低频脉冲电刺激联合摄食-吞咽训练在AIS后吞咽障碍的应用及疗效

探讨低频脉冲电刺激联合摄食-吞咽训练在急性缺血性脑卒中（AIS）后吞咽障碍的应用及对呼吸能力、吞咽功能、营养指标的影响。方法 选取本院2019年6月—2021年8月107例AIS后吞咽功能障碍患者,随机分为观察组（n=54）和对照组（n=53）,对照组给予摄食-吞咽训练,观察组在对照组的基础上使用低频脉冲电刺激治疗,两组均持续治疗1个月,比较两组治疗前后吞咽功能、舌骨喉复合体动度、喉镜吞咽功能(FEES)评估结果、呼吸功能、营养指标以及并发症发生情况。结果 观察组治疗后洼田饮水试验评定、标准吞咽功能评价量表（SSA）评分、吞咽功能初筛量表（EAT-10）评分低于对照组（P＜0.05）;观察组治疗后舌骨喉复合体动度包括舌骨向前、上移以及喉向前、喉上移最大幅度均大于对照组（P＜0.05）;观察组治疗后FEES评价中声带麻痹、食物渗漏、食物潴留、误吸比例低于对照组（P＜0.05）;观察组治疗后肺功能指标最长呼气时间、第一秒用力呼气容积（FEV1）、用力肺活量（FVC）以及最大吸气压（PImax）均大于对照组（P＜0.05）;观察组治疗后营养指标BMI指数、血清总蛋白（TP）、白蛋白（ALB）、转铁蛋白（TRF）、前白蛋白（PALB）水平均高于对照组（P＜0.05）;观察组吸入性肺炎发生率低于对照组,营养不良发生率为低于对照组（均P＜0.05）。结论 低频脉冲电刺激联合摄食-吞咽训练治疗AIS后吞咽障碍,可有效促进吞咽功能恢复,改善舌骨喉复合体动度,增强呼吸功能,提高营养状态,降低并发症发生风险     

Neuromuscular changes after long-lasting mechanically and electrically elicited fatigue

Central fatigue was investigated under an isolated active condition whereby the possible effects of supraspinal fatigue were minimized. Therefore, ten subjects were fatigued by simultaneously and repeatedly mechanically stretching and electrically stimulating their calf muscles for 1 h. This was performed using an ankle ergometer. The active fatigue task included a total of 2400 muscle stretches with an intensity of 10% of the maximal voluntary contraction (MVC). This protocol clearly impaired neuromuscular function, as revealed by a significant reduction in MVC (P<0.01) and the neural input to the muscle (average EMG) (P<0.01–0.001). The interpolated nerve stimulation compensated for this force loss by 4.28% (P<0.05). Stretch-reflex recordings revealed a notable post-fatigue reduction in the peak-to-peak amplitude (59.1%, P<0.01) and stretch-resisting force of the muscle (14.1%, P<0.01). The maximal H-reflex declined by 50.5% (P<0.001) and did not recover while the leg was kept ischemic. It is suggested that the existing protocol with minor metabolic loading can induce central fatigue, which seems to be of reflex origin from the fatigued muscle. Although the role of presynaptic inhibition of Ia terminals is possibly reinforced, disfacilitation via reduced spindle sensitivity cannot be excluded. Electronic Publication     

DFNA54, a third locus for low-frequency hearing loss

Nonsyndromic hereditary hearing impairment (NSHHI) is a highly heterogeneous disorder with more than 90 loci mapped, of which nearly one-half of the responsible genes are identified. In dominant NSSHI hearing loss is typically biased towards the high frequencies while low-frequency hearing loss is unusual. Only two NSHHI loci, DFNA1 and DFNA6/14/38, are associated with predominantly low- frequency loss. We mapped the loci harboring the gene responsible for autosomal dominant low-frequency hearing loss in a multigenerational family. The pedigree of a Swiss family with low-frequency hearing loss was established. Using genomic DNA, DFNA1 and DFNA6/14/38 were excluded by linkage analysis or by direct sequencing of the responsible gene. Genome-wide linkage analysis was performed using commercially available microsatellite markers. Two-point linkage analysis demonstrated linkage to chromosome 5q31, the locus for DFNA15, with a lod score of 6.32 at recombination fraction =0 for marker D5S436. Critical recombinations were seen at markers D5S1972 and D5S410. Sequencing of the corresponding gene POU4F3 yielded no pathogenic mutation segregating with the affected members. In addition to Wolfram syndrome gene 1 (DFNA6/14/38) and diaphanous (DFNA1) there is evidence for a third gene involved in low-frequency hearing loss located at DFNA15. Because of the differences in auditory phenotype and the absence of pathogenic mutation in the coding region of POU4F3 it is likely that there is a second gene in 5q31, designated DFNA54, associated with NSHHI.     

低频超声透皮给药的研究进展与应用

低频超声可以增强包括大分子药物在内的许多药物的透皮传输,其主要机制是超声的空化作用,大多数人认为是通过改变角质层角化细胞排列结构来提高皮肤渗透能力的.低频超声透皮给药已被人们用于离体实验和动物活体实验,到目前为止,无论是小分子透皮传输还是大分子透皮传输都有很多成功的例子.但是真正通过低频超声透皮导入药物进行治疗的临床应用报道很少,需要更进一步大量的临床试验以确定其安全性与实用价值.一旦其安全性得以证实,合适的低频超声透皮仪研制成功,低频超声快速透皮必将成为一种安全、有效、可控、经济的新型给药方式.     

Energy state and myosin heavy chain isoforms in single fibres of normal and transforming rabbit muscles

 Energy-rich phosphates, [ATP]/[ADP_free] ratios, and the myosin heavy chain (MHC) complement were determined in single fibres from normal rabbit muscles, and in fibres isolated from tibialis anterior muscle undergoing fast-to-slow conversion by chronic low-frequency stimulation (CLFS). In normal muscles, energy-rich phosphate contents and [ATP]/[ADP_free] ratios could thus be assigned to different MHC-based fibre types. Phosphocreatine (PCr) contents and [ATP]/[ADP_free] ratios differed markedly between fast- and slow-twitch fibres, as well as within the fast fibre subtypes. Both magnitudes were approximately twofold higher in the fastest (type IIB) fibres as compared to the slowest (type I) fibres. According to PCr contents and [ATP]/[ADP_free] ratios pure and hybrid fibres were aligned in an order similar to that determined by their contractile properties and myofibrillar ATPase activities. CLFS for up to 30 days induced pronounced decreases in PCr and [ATP]/[ADP_free] which attained levels twofold lower than in normal slow-twitch fibres. In both normal and stimulated muscles, PCr and [ATP]/[ADP_free] ratios were correlated, indicating their equilibrium in the different fibre types. The relationship detected between MHC isoform expression and the [ATP]/[ADP_free] ratio suggests that the drastic and persistent depression of the cellular energy state may act as an important signal initiating fast-to-slow transformation processes in muscle fibres. Received: 26 June 1998 / Accepted: 31 July 1998     

Control of upright standing posture during low-frequency linear oscillation

We examined the effects of anteroposterior movement of a sled on human upright standing. Each of six healthy men stood on the platform of a sled in the dark. The sinusoidal acceleration was provided, from 0.02 to 0.04 G, followed by 0.06 and 0.08 G, at a stroke length from 6 to 10 m and then to 14 m. Low acceleration (0.02 and 0.04 G) induced body sway, pivoting on the ankle joint. High acceleration (0.06 and 0.08 G) increased body sway, but the head-neck joint remained locked upright. The electromyographic recordings of the lower leg muscles revealed continuous tonic EMG activities of the gastrocnemius and tibialis anterior muscles at acceleration of 0.02 and 0.04 G, while reciprocal activation was observed at 0.06 and 0.08 G. During head movement, the neck muscles were slightly activated tonically at acceleration of 0.02 and 0.04 G, but they were markedly and tonically activated at 0.06 and 0.08 G. We speculate that the sled oscillation caused body sway in proportion to the acceleration, with the ankle joint playing a principal role. Analysis of neck movement also revealed that the head was held in a fixed upright position, indicating that the vestibulocollic reflex might tonically activate the neck muscles.     

低频超声电导应用于胸外科伤口止痛的疗效观察

目的观察低频超声电导经皮局部透药和镇痛泵经静脉给药治疗伤口疼痛的疗效。方法 272例胸外科手术患者按入院顺序分为治疗组和对照组各136例。治疗组采用低频超声电导经皮局部透入含止痛药的凝胶贴片作为耦合剂治疗,每次30分钟,每天2次,3天为1疗程;对照组采用镇痛泵泵入3天为1个疗程。治疗3天后对两组疼痛症状进行视觉模拟评分(VAS)并观察临床疗效。结果治疗组治疗后的VAS评分低于对照组(t=2.895,P<0.05),显效率优于对照组(χ2=11.62,P<0.05),差异均有统计学意义。结论 低频超声电导经皮局部透药是治疗伤口疼痛的一种有效治疗方法。     

The 40 Hz Modulation-following Response: Prediction of Low-frequency Uncomfortable Loudness Levels in Normally Hearing Adults

Preliminary investigations have been made in normally hearing alert adults to establish whether the 40 Hz modulation-following response (MFR) can be used to predict 400 Hz uncomfortable loudness levels (ULLs). The MFR stimulus was a 400 Hz carrier, amplitude- and frequency-modulated by a 40 Hz sine function. Subjective ULLs were obtained using standard procedures. 1 Objective ULLs were obtained from MFR parameter-intensity functions using rms amplitude, phase angle and magnitude-squared coherence (40 Hz components). The best predictions of the subjective ULL were made using objective ULLs calculated from the gradients of linear best-fit lines for individual phase-intensity functions (80 per cent predicted within 10 dB of the subjective ULL; maximum deviation = 16 dB). Poorest predictions were based on inter-subject average rms amplitude-intensity functions, where as few as 14 per cent were within 10 dB of the subjective value. The best predictions were considered sufficiently accurate to warrant further investigation using a variety of modulation and carrier frequencies in different age groups and with varying degrees of hearing loss.     

低频超声联合顺铂对卵巢癌细胞影响研究

目的探讨低频超声联合顺铂对人卵巢癌A2780细胞增殖和凋亡的影响。方法培养人卵巢癌A2780细胞,将其随机分为对照组、低频超声组、顺铂组和联合组。低频超声组给予超声840 k Hz,0.75 W/cm23 min辐照;顺铂组给予顺铂5 n M,培养48 h;联合组给予低频超声+顺铂处理。应用CCK-8检测各组细胞的增殖情况;流式细胞仪检测各组细胞凋亡以及细胞周期。结果与单独应用低频超声或顺铂比较,低频超声联合顺铂抑制人卵巢癌A2780细胞增殖的能力更强,更明显地诱导癌细胞的凋亡以及细胞周期S期阻滞,差异有统计学意义(P<0.05)。结论低频超声联合顺铂可抑制人卵巢癌细胞的增殖,诱导癌细胞的凋亡以及细胞周期S期的阻滞作用。     

精神分裂症顽固性幻听实施双背侧前额叶低频重复经颅磁刺激治疗的效果研究

目的：分析双背侧前额叶低频重复经颅磁刺激治疗精神分裂症顽固性幻听的临床效果。方法：选取本院2012年3月-2013年3月收治的28例精神分裂症顽固性幻听患者,按照随机数字表法将其分成对照组和观察组各14例,对照组采用1 Hz伪刺激治疗,观察组采用1 Hz真刺激治疗,分析比较两组患者的治疗效果。结果：观察组的幻听症状、精神病理症状以及总评分改善情况均明显优于对照组,差异均有统计学意义（P〈0.05）。幻听症状改善主要表现在：观察组患者的幻听声音大小以及频率改善情况明显优于对照组,且患者的抑郁、焦虑等精神病理症状和意志活动方面的阴性症状均较对照组有所改善,比较差异均有统计学意义（P〈0.05）。结论：1 Hz的双背侧前额叶低频重复经颅磁刺激（rTMS）治疗精神分裂症顽固性幻听效果显著,且安全系数高,值得深入研究。