高强度和低强度直流电刺激对脑组织Akt激活的不同作用

目的:磷酸化蛋白激酶(Akt)是重要的促细胞存活信号,本研究观察双侧双极经颅直流电刺激(tDCS)模式对大鼠脑组织中Akt激活水平(即Akt的磷酸化水平)的影响。方法:将SD大鼠随机分成对照组和tDCS处理组,釆用不同电流参数不同时间刺激后,用免疫印迹法检测脑组织中Akt磷酸化水平(p-Akt)及Akt总蛋白量(tAkt)表达。计算p-Akt/t-Akt比值定量Akt磷酸化水平。结果:高强度刺激(250μA;2h)降低Akt磷酸化水平(P<0.05);低强度刺激(100μA;1h)明显上调Akt磷酸化水平,并持续上调12h(P<0.05)。结论:低强度双侧双极tDCS在12h内持续增强Akt活性,但过强tDCS引起Akt活性降低。     

经颅直流电刺激结合Walker View步行训练系统对早期脑卒中患者步行功能的影响

目的:观察经颅直流电刺激(tDCS)联合"Walker View"康复训练系统对脑卒中患者步行能力的影响。方法:将60例脑卒中患者随机分为观察组(30例)和对照组(30例):对照组给予常规的康复治疗;观察组下肢增加Walker View步行训练系统进行康复治疗时给予患侧大脑半球C3、C4区30 min的tDCS治疗,并分别于治疗前和治疗8周后运用Berg平衡量表、Fugl-Meyer下肢运动功能量表、卒中患者运动功能评估量表(MAS)、Holden步行能力及Walker View系统来评估两组患者的步行能力。结果:治疗前两组患者Berg、Fugl-Meyer、MAS评分和Holden等级比较,差异无统计学意义(P>0.05),治疗后观察组Berg、Fugl-Meyer、MAS评分和Holden等级明显高于对照组,差异有统计学意义(P<0.05);Walker View步态评估:两组患者治疗前左右步宽差、患侧负重比、步速比较,差异无统计学意义(P>0.05),治疗后观察组患者步速、患侧负重高于对照组,左右步宽差低于对照组,差异有统计学意义(P<0.05)。结论:tDCS联合Walker View系统能有效提高脑卒中患者步行能力。     

经颅直流电刺激联合伏硫西汀对快感缺失型抑郁症患者的疗效探究

目的 探讨以左背外侧前额叶为刺激靶点的经颅直流电刺激治疗对快感缺失型抑郁症的疗效。方法 选取2020年6月—2021年6月在杭州市第七人民医院就诊的抑郁症患者61例,采用随机数字表法分为真刺激组(30例)和伪刺激组(31例),真刺激组进行2 mA的经颅直流电刺激(transcranial direct current stimulation, tDCS)治疗,伪刺激组进行参数设定一致的伪刺激治疗,所有患者同时接受药物伏硫西汀10 mg/d治疗,2组均治疗2周。于治疗前、治疗1周、治疗2周分别进行汉密尔顿抑郁量表(HAMD-17)、斯耐思-汉密尔顿快感量表(SHAPS)、中文版快感缺失量表(DARS)评估。结果 治疗前,2组患者年龄、性别、受教育年限、总病程、发作次数比较差异无统计学意义(均P>0.05)。治疗后,真刺激组患者SHAPS评分、HAMD-17评分均低于治疗前(均P<0.05),DARS评分高于治疗前(P<0.05)。治疗2周后,真刺激组患者SHAPS评分[(17.71±3.11)分]低于伪刺激组[(19.45±3.42)分],真刺激组患者HAMD-17评分...     

Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis

Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.     

重复经颅磁刺激在脑卒中康复中的临床应用进展

近年来,中国脑卒中的发病率逐年升高,且其所致的神经功能缺损严重影响患者的后期生活质量。重复经颅磁刺激(rTMS)作为一种新型康复治疗手段,广泛应用于脑卒中患者的神经康复治疗。rTMS仪通过线圈产生磁场双向调节大脑兴奋性维持半球间的兴奋性平衡,从而促进损伤皮质的自我修复,改善神经功能。然而,不同的刺激程序有不同的效果,高频的经颅磁刺激能增加皮质兴奋性,低频的刺激则降低皮质兴奋性,因此针对脑卒中后不同神经功能损伤(运动障碍、认知障碍、吞咽困难等),rTMS对应的治疗方案也有所不同。未来,应进一步探索更为高效安全的治疗方案。     

Effect of Combined Low-frequency Repetitive Transcranial Magnetic Stimulation and Virtual Reality Training on Upper Limb Function in Subacute Stroke:a Double-blind Randomized Controlled Trail

The effect of combined low-frequency repetitive transcranial magnetic stimulation(LF r TMS) and virtual reality(VR) training in patients after stroke was assessed. In a double-blind randomized controlled trial, 112 patients with hemiplegia after stroke were randomly divided into two groups: experimental and control. In experimental group, the patients received LF r TMS and VR training treatment, and those in control group received sham r TMS and VR training treatment. Participants in both groups received therapy of 6 days per week for 4 weeks. The primary endpoint including the upper limb motor function test of Fugl-meyer assessment(U-FMA) and wolf motor function test(WMFT), and the secondary endpoint including modified Barthel index(MBI) and 36-item Short Form Health Survey Questionnaire(SF-36) were assessed before and 4 weeks after treatment. Totally, 108 subjects completed the study(55 in experimental group and 53 in control group respectively). After 4-week treatment, the U-FMA scores [mean difference of 13.2, 95% confidence interval(CI) 3.6 to 22.7, P<0.01], WMFT scores(mean difference of 2.9, 95% CI 2.7 to 12.3, P<0.01), and MBI scores(mean difference 16.1, 95% CI 3.8 to 9.4, P<0.05) were significantly increased in the experimental group as compared with the control group. The results suggested the combined use of LF r TMS with VR training could effectively improve the upper limb function, the living activity, and the quality of life in patients with hemiplegia following subacute stroke, which may provide a better rehabilitation treatment for subacute stroke.     

重复性经颅磁刺激联合感知提醒对脑卒中患者单侧忽略的影响研究

【摘要】 目的 对比低频重复性经颅磁刺激（rTMS）联合感知提醒（SC）治疗与单独使用rTMS治疗对脑卒中亚急性期单侧忽略患者忽略严重程度、上肢功能以及日常生活活动能力的影响。方法 采用随机对照研究、评定者盲法设计,将33例右侧脑卒中后单侧忽略患者随机分为rTMS＋SC组（n =16）和rTMS组（n =17）。在常规康复治疗基础上,rTMS＋SC组患者同时接受rTMS以及SC治疗,rTMS组患者仅接受rTMS治疗。rTMS治疗采用经颅磁刺激仪,刺激左侧后顶叶皮层,刺激频率1 Hz,刺激强度为90%静息运动阈值,治疗时间为1次/d,5 d/周,连续治疗2周;SC治疗采用佩戴提醒腕表,每天累计提醒时间为3 h, 5 d/周,连续佩戴2周。治疗前及治疗2周后分别评定单侧忽略严重程度〔单侧行为忽略常规子量表（BIT-C）和凯瑟琳博格量表(CBS)〕,上肢运动功能〔上肢运动评分量表(FMA)、上肢活动量表（ARAT）〕以及日常生活自理能力〔改良巴氏指数（MBI）〕。结果 治疗2周后,两组患者各项指标均较治疗前有改善。与单纯rTMS治疗比较,rTMS+SC组在BIT-C方面改善更好（P <0.05）。其余CBS、上肢功能（FMA、ARAT）指标治疗后两组差异无统计学意义。结论 rTMS联合SC能更有效的改善脑卒中患者单侧忽略症状, 可望作为单侧忽略的多技术联合治疗策略之一在临床推广应用。     

以深层咽肌神经刺激疗法为主的康复治疗对脑卒中后吞咽障碍的影响

目的探讨以深层咽肌神经刺激疗法(DPNS)为主的康复治疗对脑卒中后吞咽障碍的影响。方法选择2013年1月至2015年12月海安县人民医院康复科收治的70例脑卒中后吞咽障碍患者作为研究对象,按照随机数字法分为观察组和对照组,各35例。对照组在常规脑卒中药物治疗的基础上,进行康复训练治疗;观察组在对照组的基础上给予双边软腭平滑、三边软腭、舌后根、舍旁、舌中央、双边咽喉壁紧缩反射、舌后根回缩反射力量和小舌头/悬雍垂刺激等DPNS为主的康复治疗,1周为1个疗程,共治疗3个疗程。治疗后,观察两组患者的洼田饮水试验评分、标准吞咽功能评分(SSA)、X线吞咽造影检查(VFSS)评分、吸入性肺炎率、营养不良率等的变化情况。结果治疗后,观察组的洼田饮水试验、SSA评分低于治疗前,VFSS评分高于治疗前;且观察组的洼田饮水试验、SSA评分低于对照组[(2.61±0.23)分比(3.54±0.37)分,(24.90±3.36)分比(28.80±3.42)分],VFSS评分高于对照组[(7.58±0.64)分比(6.04±0.59)分](P<0.01)。治疗后,观察组的吸入性肺炎和营养不良发生率均低于对照组[8.57%(3/35)比20.00%(7/35),11.43%(4/35)比25.71%(9/35)](P<0.05)。结论对脑卒中后吞咽障碍患者给予DPNS为主的康复治疗,能有效改善吞咽功能,减少并发症的发生,促进疾病康复。     

基于中医古籍的中风症药时间序列分析

目的 为探究在中医发展历程中中风方剂蕴含的症药规律,深度挖掘历史时间线上中风的症状与用药之间的关系,从而丰富对中医古籍中中风症药关系的认识.方法 以中医古籍中中风方剂的症药为研究对象,采用时间序列相似性分析方法,通过筛选中风相关方剂,对症状和中药进行提取,形成标准化数据,自编R语言程序实现症状、中药的形态相似距离(MS...     

当归直流电导入与超短波治疗颈椎病疗效分析

颈椎病是一种常见病,临床治疗方法较多,疗效各异。为探求当归导入对各类颈椎病的治疗效果,现将我科以中药当归导人治疗颈椎病76例与超短波治疗64例,进行疗效评价,报道如下。1资料与方法1．1一般临床资料140例颈椎病患者均经专科临床检查、X线颈椎正侧位拍片检查,其诊断符合《骨科手册》中所列颈椎病诊断标准［1］。140例患者分为两组,当归直流电导入组76例,其中男31例,女45例,年龄21～73（平均44．6士7．8）岁。超短波组64例,其中男28例,女26例,年龄23～74（平均43．9士8．3）岁,两组性别、年龄、病程、病情程度等临床资料均…     

Design and Construction of a Low Cost dsPIC Controller Based Repetitive Transcranial Magnetic Stimulator (rTMS)

In this work, a digital signal peripheral interface controller (dsPIC) based repetitive transcranial magnetic stimulator (rTMS) was designed and tested under low voltages. In addition, some limited knowledge of TMS, especially design parameters and notions concerned with it, also were investigated. The reason employing the dsPIC in the design is that design parameters can effectively be controlled. Pulse width modulation and switching output of the control unit, which is necessary to control the rTMS device, were controlled in a more effective way. The other novelty is that developed system can be used for therapeutic or diagnostic purposes in future work provided by digital signal processing performance of dsPIC. Bounded-cylindrical in shape head model made from nonmagnetic material, was used during the tests of the system. Spectrum analyses of clicking sounds were performed with FFT by using MATLAB. The effectiveness of the designed system have been proved by its’ measurement results compared with previous works.     

Analysis of Data from a System of Assessment of the Gonadal Radiation Dose During Radiographic Procedures

The radiation hazard, if any, from diagnostic x-ray examinations was assessed in a study divided into three phases: (1) the gathering of data to allow estimation of the total gonadal dose received by each patient; (2) the accumulation of the individual and accumulative gonadal-dose totals on a large group of patients; (3) the examination and follow-up of patients who had received a substantial gonadal dose to determine any relationship between small recurring doses of ionizing radiation and various indices of somatic and genetic damage.

The mean gonadal dose received by females was much higher than that received by males—1012 mr. as compared to 310 mr. Of 7021 individuals in this study, only 428 (6.1%) received 2 r. or more during the three-year test period. No definite conclusions as to radiation hazard could be made. A system, however, has been developed which, if continued, could eventually produce this basic information.

     

北京市某社区脑卒中高危人群超重、肥胖现况调查

目的了解北京市某社区脑卒中高危人群分布及超重肥胖状况,以明确干预工作的重点,为社区制定脑卒中防治干预策略服务。方法采取随机整群抽样调查的方法对社区50岁及以上(1961年12月31日前出生)本市户籍居民605人进行问卷调查及体检。结果 605名居民中有473人被评估为脑卒中高危人群,占总人数的78.1%。超重220人,占高危人群总数的46.5%;肥胖89人,占高危人群总数的18.8%;中心性肥胖226人,占高危人群总数的47.8%,女性中心性肥胖不同年龄组比较差异有统计学意义(χ2=7.575,P=0.023),年龄越高,中心性肥胖发生率越高;男性中心性肥胖不同年龄组比较差异无统计学意义;中心性肥胖不同年龄组间比较、不同性别间比较差异无统计学意义。结论社区中老年人群超重肥胖发生率较高,应立足社区卫生服务,从宣传教育和健康促进入手,对高危人群进行体重管理及综合干预,降低或延缓脑卒中发生。     

2007-2009年湖北省某地城区居民伤害疾病负担分析

目的:分析湖北省十堰市城区居民伤害的流行病学疾病负担,为优先配置卫生资源提供一定参考。方法:利用2007-2009年十堰市死因监测资料,计算伤害死亡率、过早死亡损失寿命年(years of life lost,YLL)、伤残损失寿命年(years of lived with disability,YLD)和伤残调整健康寿命年(disability adjusted life years,DALY),描述本地城区人群伤害疾病负担现状。结果:2007-2009年十堰市因伤害死亡678例,死亡率为59.7/10万,标化死亡率为61.4/10万;造成的YLL、YLD和DALY分别为12.0/1000、4.7/1000和16.7/1000。因意外伤害死亡人数占伤害死亡总人数的78.3%,按DALY负担排序,前3位伤害依次是电动交通事故、跌落和其他无意伤害,导致的DALY依次为5.5/1000、4.1/1000和2.8/1000。电动交通事故造成的疾病负担呈上升趋势,死亡率从2007年18.3/10万上升到2009年25.1/10万;跌落导致的疾病负担呈现下降趋势,死亡率从2007年14.8/10万下降到2009年11.3/10万。男性死亡率及因伤害造成的DALY均高于女性;婴幼儿(0~4岁)、青年(15~44岁)及老年(65岁~)人群因伤害引起的疾病负担较大。结论:伤害是导致湖北省十堰市城区人群疾病负担的重要疾病,近年来,电动交通事故疾病负担逐步上升,应针对电动交通事故、跌落等伤害,以男性,婴幼儿、青年及老年人群为重点,采取针对性的防控措施。     

阿兹夫定对新型冠状病毒感染患者肝肾功能影响的研究

背景 阿兹夫定是中国新型冠状病毒感染常用抗病毒药物,但其对肝肾功能影响的研究极为匮乏。目的 探讨新型冠状病毒感染患者使用阿兹夫定后肝肾功能的变化,为肾功能不全患者安全使用阿兹夫定提供用药参考。方法 回顾性连续纳入某三甲综合医院2022-12-26—31使用阿兹夫定治疗新型冠状病毒感染的住院患者,按估算肾小球滤过率(eGFR)水平将其分为正常组、轻度损伤组、中度损伤组、重度损伤组、终末期组,观察各组患者使用阿兹夫定后肝肾生化指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、白蛋白、总胆红素(TB),血肌酐(Scr)、eGFR]变化;对eGFR<60 mL·min^-1·(1.73 m²)^-1的患者应用D＿FR=D＿NL×[1-F＿k(1-K＿f)]公式校正阿兹夫定维持剂量,按是否遵循此公式给药将其分为校正组和未校正组,比较两组患者肝肾功能生化指标变化。结果 336例使用阿兹夫定的患者中190例符合纳入、排除标准,按eGFR水平分组后各组年龄、新型冠状病毒感染严重程度、降钙素原峰值、降...     

多创新点项目查新咨询结论的实例分析

笔者结合实例,提出对检出的相关文献进行适度的加工,与该项目的查新要点进行对比分析,为成果鉴定提供可靠的依据.文后密切相关文献均按国家标准GB7714-87著录,且附有委托查新用户的反馈意见.     

新型抗菌肽分子的计算机辅助设计

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