Sleep time and sleep-related symptoms across two generations – results of the community-based RHINE and RHINESSA studies

Study objectivesTo analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations.MethodThe participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS.ResultsAll sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents' total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20–1.93), DMS (1.34, 1.15–1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15–2.37), insomnia (1.39, 1.13–1.73), short sleep time (<6 h/night) (2.51, 1.72–3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9 h/night).ConclusionThe familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems.     

Five‐Year Follow‐up After Sacral Neuromodulation: Single Center Experience

Objective. We studied long‐term clinical efficacy of sacral neuromodulation (SNM) therapy in patients with refractory urgency incontinence (UI), urgency/frequency (UF) and voiding difficulty (VD), together with urodynamic data at baseline and six   months postimplant. Materials and Methods. Twenty‐two patients were implanted with a neurostimulator after a positive response to a percutaneous nerve evaluation test defined as a greater than 50% improvement in symptoms. Results. At five‐year follow‐up, the number of incontinent episodes and pad usage per day decreased significantly in 10 out of 15 UI patients. Two of five UF patients were successfully treated with SNM; the number of daily voids for all UF patients decreased from 25 to 19 and average voided volume increased from 98 to 212 mL. One of the two VD patients was able to void to completion. Mean first sensation of filling at the six‐month urodynamic investigation for the UI and UF patients increased from 78 to 241 mL and 141 to 232 mL, respectively, and the maximum bladder capacity increased from 292 to 352 mL and 223 to 318 mL, respectively. Five of 22 patients underwent device explant and one patient still has an inactive stimulator implanted. Conclusion. SNM is an effective treatment modality that offers sustained clinical benefit in the majority of patients with refractory UI, UF, and VD that do not respond to other, more conservative therapies.     

双音节普通话言语测听词表的等价性评估

目的：本项研究针对已编制完成的具有语音平衡特性的双音节普通话测听词汇表（MSTM）进行难度等价性分析，以期挑选出具有难度一致性的一组词表应用于临床。方法：对10张（每张50词）的双音节词表进行数字化录音。选取65名年龄18～25岁具有大专以上文化程度，日常生活中以普通话为交流方式的听力正常人作为受试者。对5名受试者进行预试验，获得正式测试时所需的给声强度。对60名受试者进行正式的言语识别测试，使用SPSS11．0软件对结果进行等价性分析。结果：10张双音节测试词表中，除测试表5外，其余各表间均具有难度等价性。结论：9张双音节普通话测听词汇表具有较好的难度等价性，可应用于临床测试和实验研究中。     

Electrophysiological measures of conflict and reward processing are associated with decisions to engage in physical effort

Anterior cingulate cortex (ACC), a key brain region involved in cognitive control and decision making, is suggested to mediate effort- and value-based decision making, but the specific role of ACC in this process remains debated. Here we used frontal midline theta (FMT) and the reward positivity (RewP) to examine ACC function in a value-based decision making task requiring physical effort. We investigated whether (1) FMT power is sensitive to the difficulty of the decision or to selecting effortful actions, and (2) RewP is sensitive to the subjective value of reward outcomes as a function of effort investment. On each trial, participants chose to execute a low-effort or a high-effort behavior (that required squeezing a hand-dynamometer) to obtain smaller or larger rewards, respectively, while their brainwaves were recorded. We replicated prior findings that tonic FMT increased over the course of the hour-long task, which suggests increased application of control in the face of growing fatigue. RewP amplitude also increased following execution of high-effort compared to low-effort behavior, consistent with increased valuation of reward outcomes by ACC. Although neither phasic nor tonic FMT were associated with decision difficulty or effort selection per se, an exploratory analysis revealed that the interaction of phasic FMT and expected value of choice predicted effort choice. This interaction suggests that phasic FMT increases specifically under situations of decision difficulty when participants ultimately select a high-effort choice. These results point to a unique role for ACC in motivating and persisting at effortful behavior when decision conflict is high.     

Emergency ventilation using the Combitube in cases of difficult intubation

Summary The esophageal-tracheal Combitube (Sheridan, Argyle, NY) is a new device for emergency intubation, which can be inserted blindly without the use of a laryngoscope. Ventilation is independent of the position of the Combitube in either the esophagus or the trachea, since ventilation is always provided by the tube's double channel. The tracheal channel acts as a conventional endotracheal airway and has an open distal end. The esophageal channel has a blocked distal end, so that together with the inflated distal cuff it acts as an esophageal obturator in cases of esophageal intubation. Perforations at the pharyngeal section direct the airflow to the trachea. At the oropharyngeal section a large elastic balloon is positioned in order to obturate the oral cavity and the nasopharynx. Two patients are described to exemplify the Combitube's clinical use. Both had rapidly enlarging cervical hematomas causing upper airway obstruction and thus requiring immediate intubation. Endotracheal intubation failed because the glottis could not be visualized with a laryngoscope. In both cases the Combitube was applied successfully and adequate ventilation was provided via the Combitube placed esophageally. To better secure each patient's airway, tracheotomy was performed during ventilation without any complications.     

试论群众看病难、看病贵的原因及对策

社会各界热切关注的看病难、看病贵,主要原因是卫生资源总体不足,卫生发展落后于经济发展。看病难、看病贵同许多社会现象一样,是有城乡差别的。在城市里是看病贵,小病大治、药价昂贵、名医难求、医托药托泛滥,城里人特别向往大医院、只挂专家门诊, 主要体现的是一个“贵”字,病是能看、能治,但城里人是要求锦上添花。而在农村则因为收入低,经济窘迫,医疗水平差,现实困难重重, 是看病难,小病硬扛,大病小养,因病返贫,因病致贫现象还很普遍,农村是要求雪中送炭。因此,城里人看病难与农村人看病难有天壤之别。不区别城乡差别的现实,那解决问题就是盲人摸象。本文试图从造成群众看病难、看病贵的主要原因中,提出解决的对策。     

车前番泻复合颗粒治疗功能性便秘的临床观察

目的 观察车前番泻复合颗粒治疗功能性便秘的有效性和安全性。方法 将80例确诊为功能性便秘患者分为两组,每组40例。治疗组给予车前番泻复合颗粒5 g口服,每日1次, 对照组则给予淀粉颗粒5 g口服,每日1次,共2周,观察两组患者治疗前后排便次数、大便性状、排便困难症状评分、伴随症状评分、胃肠传输时间及不良反应。结果 对照组排便次数、大便性状、排便困难症状评分、伴随症状评分、胃肠传输时间治疗前后差异无统计学意义(P＞0.05), 而治疗组上述各指标治疗前后比较,差异有统计学意义(P<0.05)。且治疗后两组上述指标比较,差异亦有统计学意义(P<0.05)。两组均无明显不良反应发生。结论 车前番泻复合颗粒能显著增加功能性便秘患者的排便次数、改变大便性状、缓解排便困难症状及伴随症状、缩短胃肠传输时间, 并具有较好的安全性和耐受性。     

学龄初期学习困难儿童的智力及注意分配的研究

目的：探讨我国学龄初期学习困难（LD）儿童智力及注意分配能力与正常儿童的异同。方法：采用WISC-RC和注意分配实验仪对64例LD儿童和32例正常儿童进行测试比较。结果：LD组IQ、VIQ、PIQ显著低于对照组；注意分配测试结果：声、光及声加光中声的注意分配有极显著差异，但声加光中光的注意分配差异不显著。结论：学龄初期LD儿童右脑发育不及左脑，动手能力较差，尤其女性。     

大学生睡眠质量与心理健康状况的相关性研究

  目的  了解中山市成年居民失眠症状现况。  方法  2017年2 — 5月,采用随机抽样方法对中山市25个乡镇和城区的12 182名 > 18岁成年居民进行失眠症状调查。  结果  中山市成年居民失眠症状检出率为10.02 %,其中女性的检出率为11.76 %,男性为8.17 %;成年居民失眠症状总得分为（1.19 ± 0.01）分,入睡困难得分为（0.37 ± 0.01）分,再入睡困难得分为（0.48 ± 0.01）分,早醒得分为（0.35± 0.01）分;回归分析结果显示,除了学历和家庭所在地之外,性别、年龄、职业、婚姻状况、子女人数和家庭经济水平均为失眠症状的影响因素(P < 0.05)。  结论  中山市成人失眠症状的检出率较高;性别、年龄、职业、婚姻状况、子女人数和家庭经济水平等都是失眠症状的主要影响因素。