肌内效贴配合间接吞咽训练改善脑卒中后咽期吞咽障碍的疗效观察

目的探讨肌内效贴配合间接吞咽训练改善脑卒中后咽期吞咽障碍的临床疗效。方法入选患者分为2组,即肌内效贴+间接吞咽治疗组(肌贴组),间接吞咽治疗组(对照组),各25例。两组患者在治疗前及治疗2周后进行洼田饮水试验和改良染色测试评定。结果治疗2周后两组患者对比,肌贴组饮水试验分级、染色试验残余量测定,观察结果均优于常规治疗组(P<0.05)。结论肌内效贴有助于改善脑卒中患者的咽期吞咽功能。     

针刺配合吞咽功能训练治疗脑卒中后吞咽障碍31例

目的研究短时间使用针刺疗法配合基础吞咽功能训练和进食训练对脑卒中假性球麻痹吞咽障碍的影响。方法62例脑卒中伴有吞咽障碍病人分入治疗组（31例）和对照组（31例）。治疗组采用针刺翳风、完骨、风池、廉采、天突穴位，配合基础吞咽功能训练和进食训练。对照组除了不进行针刺疗法外，其他康复训练方法同治疗组。疗程为两周，每周治疗5d。治疗前后各行1次洼田氏饮水试验评价。结果两组病人的吞咽功能均得到改善，治疗组有效率达96．77％。对照组有效率为87．10％，治疗组效果更明显。结论针刺疗法配合基础吞咽功能训练和进食训练短时间即可明显改善脑率中假性球麻痹的吞咽障碍。     

硫氧还蛋白-1通过调控IRE1-JNK信号通路改善血管性痴呆大鼠认知功能和神经损伤

目的研究慢病毒介导的硫氧还蛋白(Trx)-1过表达对血管性痴呆(VD)大鼠认知功能和神经损伤的改善作用及机制。方法按体重将SD大鼠随机分成假手术组(Sham组)、模型组(VD组)、Trx-1过表达空载慢病毒干预组(VD/Lv-NC组)、Trx-1过表达慢病毒干预组(VD/Lv-Trx-1组)及肌醇酶(IRE)-1抑制剂KIRA6干预组(VD/KIRA6组)各10只。各干预组及模型组以双侧颈总动脉夹闭再通法建立VD模型。VD/Lv-NC及VD/Lv-Trx-1组在造模前24 h侧脑注射对应慢病毒溶液0.2 ml;VD/KIRA6组在造模前2 h侧脑注射KIRA6溶液(剂量10 mg/kg);Sham及VD组则注射等量生理盐水。在造模24 h后,采用Morris水迷宫测试认知能力;取海马组织,原位末端标记技术(TUNEL)检测神经细胞凋亡情况;Western印迹检测磷酸化肌醇酶(p-IRE)1及磷酸化c-Jun氨基末端激酶(p-JNK)蛋白的表达水平。结果造模24 h后,VD组较Sham组逃避潜伏期显著延长、跨越原平台次数显著减少(均P<0.01);与VD组比较,VD/Lv-Trx-1组及VD/KIRA6组逃避潜伏期显著缩短、跨越原平台次数显著增多(均P<0.01)。与Sham组比较,VD组Trx-1显著降低、p-IRE1和p-JNK显著增多(均P<0.01);与VD组比较VD/Lv-Trx-1组、VD/KIRA6组Trx-显著增多、p-IRE1和p-JNK显著降低(均P<0.05)。结论过表达Trx-1可能通过抑制IRE1-JNK信号通路的激活发挥抗神经元凋亡作用,从而改善VD大鼠海马区损伤及认知能力。     

“脑-肠轴”学说研究益生菌联合肠内营养对脑梗死大鼠免疫及认知功能的影响

目的探究益生菌联合肠内营养对脑梗死大鼠免疫及认知功能的影响。方法采用大脑中动脉线栓法制备脑缺血再灌注大鼠模型共48只随机分为模型组、益生菌组、肠内营养组、益生菌+肠内营养组各12只,取12只SD大鼠设为假手术组,给予益生菌、肠内营养治疗14 d后,使用二胺氧化酶(DAO)检测试剂盒及D-乳酸检测试剂盒分别检测各组大鼠血浆中DAO、D-乳酸的水平;采用酶联免疫吸附试验(ELISA)检测血清中免疫球蛋白(Ig)G、IgM含量;采用流式细胞术检测血清中T淋巴细胞CD4~+和CD8~+百分比,计算其比值;观察大鼠活动情况,对各种大鼠神经功能缺损情况进行评分;采用Morris水迷宫实验检测各组大鼠认知功能。结果与对照组相比,模型组大鼠DAO、D-乳酸的水平,神经功能缺损评分,水迷宫实验从第3天起平均逃避潜伏期均明显升高(P0.05);IgG、IgM含量,CD4~+/CD8~+,水迷宫实验大鼠穿越原平台位置次数均明显降低(均P0.05)。与模型组相比,益生菌组、肠内营养组、益生菌+肠内营养组大鼠DAO、D-乳酸的水平,神经功能缺损评分,水迷宫实验从第3天起平均逃避潜伏期均明显降低(均P0.05);IgG、IgM含量,CD4~+/CD8~+,水迷宫实验大鼠穿越原平台位置次数均明显升高(均P0.05)。分别与益生菌组、肠内营养组相比,益生菌+肠内营养组大鼠DAO、D-乳酸的水平,神经功能缺损评分,水迷宫实验从第三天起平均逃避潜伏期均明显降低(均P0.05);IgG、IgM含量,CD4~+/CD8~+,水迷宫实验大鼠穿越原平台位置次数均明显升高(均P0.05)。结论益生菌联合肠内营养治疗可改善脑梗死大鼠免疫功能,提高其认知功能。     

心衰大鼠IL-6的变化及氟伐他汀的干预作用

目的了解白介素和转化生长因子在心肌梗死大鼠心衰发展过程中的改变,以及氟伐他汀的干预作用。方法选用雄性SD大鼠,随机分为假手术组(Sham组),心梗组(MI组)和心梗他汀组(MI+statin组),经冠状动脉前降支结扎术建立心肌梗死后心衰模型,建模1d后MI+statin组大鼠管饲氟伐他汀4mg·kg-1·d-1,Sham组和MI组大鼠管饲安慰剂。术后3d、4w检测大鼠非梗死区心肌转化生长因子β1(TGFβ1)的含量(免疫组化法),胶原及IL6的改变(ELISA法),以及左室血流动力学改变。结果(1)术后各时点IL6的含量,MI组及MI+statin组显著高于Sham组(P<005),而MI+statin组显著低于MI组(P<005);(2)术后各组各时点非梗死区心肌表达TGFβ1的变化趋势与IL6相同;(3)与MI组比较,MI+statin组心功能明显改善,胶原容积分数(CVF)及Ⅰ/Ⅲ型胶原比值(RatiooftypeⅠ/Ⅲ)降低(P<005)。结论氟伐他汀通过抑制IL6的升高而减轻炎性反应,从而预防心室重构,改善心脏功能。     

老年晚期肿瘤误吸与死亡的探讨

误吸指进食或非进食时吞咽过程中有数量不一的液体或固体食物(包括分泌物或血液等)进入到声门以下的气道,而不是象通常一样的全部食团随着吞咽动作顺利地进入到食管[1]。吞咽是一系列复杂的神经肌肉运动过程,受大脑支配,需口、咽、食管共同参与,其中任何一个部位的机能障碍均可导致误吸[2]。我科收治的多数为老年晚期肿瘤患者,老年人由于     

Wnt/β-catenin信号通路通过下调自噬改善大鼠脑缺血再灌注损伤

目的观察Wnt/β-catenin信号通路通过调控大鼠皮层神经元细胞自噬水平对脑缺血再灌注(CIR)损伤的影响。方法将56只雄性SD大鼠随机分为4组:假手术组(Sham组)、CIR组、Wnt/β-catenin激动剂氯化锂(Li Cl)处理组(Li Cl+CIR组)、生理盐水(NS)处理组(NS+CIR组),每组14只。采用大脑中动脉线栓阻塞法建立大鼠CIR损伤模型,缺血2 h后再灌注24 h。采用Garcia神经功能缺陷评分评估各组大鼠神经行为学改变;氯化三苯基四氮唑染色测定脑梗死体积;Western blot测定大鼠皮层β-catenin、LC3-Ⅱ及P62蛋白表达。结果再灌注24 h后,与Sham组相比,CIR组神经行为学评分升高,脑梗死体积增加,皮层β-catenin表达降低,LC3-Ⅱ表达升高,P62蛋白表达水平下降(P0.05);与CIR组相比,Li Cl+CIR组神经行为学评分降低,脑梗死体积减少,皮层β-catenin表达增加,LC3-Ⅱ表达降低,P62蛋白表达水平增加(P0.05)。结论 Wnt/β-catenin信号通路通过调控自噬改善大鼠CIR的神经损伤。     

针刺联合康复训练治疗吞咽障碍的临床研究

目的 研究短时间内使用针刺疗法联合吞咽综合功能训练对脑卒中假性球麻痹性吞咽障碍的影响.方法 126例脑卒中伴有吞咽障碍患者随机分为治疗组(64例)和对照组(62例).治疗组采用针刺翳风、完骨、风池、廉泉、吞咽、外金津玉液穴位,配合基础吞咽功能训练和进食训练.对照组除不进行针刺外,其他康复训练方法 同治疗组.病程为2周,每天1次,每周治疗6 d.治疗前后各行1次洼田氏饮水试验评价.结果 两组患者的吞咽功能均得到改善,治疗组有效率达96.87%,对照组有效率为87.10%,治疗组效果更为明显(P＜0.05).结论 针刺疗法配合基础吞咽功能的综合训练和进食训练,短时间内即可明显改善脑卒中假性球麻痹患者的吞咽障碍.     

右美托咪定对老年脓毒症大鼠Shh信号通路及认知功能的影响研究

背景右美托咪定可透过血-脑脊液屏障并对脓毒症大鼠具有一定保护作用,但目前关于其对脓毒症所致认知障碍改善效果的研究报道较少见。目的探讨右美托咪定对老年脓毒症大鼠Shh信号通路及认知功能的影响。方法2019年1—9月,选取健康雄性SD大鼠54只,采用随机数字表法分为Sham组、CLP组、Dex组,每组18只。Sham组大鼠仅行剖腹探查术,CLP组大鼠采用盲肠结扎穿孔法制备脓毒症模型,Dex组大鼠于脓毒症模型制备后6 h腹腔注射右美托咪定。比较三组大鼠给药后逃避潜伏期,穿越平台次数,处于平台所在象限时间,脑组织含水量,海马组织Shh、Gli-1、Ptc含量及ZO-1、Claudin-5相对表达量。结果与Sham组比较,CLP组、Dex组大鼠给药后逃避潜伏期延长,穿越平台次数减少,处于平台所在象限时间缩短(P<0.05);与CLP组比较,Dex组大鼠给药后逃避潜伏期缩短,穿越平台次数增多,处于平台所在象限时间长(P<0.05)。与Sham组比较,CLP组、Dex组大鼠给药后脑组织含水量增多(P<0.05);与CLP组比较,Dex组大鼠给药后脑组织含水量少(P<0.05)。与Sham组比较,CLP组、Dex组大鼠给药后海马组织Shh、Gli-1含量降低,Ptc含量升高(P<0.05);与CLP组比较,Dex组大鼠给药后海马组织Shh、Gli-1含量升高,Ptc含量降低(P<0.05)。(4)与Sham组比较,CLP组、Dex组大鼠给药后海马组织ZO-1、Claudin-5相对表达量降低(P<0.05);与CLP组比较,Dex组大鼠给药后24 h海马组织ZO-1、Claudin-5蛋白相对表达量升高(P<0.05)。结论右美托咪定可有效改善老年脓毒症大鼠认知功能,降低血-脑脊液屏障通透性,其作用机制可能与激活Shh信号通路有关。     

肾去交感支配术对心肌梗死大鼠心功能和结缔组织生长因子的影响

目的探讨肾去交感支配术(renal sympathetic denervation,RSD)对心肌梗死(myocardial infarction,MI)大鼠心肌纤维化的影响及其可能机制。方法健康雄性SD大鼠54只,分为假手术(Sham组,10只)、RSD组(12只)、Sham 3d+MI组(16只)、RSD 3d+MI组(16只),观察期为MI术后4周。超声心动图评估大鼠心功能、RT-PCR法和蛋白印迹法分别评估大鼠左心室心肌组织中结缔组织生长因子(CTGF)mRNA和蛋白的表达水平。结果Sham 3d+MI组较Sham组和RSD组左心室收缩末内径和左心室舒张末容积水平明显增加(P0.01),左心室短缩率和LVEF水平明显降低(P0.01)。Sham 3d+MI组和RSD 3d+MI组大鼠心肌胶原容积分数[(59.13±6.00)%和(43.96±6.23)%vs(4.94±0.37)%和(4.19±0.59)%,P0.01]、CTGF mRNA相对表达(2.28±0.18和1.53±0.23 vs 0.80±0.11和0.71±0.07,P0.01)、CTGF蛋白相对表达(0.25±0.02和0.16±0.02 vs0.12±0.02和0.08±0.01,P0.01)较Sham组和RSD组明显增加,但RSD 3d+MI组大鼠心肌胶原容积分数、CTGF mRNA相对表达、CTGF蛋白相对表达水平较Sham 3d+MI组明显降低。结论 RSD术能改善MI大鼠心肌纤维化及心功能,可能与其下调致纤维化因子CTGF的表达有关。     

Preliminary observations on the effects of age on oropharyngeal deglutition

Swallows of 4 bolus volumes (1, 5, 10, 20 ml) were examined in three groups of subjects: 6 subjects 20–29 years of age, 12 subjects 30–59 years of age, and 6 subjects 60–79 years of age. A simultaneous manometric and videofluoroscopic data collection protocol permitted measurement of bolus transit, temporal aspects of the oropharyngeal swallow, and pharyngeal peristalsis. Statistically significant effects of increasing bolus volume were oral transit of the bolus head (decreased) and duration of cricopharyngeal opening (increased). Five measures were significantly changed with increasing age: duration of pharyngeal swallow delay (increased), duration of pharyngeal swallow response (decreased), duration of cricopharyngeal opening (decreased), peristaltic amplitude (decreased), and peristaltic velocity (decreased).     

Pharyngeal swallow in gastroesophageal reflux disease

Outside of the otolaryngologic literature it is not generally recognized that symptoms of gastroesophageal reflux are associated with abnormalities in the larynx and pharynx. Published data of videorecordings of the normal pharyngeal swallow in 16 patients asymptomatic for dysphagia or gastroesophageal reflux were compared to data from recordings from a second group of 70 patients, who were symptomatic for dysphagia or gastroesophageal reflux. Both groups were timed in a similar manner, and the timing data were compared by Studentt-test to determine if functional variations between the groups existed. Fifty-eight timed events occurring during the swallowing process, 23 in the anterior view and 35 in the lateral view, were analyzed. A comparison of events occurring before and after bolus arrival in the esophagus was made. Eighteen percent of events in the pre-esophageal period occurred significantly earlier (p<0.05) in the symptomatic group. Marked differences were seen after the bolus entered the esophagus as 39% of events occurred significantly later in the symptomatic group. Our data suggest that individuals with symptoms of gastroesophageal reflux disease demonstrate a number of functional variations during the pharyngeal swallow. This finding is consistent with structural changes described in the otolaryngologic literature. This study was supported in part by Navy Clinical Investigation Protocol No. 84-06-2038 and USUHS Grant C08900     

Voluntary and Reflex Influences on the Initiation of Swallowing Reflex in Man

The electrophysiological features of voluntarily induced and reflexive/spontaneous swallows were investigated. In normal subjects, swallows were elicited by infusing water either into the mouth (1–3 ml) or directly into the oropharyngeal region through a nasopharyngeal cannula (0.3–1 ml). For water infused orally, subjects were either requested to swallow voluntarily or instructed to resist swallowing and maintain the horizontal head position until swallowing occurred reflexively. Spontaneous saliva swallowing was investigated in patients with severe dysphagia who had a prominent clinical picture of suprabulbar palsy. Comparisons between different swallowing types were made by measuring the time interval between the onset of submental electromyographic activity (SM-EMG) and the onset of the upward movement of the larynx recorded by a movement sensor. This interval was less than 100 ms, even frequently less than 50 ms, in reflexive/spontaneous swallows, while in voluntarily induced swallows it was substantially longer. The rising time of submental muscle's excitation was also shorter in reflexive/spontaneous swallows. It was suggested that the triggering of voluntarily induced swallows commences more than 100 ms before the onset of swallowing reflex and that this mechanism is under the control of corticobulbar–pyramidal pathways. If the swallowing reflex is triggered within such a short period of time following the onset of SM-EMG, the central control by the bulbar swallowing center should be effective until the end of oropharyngeal swallowing.     

中老年女性绝经期前后盆底功能状况初步调查

目的了解绝经前后中老年女性盆底功能综合状况,为提高老年女性生活质量以及围绝经期盆底预防性治疗提供参考依据。方法选择2018年3月至2019年3月期间,在北京医院接受常规妇科体检的45～60岁女性,共123例,以绝经状态分为绝经前组和绝经后组,采用盆底功能障碍问卷-20(PFDI-20)、盆腔脏器脱垂/尿失禁性功能问卷(PISQ-12)、国际尿失禁咨询委员会尿失禁问卷(ICIQ)、膀胱过度活动症症状评分表(OABss)、盆腔脏器脱垂量化分期(POP-Q),以及盆底肌电检测综合评价受试者盆底功能状况。结果①绝经后组PFDI-20与PISQ-12评分明显高于绝经前组(P<0.05),而两组ICIQ与OABss问卷评分无统计学差异;②绝经后组盆底Ⅰ类肌纤维平均肌电位、Ⅱ肌纤维最大肌电位均明显低于绝经前组(P<0.05)。结论绝经后中老年女性盆底功能较绝经前显著下降,并影响女性老年生活质量,需要制订必要的干预和治疗办法,早期发现,早期防治是非常重要的。     

Research: Influence of different health‐care systems on health of older adults: A comparison of Hong Kong,Beijing urban and rural cohorts aged 70 years and older

Objective: To explore the hypothesis that better health status of elderly populations is primarily determined by the provision of freely accessible health service at low or no cost to the user and a social welfare system. Method: Information was collected by questionnaire from surveys of three cohorts of elderly (70 years and older) Chinese. Data from two health‐care systems were compared: the low‐cost or free government‐subsidised system in Hong Kong, and the market‐orientated user‐pays system in urban (Beijing), and rural China. Results: The Beijing rural cohort had the best health profile, whereas the Hong Kong cohort had the worst, despite the better lifestyle practices in the Hong Kong and Beijing urban cohorts compared with the Beijing rural cohort, and higher socioeconomic status in the Beijing urban and Hong Kong cohorts. However, the Beijing rural cohort had the highest prevalence of functional limitations. Conclusion: While health‐care systems may affect life expectancy at birth, psychosocial, lifestyle and socioeconomic factors influence subsequent health status of elderly people in a complex manner.     

Oropharyngeal aspiration and pneumonia in children

Oropharyngeal aspiration (OPA) of food and fluids is known to be associated with pneumonia in dysphagic children with neurological disease and direct causality is often assumed. However, little is known about the relationship between OPA and pneumonia in medically complex children when other possible risk factors for pneumonia are considered. We examined the association of World Health Organization (WHO)-defined pneumonia in a heterogeneous group of children with swallowing dysfunction identified by a videofluoroscopic swallow study (VFSS). A retrospective chart review of 150 children (aged 2 weeks to 20 years) was undertaken to determine the relationship between pneumonia and (i) type of swallowing dysfunction (including OPA), (ii) consistency of aspirated food/fluid, and (iii) other factors including multisystem involvement and age (1 year). In univariate analysis, the odds ratio (OR) for pneumonia was significantly increased in children with post-swallow residue (PSR) (OR 2.5) or aspiration on thin fluids (OR 2.4), but not with aspiration of thick fluids or purees. In multi-logistic regression, type of swallowing dysfunction or aspirated food/fluid were no longer significant. Instead, pneumonia was significantly associated with diagnosis of asthma (OR 13.25), Down syndrome (OR 22.10), gastroesophageal reflux disease (GERD) (OR 4.28), or history of LRTI (OR 8.28), moist cough (OR 9.17) or oxygen supplementation (OR 6.19). Children with multisystem involvement demonstrated a higher association with pneumonia, but no difference was found for age. We conclude that the impact of OPA on development of pneumonia is considerably reduced once other factors in children with multisystem involvement are taken into account.     

调肝理脾法对非酒精性脂肪性肝病大鼠模型脂质代谢及微管相关蛋白轻链3B表达的影响

目的观察调肝理脾法对大鼠非酒精性脂肪性肝病(NAFLD)的改善作用及对大鼠肝组织微管相关蛋白轻链3B(LC3B)表达的影响,探讨调肝理脾法治疗NAFLD的作用机制。方法 SD雄性大鼠(清洁级)30只,随机分为对照组、模型组、调肝理脾法组,每组10只。模型组、调肝理脾法组大鼠皆予以高脂饮食,共12周。调肝理脾法组大鼠造模同时给予调肝理脾方2 ml·100 g-1·d-1灌胃(相当于成人剂量的5倍),对照组大鼠给予普通饲料及等量生理盐水灌胃。第12周末处死动物,采集血液、肝脏标本,检测各组大鼠血清ALT、AST、TG、TC、HDL-C、LDL-C水平,并通过HE染色观察肝脏脂肪变性情况,免疫组化法检测LC3B在肝脏组织中表达的变化。计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;计数资料组间比较采用χ2检验;等级资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验。结果 HE染色提示模型组大鼠肝细胞脂肪变性程度和炎症活动度计分与正常对照组相比,差异均有统计学意义(P值均<0.001);调肝理脾法组脂肪变性程度和炎症活动度计分明显减轻,与模型组相比差异均有统计学意义(P值均<0.01)。与正常对照组比较,模型组大鼠血清ALT、AST、TG、TC、HDL-C、LDL-C的水平均升高,差异均有统计学意义(P值均<0.001)。与模型组比较,除HDL-C外,调肝理脾法组大鼠血清ALT、AST、TG、TC、LDL-C的水平均降低,差异均有统计学意义(P值均<0.05)。与正常对照组比较,模型组大鼠肝组织LC3B表达水平略增高,差异无统计学意义(χ2=1.250,P>0.05);与模型组比较,调肝理脾法组肝组织LC3B表达水平明显增高,差异有统计学意义(χ2=5.051,P<0.05)。结论调肝理脾法对实验性SD雄性NAFLD大鼠肝功能、血脂等有较好的改善作用,其作用机制可能与升高SD雄性大鼠肝组织内的自噬水平有关。     

Dysphagia following lightning strike

Numerous articles on the topic of neurologic, cardiac, and burn complications following electrical injury have appeared in the literature since 1934 [1]. Specific mention of dysphagia as a complication of survivors of this type of injury was not found on literature review. For this reason our case is of particular interest. This patient presented with a primary deficit of severe dysphagia following medical stabilization after lightning strike. A structured series of diagnostic and treatment programs was implemented, which included serial modified barium swallows (or “cookie” swallows [2]), thermal stimulation, oral motor exercises, and laryngeal adduction tasks. The patient improved over 1 month from a nonoral intake status to a regular diet while habitually using a learned swallowing technique.