人工耳蜗:中国深度耳聋患者的新未来

自20世纪80年代人工耳蜗问世以来,人工耳蜗已经成为了世界多地重度和深度耳聋患者的常规治疗手段。本文描述了人工耳蜗系统的基本设计,包括一个外部声音处理器,植入接收/刺激器以及耳蜗内刺激电极阵列。此外,本文还对现今临床和实验室研究领域以及关键挑战等进行了阐述,这些研究将对人工耳蜗技术在中国的广泛应用产生影响。     

一种植入式神经修复刺激器的设计和实现

目的：研究设计可用于修复神经损伤的植入式功能性电刺激器。方法：基于数字信号处理器TMS320VC54x和可编程逻辑器件XC95144XL,设计了植入式神经修复刺激器核心电路,进行了相关程序的开发并开展简单实验。结果：植入神经刺激器和外部核心电路之间可以实现双向无线通信,植入神经刺激器的刺激强度、频率、脉宽等参数输出可控。结论：研究设计的植入式神经修复刺激器实现系统化和低功耗,可产生所需的双相电流刺激脉冲,该系统完善后可用于周围和中枢神经损伤的修复。     

人工耳蜗植入系统的环境适应性检测方法研究

介绍了人工耳蜗植入系统的标准执行情况,分析了在评价人工耳蜗植入系统的环境适应性过程中遇到的问题,提出了一种辅助检测装置及其测试方法,解决了由于人工耳蜗植入体与人工耳蜗声音处理器的设计工作环境温度不同而导致在低温环境下测试失败的问题,为人工耳蜗植入系统的环境适应性检测提供了参考。     

多通道可植入神经刺激器的设计和实现

目的：主要设计和实现人工电子耳蜗的植入部分，即多通道可植入神经刺激器。方法：利用硬件描述语言，基于可编程逻辑器件（Programable Logic Device，PLD），采用“脉冲持续调制（PDM）解码和外部定时控制（ETC）码控制”及其改进的方案进行硬件电路设计。结果：实现的多通道可植入神经刺激器可提供多达8个通道的输出，具有较高的分辨率。结论：该多通道可植入神经刺激器体积小，便于携带，效率高，而且包含比较完善的错误纠正机制，其产生的刺激波形能满足电荷平衡、电流限制和电荷限制等安全要求。     

人工耳蜗植入术围手术期整体护理

目的:探讨围手术期整体护理在人工耳蜗植入术中的应用价值。方法:选取我院24例实施人工耳蜗植入术患者给予围手术期整体护理。结果:24例患者手术均成功,术后未出现并发症。结论:给予实施人工耳蜗植入术患者围手术期整体护理可以保证手术成功,预防并发症发生。     

人工耳蜗术后常见问题和注意事项

正人工耳蜗是一种电子装置,由体外言语处理器将声音转换为一定编码形式的电信号,通过植入体内的电极系统直接兴奋听神经来恢复或重建聋人的听觉功能。现在全世界已把人工耳蜗作为治疗重度聋至全聋的常规方法。而对于普通语前聋患者,最佳植入年龄为小于2岁。孩子在0~3岁是学习语言的黄金期,“过站再买票”比较费力。虽然,植入人工耳蜗可以让很多孩子听见世界的声音。但人工耳蜗的费用的确很高,让很多经济     

人工耳蜗植入概况

人工耳蜗是帮助双侧极重度感音神经性听力损失患者改善听力和言语交流能力的一种模拟耳蜗功能的声电换能助听装置。近年来,国际上人工耳蜗技术取得突破性进展,有越来越多的重度感音神经性聋患者接受了人工耳蜗植入术,生活质量提高,并重新参与社会生活。人工耳蜗植入后的效果不只依赖于产品质量的改进和进步,它涉及多方面的因素。可以说,人工耳蜗植入是一程序复杂的系统工程,包括术前听力学及影像学的评估、植入适应证及手术方法的选择,术中、术后的听力学评估及人工装置调试,术后听觉言语康复训练等。本文就CI的发展、病例选择、手术、术后康复与疗效评估等方面进行综述。     

走出无声世界

耳聋患者被无情地剥夺了聆听和表达的能力,而人工耳蜗将数字电路和信息处理完美结合,成为他们与有声世界交流的神奇工具。但是,哪些耳聋患者适合人工耳蜗植入?如何选择可以信赖的耳蜗中心、医生和产品?影响人工耳蜗植入的因素有哪些……将由中华耳鼻喉头颈外科主任委员韩德民教授为你详细介绍。     

人工耳蜗植入临床适应证的进展

人工耳蜗是20世纪最伟大的科技成果之一。近10年来,人们对听觉病理、生理认知的不断深入,以及人工耳蜗软硬件技术的不断发展,使得人工耳蜗植入手术对内耳组织结构的保护以及声音精细结构的重建水平得到显著提高。人工耳蜗植入临床适应证已有明显拓展,体现在人工耳蜗植入低龄化、双侧人工耳蜗植入、残余听力保护及内耳畸形人工耳蜗植入等方面。未来更为先进的言语编码策略、植入电极设计及全植入式人工耳蜗的问世,将为更多的人群带来更完美的听觉解决方案。     

提高听觉质量的好办法：双侧助听

目前,解决极重度耳聋和全聋患者听觉障碍的最有效方法是檀入人工耳蜗。不过,由于大部分人工耳蜗都是单侧植入,仅一侧耳朵能够听到声音,故对声源的定位有一定困难,在嘈杂环境下分辨声音也有一定困难。解决方案有2种,一种是双侧植入人工耳蜗;另一种是一侧植入人工耳蜗,另一侧配戴助听器。     

放射诊疗设备“重要部件”的界定

对新安装、维修或更换重要部件后的放射诊疗设备进行验收检测,是保证设备正常投入使用的重要技术手段。卫生监督检查发现,医疗机构往往容易忽略使用过程中的验收检测,不对维修或更换重要部件后的放射诊疗设备进行验收检测。但由于没有法律法规或技术标准界定过“重要部件”的定义和范围,很难要求医疗机构改正。本文就放射诊疗设备“重要部件”的界定进行研究和讨论,并对研究结果的实际应用提出建议。     

Carbon/carbon implants in oral and maxillofacial surgery--Part 2

In their previous report, the authors presented observations regarding the long-term application of carbon/carbon implants. After evaluating the good functional and aesthetic results, the effect of the human body on the structure and morphology of the implants was investigated with state of the art methods. An implant retrieved from the body after eight years was compared to implants which were sterilized but not implanted (reference). Carbon and oxygen were the main components of both implants, however, as a result of the interaction with the human body the amount of oxygen increased 3-4 times and phosphorus, sulphur, calcium and iron were detectable as trace elements on the surface. The width of the carbon fibres (5-7 μm) building up the implants was not changed during the interaction with the human body. The surface of the implant retrieved from the human body was covered with a 15-17 μm thick layer, not present on the reference implant, having a similar composition to that of the carbon fibres (high amount of calcium that is typical to bone tissue was not detected). According to these results, the structure and the morphology of the implants were not altered notably by the human body.     

A quality improvement study: Optimizing pneumococcal vaccination rates in children with cochlear implants

Children with cochlear implants are at increased risk of invasive pneumococcal disease, with national and international guidelines recommending additional pneumococcal vaccines for these children.This study aimed to examine the pneumococcal immunization status and rate of invasive pneumococcal disease in children with cochlear implants at a tertiary paediatric hospital over a 12-year period. Additionally, the impacts of vaccination reminders and a dedicated immunization clinic on pneumococcal vaccination rates were assessed.This quality improvement study included 200 children who had received a cochlear implant through the Children’s Hearing Implant Program at a tertiary paediatric hospital servicing the state of Western Australia. The majority of children (88%) were not up to date with additionally recommended pneumococcal vaccinations. Over the 12-year study period, 2% of children developed invasive pneumococcal disease associated with cochlear implant infections. Generic and personalized electronic immunization reminders improved pneumococcal vaccine up-take in this paediatric cochlear implant setting from 12% (19/153) at baseline to 49% (75/153, p < 0.0001) post implementation. The value of a nurse-led dedicated immunization clinic was also demonstrated with all children (42/42, 100%) up to date with Prevenar13 and the majority (34/42, 81%) up to date with Pneumovax23 post initiation of this referral pathway. These data support the expansion of this model to other medically-at-risk paediatric groups that have been highlighted consistently to be under-vaccinated.     

钙与人体健康

钙是组成人体重要的生命元素,直接影响着人体的生理健康。阐述了钙对人体组织、器官机能的影响及体内钙含量的变化对人体健康造成的危害,并指出人们要科学补钙。     

The donor organ as an ‘object a’: a Lacanian perspective on organ donation and transplantation medicine

Bioethical discourse on organ donation covers a wide range of topics, from informed consent procedures and scarcity issues up to ‘transplant tourism’ and ‘organ trade’. This paper presents a ‘depth ethics’ approach, notably focussing on the tensions, conflicts and ambiguities concerning the status of the human body (as something which constitutes a whole, while at the same time being a set of replaceable elements or parts). These will be addressed from a psychoanalytical (Lacanian) angle. First, I will outline Lacan’s view on embodiment as such. Subsequently, I will argue that, for organ recipients, the donor organ becomes what Lacan refers to as an object a, the ‘partial object’ of desire, the elusive thing we are deprived of, apparently beyond our grasp. Within the recipient’s body an empty space emerges, a kind of ‘vacuole’, once occupied by a faltering organ (now removed). This space can only be filled by a ‘gift’ from the other, by an object a. Once implanted, however, this implant becomes an ‘extimate’ object: something both ‘external’ and ‘intimate’, both ‘embedded’ and ‘foreign’, and which is bound to remain an object of concern for quite some time, if not for life. A Lacanian analysis allows us, first of all, to address the question what organ transplantation has in common with other bodily practices involving bodily parts procured from others, such as cannibalism. But it also reveals the basic difference between the two, as well as the distance between the ‘fragmented body’ of Frankenstein’s ‘monster’—as an aggregate of replaceable parts—and the multiple organ recipients (the ‘puzzle people’) of today.     

What is gender? Feminist theory and the sociology of human reproduction

Feminist theory and research on the sociology of human reproduction have historically been bound together as each has developed. Yet recently sociologists of reproduction and ‘women's health’ have lost sight of core debates in feminist theory. They still tend to work with the assumption that feminism is an internally coherent body of thought, despite the emergence of significant internal divisions since the mid-1980s. In this paper we evaluate the challenge that feminist post- structuralism poses to prior conceptualisations of gender in the context of reproductive health through a critique of sociological work in this area from the 1970s and 1980s. We conclude with a critical exploration of the new insights that might emerge from a post-structuralist ‘deconstruction’ of gender in the context of human reproduction.     

新型MCU直接驱动的人机交互接口电路的设计及应用

主要介绍了TI公司的新型的16位超低功耗F1ash型MSP430F44X系列单片机的结构、特性和功能及液晶显示器LCD的发光原理和类型，讨论了该系列单片机与LCD及键盘的人机接口电路的设计方案和相应的软件的实现方法，最后给出它在体内电刺激器的应用实例。     

血小板恒温震荡保存箱校准装置的研制

目的：血小板恒温震荡保存箱广泛用于医院输血科、实验室和血站,为了确保其技术参数的准确性,研制一套适用于临床的校准装置。方法：采用红外线发射器、数字温度传感器及ARM单片机等器件组成校准装置,对保存箱的温度、幅度和频率进行检测,并通过蓝牙通讯功能传输数据,最终打印出检测报告供临床参考。结果：研制的保存箱检测装置可检测保存箱的重要性能参数,以确保患者的输血安全。结论：该血小板恒温震荡保存箱校准装置操作简单、实用性强且性能稳定,经实验验证,可以检测保存箱的技术参数,保障其质量安全。     

人工电子耳蜗中语音处理器的研究

语音处理器是人工电子耳蜗系统中重要的一个组成部分。我们设计的语音处理器主要基于TI公司的DSP芯片TMS320VC5409和立体声音频编解码芯片TLV320AIC23B。本文介绍了其整体的设计方案和工作原理,并讨论了人工电子耳蜗系统中专用语音处理集成电路的研究。