自动体外除颤器临床应用的研究

目的探讨自动体外除颤器（AED）临床应用中对室性心动过速（室速）／心室颤动（室颤）的诊断能力、治疗效果和存在的问题。方法应用Power Heart全自动体外除颤器对入选的21例室速、室颤患者进行监测。结果全组发生需电击的心律失常108次，实施自动电除颤99次，发放的电除颤转复成功率96．97％（96次），无效率3．03％（3次，含1次心房扑动误治疗），误治疗率2．02％（2次）。AED电除颤成功治疗后缓慢性心律失常发生率17．71％（17次）。4例患者AED治疗后出现窦性心动过速和室速、室颤发作频度增加，发作间期缩短的现象。结论AED能够有效地自动诊断和治疗室速、室颤，但临床应用仍有较多问题需注意。     

电导滴定法测定氨基化磁性微球表面氨基含量

目的建立电导滴定法测定磁性微球表面微量氨基的化学计量点选择新方法,定量分析其氨基含量,为其表面修饰及偶联奠定基础。方法观察不同因素对滴定结果准确度的影响,在此基础上采用电导滴定法对磁性微球表面氨基进行定量测定,比较曲线拟合及电导率的变化率(ΔK)确定化学计量点2种不同方法对滴定结果的影响。结果建立了更为直接、客观的电导滴定法测定磁性微球表面微量氨基的新方法。利用滴定曲线拟合计算氨基化磁性微球表面氨基含量为(35.05±14.18)μmol/g(RSD=40.47%,n=5);而用ΔK确定化学计量点计算氨基化磁性微球表面氨基含量为(51.38±2.91)μmol/g(RSD=5.66%,n=5),后者的测定精度明显高于前者。结论利用电导率的变化率(ΔK)确定滴定拐点更为直接客观,降低了主观误差,测定精度较高。     

Mental stress and gastric acid secretion

In 14 healthy male volunteers, we studied the influence of acute mental (=psychological) stress induced by performing mental arithmetic and solving anagrams against a financial reward on endogenously stimulated gastric acid output. Personality factors were determined by the Personality Research Form. Acute mental stress significantly (P<0.05) increased systolic blood pressure (+8.9±2.0 mm Hg±sem) and heart rate (+5.3±1.6 beatslmin). The mean gastric acid output during the mental stress period (17.9±2.7 mmol/32 min) did not significantly differ from pre- (16.9±2.3 mmol/32 min) and poststress (18.1±2.2 mmol/32 min) values. However, detailed analysis revealed that mental stress induced contrary changes of gastric acid output in different subjects. About half the individuals reacted with a decrease (up to 60%) and the other half with an increase (up to 60%) in acid output. In some individuals the changes of gastric acid output were very small. By multiple correlations, impulsivity was identified as the personality trait with the highest correlation coefficient (r=0.82) with changes of gastric acid output during the acute mental stress period. During the mental stress period, gastric acid output increased in subjects with high scores on the impulsivity scale, but significantly decreased in those with low scores. We conclude that (1) there is a great individual variability in gastric acid response to acute mental stress, and (2) this variability may be partly attributed to differences in personality traits.     

糖尿病患者的自主神经功能及其对肛管直肠动力的影响

目的 了解糖尿病患者的自主神经功能及其对肛管直肠运动的影响.方法 对26例糖尿病患者和15名健康志愿者分别行自主神经功能测定(标准心血管反射试验)和肛管直肠压力测定.结果 糖尿病自主神经功能异常者占95%,其交感、副交感和自主神经功能计分均显著高于健康对照组,副交感神经功能受损更为明显.肛管直肠压力测定显示直肠静息压、肛管静息压及肛管最大自主收缩压降低,肛管直肠协调功能障碍,直肠敏感性降低.结论 糖尿病患者有明显的自主神经功能异常,其中副交感神经功能受损更为明显,且存在肛管直肠动力障碍.糖尿病患者肛管直肠动力障碍与自主神经功能受损有关.     

The relationship between positive and negative automatic thought and activity in the prefrontal and temporal cortices: A multi-channel near-infrared spectroscopy (NIRS) study

Background

Recently, neurobiological studies of the cognitive model of depression have become vastly more important, and a growing number of such studies are being reported. However, the relationship between the proportion of positive and negative automatic thought and activity in the prefrontal and temporal cortices has not yet been explored. We examined the relationship between brain activity and the proportion of positive and negative automatic thought in patients with major depressive disorder (MDD), using multi-channel near-infrared spectroscopy (NIRS).

Methods

We recruited 75 individuals with MDD (36 females; mean age=39.23±12.49). They completed the Hamilton Rating Scale for Depression, Automatic Thoughts Questionnaire-Revised, Japanese version of the National Adult Reading Test, and the State-Trait Anxiety Inventory. Brain activation was measured by 52-channel NIRS.

Results

We found that activation in the vicinity of the right superior temporal gyrus is related to a deviation to negative of the proportion of positive and negative thoughts in individuals with MDD. Left dorsolateral prefrontal cortex activity was higher in the group with comparatively frequent positive thought.

Limitations

Our participants were patients taking antidepressant medication, which is known to influence brain activity. Second, the poor spatial resolution of NIRS increases the difficulty of identifying the measurement position.

Conclusions

We found that activation of the prefrontal and temporal cortices is related to the proportion of automatic thoughts in the cognitive model of depression.     

The impact of noise on the reliability of heart-rate variability and complexity analysis in trauma patients

This study focused on the impact of noise on the reliability of heart-rate variability and complexity (HRV, HRC) to discriminate between different trauma patients and to monitor individual patients. Life-saving interventions (LSIs) were chosen as an endpoint because performance of LSIs is a critical aspect of trauma patient care. Noise was modeled and simulated by modifying original R–R interval (RRI) sequences via decimation, concatenation, and division of RRIs, as well as R-wave detection using the electrocardiogram. Results showed that under increasing simulated noise, entropy and autocorrelation measures can still effectively discriminate between LSI and non-LSI patients and monitor individuals over time.     

Towards validation and standardization of automatic gait event identification algorithms for use in paediatric pathological populations

BackgroundTo analyse and interpret gait patterns in pathological paediatric populations, accurate determination of the timing of specific gait events (e.g. initial contract – IC, or toe-off – TO) is essential. As currently used clinical identification methods are generally subjective, time-consuming, or limited to steps with force platform data, several techniques have been proposed based on processing of marker kinematics. However, until now, validation and standardization of these methods for use in diverse gait patterns remains lacking.Research questions1) What is the accuracy of available kinematics-based identification algorithms in determining the timing of IC and TO for diverse gait signatures? 2) Does automatic identification affect interpretation of spatio-temporal parameters?.Methods3D kinematic and kinetic data of 90 children were retrospectively analysed from a clinical gait database. Participants were classified into 3 gait categories: group A (toe-walkers), B (flat IC) and C (heel IC). Five kinematic algorithms (one modified) were implemented for two different foot marker configurations for both IC and TO and compared with clinical (visual and force-plate) identification using Bland-Altman analysis. The best-performing algorithm-marker configuration was used to compute spatio-temporal parameters (STP) of all gait trials. To establish whether the error associated with this configuration would affect clinical interpretation, the bias and limits of agreement were determined and compared against inter-trial variability established using visual identification.ResultsSagittal velocity of the heel (Group C) or toe marker configurations (Group A and B) was the most reliable indicator of IC, while the sagittal velocity of the hallux marker configuration performed best for TO. Biases for walking speed, stride time and stride length were within the respective inter-trial variability values.SignificanceAutomatic identification of gait events was dependent on algorithm-marker configuration, and best results were obtained when optimized towards specific gait patterns. Our data suggest that correct selection of automatic gait event detection approach will ensure that misinterpretation of STPs is avoided.     

Data quality of a wearable vital signs monitor in the pre-hospital and emergency departments for enhancing prediction of needs for life-saving interventions in trauma patients

Abstract

This study was designed to investigate the quality of data in the pre-hospital and emergency departments when using a wearable vital signs monitor and examine the efficacy of a combined model of standard vital signs and respective data quality indices (DQIs) for predicting the need for life-saving interventions (LSIs) in trauma patients. It was hypothesised that prediction of needs for LSIs in trauma patients is associated with data quality. Also, a model utilizing vital signs and DQIs to predict the needs for LSIs would be able to outperform models using vital signs alone. Data from 104 pre-hospital trauma patients transported by helicopter were analysed, including means and standard deviations of continuous vital signs, related DQIs and Glasgow coma scale (GCS) scores for LSI and non-LSI patient groups. DQIs involved percentages of valid measurements and mean deviation ratios. Various multivariate logistic regression models for predicting LSI needs were also obtained and compared through receiver-operating characteristic (ROC) curves. Demographics of patients were not statistically different between LSI and non-LSI patient groups. In addition, ROC curves demonstrated better prediction of LSI needs in patients using heart rate and DQIs (area under the curve [AUC] of 0.86) than using heart rate alone (AUC of 0.73). Likewise, ROC curves demonstrated better prediction using heart rate, total GCS score and DQIs (AUC of 0.99) than using heart rate and total GCS score (AUC of 0.92). AUCs were statistically different (p?<?0.05). This study showed that data quality could be used in addition to continuous vital signs for predicting the need for LSIs in trauma patients. Importantly, trauma systems should incorporate processes to regulate data quality of physiologic data in the pre-hospital and emergency departments. By doing so, data quality could be improved and lead to better prediction of needs for LSIs in trauma patients.     

The Effects of Acute Transcranial Direct Current Stimulation on Attentional Bias in Pedophilic Disorder: A Preregistered Pilot Study

ObjectivesIndividuals with pedophilic disorder (PD) experience personal and interpersonal difficulties and are at risk of sexually offending against children. As such, innovative and empirically validated treatments are needed. Recent studies have indicated that men who have sexually offended against children (SOC) with PD display an automatic attention bias for child-related stimuli as well as reduced activity in the dorsolateral prefrontal cortex (dlPFC), a brain area involved in cognitive control, including control over sexual arousal. In this preregistered pilot study, we are the first to investigate whether acutely increasing prefrontal activity could reduce the putative pedophilic attention bias.Materials and MethodsWe delivered a single 20-min session of active anodal versus sham transcranial direct current stimulation (tDCS) over the left dlPFC to 16 SOC with PD and 16 matched healthy controls, while they performed a task requiring controlled attention to computer-generated images of clothed and nude children and adults. We collected responses unobtrusively by recording eye movements.ResultsOur results did not support the presence of the expected automatic attention bias across outcome measures. Nonetheless, we found a response facilitation with child targets in patients and, unexpectedly, in controls, likely due to unwanted salience effects. Active versus sham tDCS reduced this bias across groups, as indicated by a significant group*condition interaction (p = 0.04). However, no attentional bias and no tDCS effects on attentional responses to child and adult images emerged following tDCS.ConclusionsThese results suggest enhanced cognitive control in response to salient stimuli during active tDCS. Thus, to assist future studies on neuromodulation in PD, we provide suggestions for design improvement.