爆破式发音在治疗男声女调中的应用

男声女调是指男性青年变声期后的仍然保留变声期前的高、尖、细的声音n,2],是男性变声期后出现的一种嗓音音调异常,也叫青春期假声、变声后假声.本文对85例男声女调患者的治疗进行回顾分析,探讨爆破式发音训练在治疗男声女调中的应用价值.     

女性声带息肉术后发声功能恢复的时间观察

目的 探讨声带息肉术后发声功能恢复的时间及规律.方法 对51例声带息肉患者(患者组)分别于支撑喉镜术后1、2周及1、3、6个月进行嗓音声学指标基频(fundamental frequecy,F0)、基频微扰(jitter)、振幅微扰(shimmer)、噪/谐比(noise to harmonic ratio,NHR)及嗓音障碍指数(voice handicap index,VHI)调查,对51例嗓音正常人(正常对照组)进行嗓音学分析及VHI调查,对比分析术后嗓音恢复情况.结果 患者组F0较正常对照组降低,jitter、shimmer、NHR较正常对照组升高,差异有统计学意义(P＜0.05);随着时间的推移,患者组F0逐渐升高,其余4个指标均有一定程度的降低,其中F0、jitter、shimmer、NHR在第1个月接近正常对照组,且与3、6个月时差异无统计学意义(P＞0.05),VHI评分在3、6个月时与正常对照组相近,且差异无统计学意义(P＞0.05).结论 声带息肉患者支撑喉镜术后嗓音质量逐渐恢复,术后1周内禁声休息,1个月内休声,1个月以后可正常、正确用嗓.     

声带显微手术后发声功能恢复和嗓音训练时间的初步探讨

目的:探讨声带显微手术后发声功能恢复和嗓音训练时间。方法:选取2011年1月-2014年4月本院耳鼻咽喉科收治的152例行声带显微手术的声带息肉患者为研究对象,采用嗓音声学分析,对其术前、术后3、5、7 d,各嗓音声学参数进行比较。按照抽签随机取样法将152例患者均分为两组,A组患者于手术后1周给予嗓音训练,B组患者于手术后2周给予嗓音训练。嗓音训练6个月后,比较两组患者各嗓音声学参数、VHI量表各项评分及GRBAS各项评分。结果:术后3 d,患者各声学参数均出现下降,但是与术前比较差异无统计学意义;从术后5 d开始,各声学参数均显著降低,与术前比较差异有统计学意义(P0.05)。嗓音训练前,两组患者嗓音声学参数、VHI量表及GRBAS各项评分比较差异均无统计学意义,嗓音训练6个月后,两组患者嗓音声学参数、VHI量表及GRBAS各项评分均显著改善,且B组改善情况显著优于A组,比较差异有统计学意义(P0.05)。结论:声带息肉患者显微外科手术后5 d嗓音质量开始恢复,但是术后2周内严格声休后方可进行嗓音训练。     

对康复期抑郁症患者实施放松训练后的临床效果观察

目的：探讨放松训练对精神科康复期抑郁症患者焦虑心理及预后的影响。方法：将在本科住院的60例抑郁症患者在药物治疗和常规护理4周后,对其实施放松训练,使患者情绪镇静、心理放松,减轻其焦虑抑郁心理,2周后进行焦虑抑郁评分。结果：放松训练后患者的焦虑抑郁状态明显低于放松训练前的焦虑抑郁状态（包括药物疗效）（P〈0.05）,放松训练后家属满意度明显提高（P〈0.05）。结论：放松训练可减轻康复期抑郁症患者的焦虑抑郁心理,促进和谐的医患关系,提高患者治疗依从性及生活质量。     

声带显微微瓣手术后发声功能恢复和嗓音训练时间的分析

目的 探讨分析嗓音训练时间对声带息肉患者声带显微微瓣手术后发声功能恢复的影响。方法 选取84例声带息肉患者随机分为两组,分别于术后1周和术后2周开始嗓音训练,比较两组嗓音学指标和GRBAS评分。结果 两组患者嗓音训练后基频、基频微扰、振幅微扰、噪谐比均有显著改善,术后2周组的患者训练后基频、基频微扰、振幅微扰、噪谐比改善情况优于术后1周开始训练的患者,嗓音训练后GRBAS各项评分均显著降低,术后2周开始嗓音训练的患者GRBAS各项评分均低于术后1周开始训练的患者,差异均具有统计学意义(P＜0.05)。结论 术后2周开始嗓音训练的患者功能恢复优于术后1周开始嗓音训练的患者,建议临床可在声带显微微瓣手术后2周开始进行嗓音训练。     

嗓音训练在嗓音疾病患者中的应用效果

目的探讨嗓音训练在嗓音疾病患者中的应用效果。方法 50例嗓音疾病患者均采用嗓音训练治疗,疗程为2个月。比较患者嗓音训练前后的GRBAS评分、自我VHI量表评分、动态喉镜检查评分、空气动力学检查及计算机嗓音分析。结果训练后,患者GRBAS评分、自我VHI量表评分、动态喉镜检查评分及计算机嗓音分析结果均低于训练前,空气动力学检查结果均高于训练前(均P 0. 05)。结论采用嗓音训练治疗嗓音疾病,可明显改善嗓音质量,提高患者的社交能力,改善患者生活质量。     

嗓音训练配合颈三线按摩法治疗声带小结

目的：总结嗓音训练配合颈三线按摩法治疗声带小结的临床疗效及安全性。方法将25例声带小结患者纳入临床观察,对患者治疗前后嗓音障碍指数量表（VHI）、计算机嗓音分析、频闪喉镜检查、最长发声时间（MPT）进行评估。结果 VHI 治疗前为（39.41±18.45）,治疗后为（19.29±20.39）,前后对比有统计学意义;jitter、shimmer、NHR 治疗前分别为（0.61±0.52）、（3.78±1.14）、（0.212±0.014）,治疗后分别为（0.20±0.31）、（1.98±1.07）、（0.109±0.025）,前后对比有统计学意义。结论嗓音训练配合颈三线按摩治疗声带小结,能增强颈、喉及胸部肌群的协调性,延伸患者发声时间,安全有效。     

嗓音障碍性疾病患者应用VHI评估与嗓音声学分析的比较

目的 探讨嗓音障碍指数(voice handicap index,VHI)用于嗓音障碍性疾病患者自我评估的临床意义及与声学参数间的相关性.方法 对嗓音障碍性患者114例(患者组) 及嗓音正常者40例(对照组)采用多维嗓音软件(multi dimensional voice program,MDVP)进行嗓音声学分析和VHI调查,嗓音声学分析指标包括基频、基频微扰、振幅微扰、噪声/谐和比(noise to harmonic ratio,NHR),VHI 调查包括功能(function,F) 、生理(physiology,P) 、情感(emotion,E) 3个范畴,记录3方面得分及总分(total scores of the VHI,TVH ) 分值.结果 患者组的基频微扰、振幅微扰、NHR 均高于正常组,差异有统计学意义(P<0.01);患者组与对照组间VHI差异有统计学意义(P<0 01).VHI中P与E之间(r=0.863),F与TVH之间(r=0.818)、P与TVH之间(r=0.929)、E与TVH之间(r=0.910)均有良好相关性(P<0.01);VHI各范畴与嗓音各参数之间无显著相关性(P＞0.05).结论 临床上不能以嗓音声学分析为标准来预测主观评估结果;VHI可用于主观反映患者的嗓音障碍程度.     

电子喉镜下声带息肉切除术后联合益气清音汤和嗓音功能训练对患者发音功能 声带形态的影响

目的 探讨电子喉镜下声带息肉切除术后联合益气清音汤和嗓音功能训练对患者发音功能、声带形态的影响。方法 选取2020年7月—2022年7月于峡江县中医院耳鼻喉科接受电子喉镜下声带息肉切除术治疗的74例患者作为研究对象,按随机数字表法分为对照组和观察组,各37例。对照组术后予以嗓音功能训练,观察组在此基础上加用益气清音汤,对比分析2组干预前后自觉症状评分、发音功能[谐噪比（harmony to noise ratio,HNR）、基频微扰（Jitter）、振幅微扰（Shimme）、声门噪声能量值（normalized noise energy,NNE）、最长声时（maximum phonation time,MPT）]、噪声障碍指数（voice handicap index,VHI）评分以及声带形态恢复情况。结果 干预后,2组各项自觉症状（声音嘶哑、咽部异物感、疼痛感、咳嗽）评分均较干预前下降,且观察组低于对照组（P<0.05）。干预后,2组HNR、MPT均较干预前上升且观察组高于对照组,2组Jitter、Shimme、NNE及VHI评分均较干预前下降且观察组低于对照组（P<0....     

叙事护理对缓解儿科重症监护室糖尿病酮症酸中毒患儿焦虑及抑郁的效果观察

目的:探讨叙事护理对儿科重症监护室（PICU）糖尿病酮症酸中毒（DKA）患儿焦虑及抑郁缓解效果。方法:选取61例DKA患儿,随机抽样法分为对照组30例和观察组31例,对照组采用常规口头心理护理方法,观察组运用叙事护理干预,即问题外化、解构、改写外部见证人、治疗文件,对患儿进行干预,每周1次,共6周;分别于干预前1周及干预后第2、4、6周评价患儿焦虑、抑郁情况。结果:2组患儿干预前焦虑、抑郁评分差异均无统计学意义（P>0.05）;干预后第2、4、6周观察组患儿焦虑、抑郁评分均显著低于对照组（P<0.01）。观察组干预后第2、4、6周均显著低于干预前（P<0.01）,干预后第4周和第6周均显著低于干预后第2周,干预后第6周显著低于干预后第4周（P<0.01）。对照组仅干预后第6周抑郁低于干预前（P<0.05）。结论:PICU中DKA患儿实施叙事护理干预,可缓解患儿焦虑及抑郁情绪,树立坚定信念,积极配合治疗护理。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.