标准吞咽功能评定量表(SSA)及吞咽相关生活质量量表(SWAL-QOL)评分。结果与治疗前比较,两组洼田饮水试验法分级均明显改善,其中观察组改善效果更为显著(P<0.05);两组sEMG平均波幅均明显升高,吞咽时限缩短,其中观察组变化更为显著(P<0.05);观察组SSA评分低于对照组,SWAL-QOL评分高于对照组(P<0.05);观察组治疗后总有效率高于对照组(P<0.05)。结论EMGBF治疗急性出血性CVA后吞咽障碍患者临床疗效较NMES更明显,且能有效改善其吞咽功能,提高生活质量。     

肌电生物反馈治疗脑卒中后吞咽障碍的疗效观察

目的 观察肌电生物反馈治疗脑卒中后吞咽障碍的临床疗效.方法 采用随机数字表法将脑卒中后吞咽障碍患者分为对照组、电刺激组及肌电生物反馈组.对照组患者给予单纯吞咽功能训练,电刺激组及肌电生物反馈组在常规吞咽训练基础上分别给予电刺激或肌电生物反馈治疗,每周治疗5次,共持续治疗3周.于治疗前、治疗3周后分别采用表面肌电图(sEMG)和标准吞咽功能评估法(SSA)对各组患者吞咽功能进行评定.结果 3组患者分别经3周治疗后,发现其sEMG平均波幅、吞咽时限及SSA评分均较治疗前明显改善(P＜0.05);并且肌电生物反馈组及电刺激组sEMG平均波幅[分别为(25.96±2.49) μV和(22.71 ±4.29) μV]、吞咽时限[分别为(1.15±0.11)s和(1.25±0.11)s]及SSA评分[分别为(22.40±3.46)分和(27.39 ±4.58)分]均显著优于对照组(P＜0.05);同时肌电生物反馈组上述疗效指标亦显著优于电刺激组(P＜0.05).结论 肌电生物反馈治疗可显著改善脑卒中患者吞咽功能,其疗效明显优于电刺激及单纯吞咽功能训练.     

肌电生物反馈治疗早期脑卒中后吞咽障碍的疗效观察

目的 观察肌电生物反馈疗法治疗早期脑卒中后吞咽障碍患者的疗效。 方法 采用随机区组法将在我院治疗的60例脑卒中后吞咽障碍患者分为吞咽功能训练组、普通电刺激组及肌电生物反馈组，每组20例患者。吞咽功能训练组给予常规口腔、咽喉部肌肉感觉及力量训练，普通电刺激组、肌电生物反馈组在此基础上分别辅以电刺激、肌电生物反馈治疗。3组患者均每周治疗5次，持续治疗4周。于治疗前、治疗4周后分别采用表面肌电图(sEMG)、标准吞咽功能评估法(SSA)及视频吞咽造影功能障碍量表(VDS)对各组患者吞咽功能进行评定。 结果 治疗后发现3组患者sEMG平均波幅、VDS评分及SSA评分均较治疗前明显改善(P<0.05)；并且治疗后肌电生物反馈组、普通电刺激组sEMG平均波幅［分别为(46.4±8.4)μV和(38.2±9.7)μV］、SSA评分［分别为(21.7±3.0)分和(25.9±4.7)分］、VDS评分［分别为(40.2±9.6)分和(59.2±8.3)分］均显著优于吞咽功能训练组(P<0.05)，同时肌电生物反馈组上述疗效指标亦显著优于普通电刺激组(P<0.05)。 结论 肌电生物反馈疗法治疗早期脑卒中后吞咽障碍较普通电刺激具有较大优势，能进一步改善患者吞咽功能，该疗法值得在脑卒中患者中推广、应用。     

肌电生物反馈疗法与神经肌肉电刺激治疗脑卒中后吞咽障碍的疗效比较

目的：比较肌电生物反馈疗法与神经肌肉电刺激（NMES）治疗脑卒中后吞咽障碍的疗效。方法：吞咽障碍患者90例,随机分为对照组、NMES组和反馈组各30例。对照组进行常规吞咽训练、NMES组加用NMES治疗,反馈组加用肌电生物反馈治疗。治疗前后采用洼田饮水试验进行吞咽功能评定,并评价临床疗效。结果：治疗2个疗程后,3组洼田饮水试验吞咽功能评级均较治疗前明显提高（P〈0．05,0．01）,NMES组、反馈组更优于对照组（均P〈0．05）,反馈组更优于NMES组（P〈0．05）。3组临床疗效比较,反馈组总有效率更高于NMES组及对照组（均P〈0．05）,NMES组更高于对照组（P〈0．05）。结论：肌电生物反馈训练应用于脑卒中后吞咽障碍治疗效果优于神经肌肉电刺激疗法。     

肌电生物反馈疗法联合神经肌肉电刺激对脑卒中吞咽障碍患者吞咽功能的治疗效果

目的:探究肌电生物反馈疗法联合神经肌肉电刺激对脑卒中吞咽障碍患者吞咽功能的治疗效果。方法:纳入我院2015年6月~2016年7月脑卒中伴吞咽障碍患者108例为研究对象,随机分为常规组和联合训练组各54例。常规组进行常规吞咽训练,联合训练组在常规组基础上给予肌电生物反馈疗法联合神经肌肉电刺激。比较两组患者脑卒中吞咽障碍改善情况,治疗前后饮水试验评分、营养状况评分、生存质量及情绪状态差异。结果:联合训练组患者吞咽障碍改善情况明显优于常规组(P0.05);两组患者治疗前饮水试验评分、营养状况评分、生存质量及情绪状态比较无显著性差异(P0.05);治疗后,联合训练组饮水试验评分、营养状况评分、生存质量及情绪状态明显优于对照组(P0.05)。结论:肌电生物反馈疗法联合神经肌肉电刺激可有效改善脑卒中患者吞咽功能和营养状况,减少患者负性情绪的产生,提升生存质量,值得临床推广。     

神经肌肉电刺激联合吞咽训练治疗脑卒中后吞咽障碍的疗效观察

目的探讨神经肌肉电刺激联合吞咽训练对脑卒中后吞咽障碍患者吞咽功能恢复的影响。 方法选取脑卒中3个月后伴吞咽障碍患者150例,按随机数字表法分为常规训练组（常规吞咽训练）、电刺激组（神经肌肉电刺激）和综合治疗组（神经肌肉电刺激联合常规吞咽训练）,每组50例。3组患者均于治疗前和治疗4周后（治疗后）评定其吞咽功能（SSA）、表面肌电信号（sEMG）、吞咽障碍程度（VFSS）和生活质量（SWAL-QOL）。 结果治疗后,3组患者的sEMG最大波幅与组内治疗前比较,差异均有统计学意义（P<0.01）,且综合治疗组的sEMG的最大波幅值与常规训练组和电刺激组治疗后比较,差异均有统计学意义（P<0.01）。治疗后,3组患者的SSA、VFSS和SWAL-QOL评分与组内治疗前比较,差异均有统计学意义（P<0.01）,且综合治疗组的SSA、VFSS和SWAL-QOL评分分别为（21.34±3.61）分、（6.98±1.62）分和（438±37）分,与常规训练组治疗后的（30.22±3.71）分、（5.34±1.63）分和（627±51）分以及电刺激组的治疗后的（28.14±3.92）分、（5.69±1.58）分和（637±56）分比较,差异均有统计学意义。对3组患者治疗前、后的sEMG最大波幅以及SSA、VFSS、SWAL-QOL评分进行相关系数分析,发现各项指标两两之间均具有一定的相关性（P<0.01）。 结论神经肌肉电刺激联合吞咽训练有助于脑卒中3个月后患者吞咽功能的恢复。     

吞咽训练联合针刺和电刺激治疗脑卒中恢复期中重度吞咽障碍的疗效观察

目的探讨吞咽训练、针刺和电刺激治疗对脑卒中恢复期中重度吞咽障碍患者的临床疗效。 方法对56例脑卒中恢复期中重度吞咽障碍患者,随机分为3组,吞咽训练联合针刺及吞咽电刺激治疗组（A组）,吞咽训练联合吞咽电刺激治疗组（B组）,吞咽训练组（C组）;3组患者分别于入组前1天、治疗第20次后采用洼田氏饮水试验、吞咽障碍评价标准进行评价。 结果A组总有效率83.3%;B组总有效率75.0%,C组总有效率61.1%;组间比较,A组总有效率与B、C两组相比,差异有统计学意义(P＜0．05);B组和C组比较,差异有统计学意义(P＜0．05)。3组分别进行组内比较,治疗前后洼田氏积分、吞咽障碍评价积分差异有统计学意义(P＜0．01),提示吞咽训练、针刺和电刺激治疗均能改善脑卒中后中重度吞咽障碍患者的吞咽功能,但A组综合疗效明显优于B组、C组。 结论吞咽康复训练配合针刺和吞咽电刺激治疗在改善脑卒中恢复期中重度吞咽障碍方面具有明显优势。     

肌电生物反馈疗法联合神经肌肉电刺激对脑卒中后吞咽障碍患者吞咽功能及营养状况的影响

目的:探讨肌电生物反馈疗法联合神经肌肉电刺激(NMES)对脑卒中吞咽障碍患者吞咽功能及营养状况的影响。方法:60例脑卒中吞咽障碍患者随机分为常规组、NMES组、综合组各20例,常规组接受吞咽功能训练,NMES组接受神经肌肉电刺激,综合组接受肌电生物反馈治疗和神经肌肉电刺激。分别于治疗前及治疗1个月后采集3组患者的舌骨上肌群肌电积分值,进行营养指标测量,同时记录治疗前后3组患者胃管留置率的变化情况。结果:3组患者治疗后舌骨上肌群肌电积分值及各项营养指标均较治疗前改善(P0.05),治疗后综合组的改善幅度更优于NMES组和常规组(P0.05)。3组患者治疗后的胃管留置率均较治疗前有明显下降(P0.05),但3组间比较差异无统计学意义。结论:脑卒中吞咽障碍患者在神经肌肉电刺激基础上辅以肌电生物反馈治疗可以明显改善其吞咽功能及营养状况。     

表面肌电生物反馈及神经肌肉电刺激对脑干损伤后吞咽障碍患者吞咽功能的即时效应

摘要 目的：使用高分辨率固态测压系统（HRM）评价表面肌电生物反馈（sEMGBF）及神经肌肉电刺激（NMES）对脑干损伤后神经源性吞咽障碍患者咽部及食管上括约肌（UES）功能的即时影响。 方法：脑干损伤后吞咽障碍患者15例,分别在表面肌电生物反馈、神经肌肉电刺激及无干预措施下吞咽唾液（干吞咽）2次及吞咽3ml水2次。用高分辨率固态测压系统实时采集咽部及食管上括约肌的压力及时间参数。参数包括：咽部收缩峰值压,咽部收缩持续时间,咽部收缩速率,UES松弛残余压,UES松弛持续时间。使用重复测量的方差分析研究表面肌电生物反馈疗法及神经肌肉电刺激对这些参数的影响。 结果：与无干预状态时相比,干咽时sEMG组吞咽时UES松弛持续时间延长（P=0.042）,咽部收缩峰值增加（P=0.029）,咽部收缩速率提高（P=0.016）,咽部收缩持续时间延长（P=0.048）。NMES组咽部收缩持续时间延长（P=0.041）。吞咽3ml水时,sEMG组吞咽时UES松弛持续时间延长（P=0.033）,咽部收缩速率提高（P=0.007）,咽部收缩持续时间延长（P=0.044）。NMES组UES松弛残余压升高（P=0.020）,咽部收缩速率有所降低（P=0.008）,咽部收缩持续时间延长（P=0.039）。 结论：表面肌电生物反馈可以显著延长食管上括约肌松弛持续时间和咽部收缩持续时间;神经肌肉电刺激会显著增加食管上括约肌松弛残余压,降低咽部收缩速率,但是可以显著增加咽部收缩持续时间。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。