New factors that affect quality of life in patients with aphasia

BackgroundAphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population.ObjectiveWe aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke.MethodsPatients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors.ResultsWe included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P = 0.008) and at follow-up (P = 0.01); increased communication activity limitations at follow-up (P < 0.001); increased limitations on activities of daily life at baseline (P = 0.008) and follow-up (P < 0.001); increased fatigue at follow-up (P = 0.001); and increased depression symptoms at follow-up (P = 0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R² = 0.756, P < 0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations.ConclusionAphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies.     

血液透析后疲乏循证健康教育的现况研究

目的调查血液透析室护士和患者在血液透析后疲乏(PDF)方面的健康教育现况与最佳证据之间的差距,找出问题并分析原因,为透析室护士今后临床护理决策提供参考和依据。方法通过全面检索循证指南网站、整合最佳证据,根据整合结果自制透析室护士和患者对血液透析后疲乏的健康知识问卷。采用目的抽样法,于2018年12月,选择北京中医药大学附属东直门医院透析室7名护士和56例患者进行调查。结果7名护士PDF知识问卷得分为(56.43±4.37)分,最高分64分,最低分51分,达标率为28.57%(2/7)。56例患者PDF知识问卷得分为(52.41±9.54)分,最高分为70分,最低分为20分,达标率为28.57%(16/56)。患者和护士接受的教育形式分别为口头宣教及科室小讲课,均无统一教育内容。结论血液透析室缺少统一科学的教育内容及规范化的教育形式,应对护士开展循证健康教育,提高护士和患者在该方面的认知,从而减轻患者疲乏情况。     

补肾疏肝汤对慢性疲劳综合征大鼠模型抗疲劳作用机制的实验研究

目的研究补肾疏肝汤对慢性疲劳综合征大鼠模型抗疲劳的作用机制。方法将50只SD大鼠按照随机数字表法分为5组,即空白组、模型组及补肾疏肝汤低、中、高剂量组,各组均10只。除空白组外,其余4组大鼠均制备慢性疲劳综合征模型。在造模同时,空白组、模型组均予0.9%氯化钠注射液40 m L/(kg·d)灌胃;补肾疏肝汤低、中、高剂量组分别予补肾疏肝汤40 m L/(kg·d)灌胃,生药含量分别为17.28、34.56、69.12 g/(kg·d),分别相当于人体用量1、2、4倍,均14 d。比较各组大鼠第1 d首次、第14 d末次力竭游泳时间。比较各组大鼠血清超氧化物歧化酶(SOD)、丙二醛(MDA)水平,下丘脑5-羟色胺(5-HT)含量,大鼠骨骼肌过氧化物酶体增殖物激活受体γ辅激活因子1α(PGC-1α)、细胞色素氧化酶(COX)含量。结果补肾疏肝汤低、中、高剂量组大鼠第14 d末次力竭游泳时间均较模型组延长(P<0.05),且补肾疏肝汤中剂量组大鼠第14 d末次力竭游泳时间最长(P<0.05)。补肾疏肝汤低剂量组第14 d末次力竭游泳时间较第1 d首次力竭游泳时间缩短(P<0.05);补肾疏肝汤中剂量组第14 d末次力竭游泳时间较第1 d首次力竭游泳时间延长(P<0.05)。模型组大鼠血清SOD水平低于空白组(P<0.05),MDA水平高于空白组(P<0.05)。补肾疏肝汤低、中、高剂量组大鼠血清SOD水平均高于模型组(P<0.05),补肾疏肝汤低、中剂量组血清MDA水平低于模型组(P<0.05)。补肾疏肝汤中剂量组大鼠血清SOD水平高于补肾疏肝汤低、高剂量组(P<0.05),MDA水平低于补肾疏肝汤低、高剂量组(P<0.05)。模型组大鼠下丘脑5-HT含量低于空白组(P<0.05)。补肾疏肝汤中、高剂量组大鼠下丘脑5-HT含量均高于模型组(P<0.05),且补肾疏肝汤中剂量组高于补肾疏肝汤高剂量组(P<0.05)。模型组大鼠骨骼肌PGC-1α、COX含量均低于空白组(P<0.05)。补肾疏肝汤低、中、高剂量组大鼠骨骼肌PGC-1α、COX含量均高于模型组(P<0.05),且补肾疏肝汤中剂量组大鼠骨骼肌PGC-1α、COX水平最高(P<0.05)。结论补肾疏肝汤能增强慢性疲劳综合征大鼠模型抗疲劳作用,补肾疏肝汤中剂量组更明显。     

Subjective sleep quality in adult patients affected by Duchenne muscular dystrophy. Beyond nocturnal hypoventilation

ObjectiveIn stable neuromuscular patients under long-term non-invasive ventilation (NIV), subjective sleep quality may be predicted by chronic hypoventilation, as assessed by base excess (BE), and %N3 sleep stage duration. In this study, we explored how other variables, closely associated with self-reported health complaints, contributed to subjective sleep quality in adult patients with Duchenne muscular dystrophy (DMD).MethodsThis is a secondary analysis of a quality of life study in 48 adult DMD patients under NIV therapy, with little evidence of residual hypoventilation. Subjective sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). A PSQI score >5 was considered indicative of poor sleep quality. Several other symptoms were evaluated: sleepiness, by the Epworth Sleepiness Scale (ESS); depression and anxiety, by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); autonomic symptoms, by the Composite Autonomic Symptom Score 31; pain, by the Numeric Pain Rating Scale (NPRS); and fatigue, by the Fatigue Severity Scale (FSS).ResultsMean PSQI was 6.1 ± 2.9. Abnormal scores were found for NPRS in 40, for HADS-A in 10 and for FSS in 24 subjects. The NPRS, HADS-A and FSS scores and the N3 sleep stage, independently predicted PSQI (R² = 0.47, p < 0.0001).ConclusionsIn adult DMD patients, pain, fatigue and anxiety may have a prominent influence on subjective sleep quality. Improvement of sleep quality may be of utmost importance in DMD, as it may ameliorate quality of life and extend its benefits to cardiovascular morbidity and life expectancy.     

护士职业疲劳现况及其影响因素研究

目的 调查护士职业疲劳现况,分析护士职业疲劳潜在剖面并探讨不同类别的影响因素.方法 基于付出-回报失衡模型,采用便利抽样法于2020年12月选取上海市2所三级甲等医院551名护士作为调查对象.采用一般资料调查表、职业疲劳衰竭恢复量表、付出回报失衡问卷进行调查,以职业疲劳衰竭恢复量表3个外显指标进行潜在剖面分析.并通过单...     

抗疲劳1号对游泳大鼠血液、肌肉和脑中ATP含量及血乳酸含量的影响

目的：观察抗疲劳１号（ＡＦ－１）对游泳运动大鼠血液ＡＴＰ和乳酸，以及脑和肌肉组织中ＡＴＰ含量的影响。方法：用生物发光法测定６组不同游泳强度大鼠血液和组织中ＡＴＰ含量；血乳酸含量变化用乳酸自动分析仪监测。结果：给药组大鼠游泳１０ｍｉｎ，血中ＡＴＰ含量明显高于对照组；血中乳酸含量明显低于对照组（Ｐ＜００１）。在游泳力竭鼠中，给药组血ＡＴＰ含量也较对照组高；而血乳酸含量较对照组低（Ｐ＜００５，Ｐ＜００１）。给药大鼠中，游泳１０ｍｉｎ组肌肉ＡＴＰ含量明显高于对照组（Ｐ＜００１）；游泳力竭组仍可保持在对照组水平（游泳时间不同）。给药鼠游泳１０ｍｉｎ和力竭两组脑组织中ＡＴＰ含量与未给药动物无明显差异，但未游泳组明显高于对照组。未游泳给药鼠肌肉中ＡＴＰ含量也明显高于对照组（Ｐ＜００５，Ｐ＜００１）。结论：抗疲劳１号具有抗疲劳功用，可能通过增加组织ＡＴＰ的生成和贮存，促进能量代谢，减少乳酸堆积，进而增加运动强度及运动时间     

70 μM caffeine treatment enhances in vitro force and power output during cyclic activities in mouse extensor digitorum longus muscle

Caffeine ingestion by human athletes has been found to improve endurance performance primarily acting via the central nervous system as an adenosine receptor antagonist. However, a few studies have implied that the resultant micromolar levels of caffeine in blood plasma (70 M maximum for humans) may directly affect skeletal muscle causing enhanced force production. In the present study, the effects of 70 M caffeine on force and power output in isolated mouse extensor digitorum longus muscle were investigated in vitro at 35°C. Muscle preparations were subjected to cyclical sinusoidal length changes with electrical stimulation conditions optimised to produce maximal work. 70 M caffeine caused a small but significant increase (2–3%) in peak force and net work produced during work loops (where net work represents the work input required to lengthen the muscle subtracted from the work produced during shortening). However, these micromolar caffeine levels did not affect the overall pattern of fatigue or the pattern of recovery from fatigue. Our results suggest that the plasma concentrations found when caffeine is used to enhance athletic performance in human athletes might directly enhance force and power during brief but not prolonged activities. These findings potentially confirm previous in vivo studies, using humans, which implied caffeine ingestion may cause acute improvements in muscle force and power output but would not enhance endurance.     

动载荷作用下骨重建力学调控机制

目的探讨动载荷作用下骨重建的力学调控机制。方法对骨重建力学调控机制进行分析,吸纳力学疲劳强度理论思想,提出动载荷作用下骨重建力学调控机制;选取损伤作为力学激励,建立动载荷骨重建模型;分析动态载荷成骨效果优于静态载荷现象,数值模拟运动防治骨质疏松。结果动态载荷成骨效果优于静态载荷现象得到较为合理的解释;运动量增加10%~30%,骨密度增加3.13%~8.61%。结论动载荷作用下骨重建的力学调控机制可为机械振动防治骨代谢相关疾病提供理论指导,是骨重建力学调控理论的补充和完善。     

Surface electromyography and muscle force: limits in sEMG-force relationship and new approaches for applications

The estimation of the force generated by an activated muscle is of high relevance not only in biomechanical studies but also more and more in clinical applications in which the information about the muscle forces supports the physician's decisions on diagnosis and treatment. The surface electromyographic signal (sEMG) reflects the degree of activation of skeletal muscles and certain that the sEMG is highly correlated to the muscle force. However, the largest disadvantage in predicting the muscle force from sEMG is the fact that the force generated by a muscle cannot be directly measured non-invasively. Indirect measurement of muscle force goes along with other unpredictable factors which influence the detected force but not necessarily the sEMG data. In addition, the sEMG is often difficult to interpret correctly. The sEMG-force relationship has been investigated for a long time and numerous papers are available. This review shows the limitations in predicting the muscle force from sEMG signals and gives some perspectives on how these limitations could be overcome, especially in clinical applications, by using novel ways of interpretation.