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    find Keyword "全面性" 10 results
    • Analysis of 598 Cases of Nosocomial Infection in a New Comprehensive Hospital

      ObjectiveTo understand the characteristics of and risk factors for nosocomial infection in a newly built branch of a university teaching hospital, in order to investigate the control measures for prevention and control of nosocomial infection. MethodsA total of 598 cases of nosocomial infection from April 2012 to June 2014 were enrolled in this study. We analyzed statistically such indexes as nosocomial infection rate, infection site, pathogen detection, and use of antibiotics. Meantime, infection point-prevalence survey was introduced by means of medical record checking and bedside visiting. ResultsAmong all the 44 085 discharged patients between April 2012 and June 2014, there were 598 cases of nosocomial infection with an infection rate of 1.36%. Departments with a high nosocomial infection rate included Intensive Care Unit (ICU) (9.79%), Department of Orthopedics (2.98%), Department of Geriatrics (2.62%), and Department of Hematology (1.64%). The top four nosocomial infection sites were lower respiratory tract (45.32%), urinary tract (13.21%), operative incision (8.86%), and blood stream (8.86%). The samples of 570 nosocomial infections were delivered for examination with a sample-delivering rate of 95.32%. The most common pathogens were acinetobacter Baumanii (17.02%), Klebsiella pneumoniae (14.21%), Escherichia coli (13.68%), Pseudomonas aeruginosa (11.93%), and Staphylococcus aureus (9.12%). And urinary tract intubation (42.81%), admission of ICU (28.60%), and application of corticosteroid and immunosuppressive agents (26.42%) were the top three independent risk factors for nosocomial infection. ConclusionGeneral and comprehensive monitoring is an effective method for the hospital to detect high-risk departments, factors and patients for nosocomial infection, providing a theoretical basis for prevention and control of nosocomial infection.

      Release date:2016-10-02 04:54 Export PDF Favorites Scan
    • 青少年肌陣攣癲癇的社會心理長期結局

      青少年肌陣攣癲癇(Juvenile myoclonic epilepsy,JME)是一種定義明確的特發性全面性/遺傳性癲癇綜合征。它與特定的人格特征相關,并且與不利的社會結局有相關性。文章旨在分析JME患者的社會心理結局。為了從環境本身固有的神經生物學因素中描繪慢性發作性疾病的結局,對年齡和性別對照匹配的JME患者與失神癲癇(Absence epilepsy,AE)患者的社會結局進行了對比。研究納入癲癇病程至少20年的患者。所有JME和AE患者(n=41)回答關于癲癇發作、治療和社會心理變量的結構化問卷。除此以外,JME患者進行了癲癇生活質量量表 31(QOLIE-31)評估。在JME中,癲癇起病后46.3(20~69)年,總體社會心理長期結局是有利的(80.5%的患者從未失業超過1年,90.2%能夠良好融入社會環境)。生活質量中所有詢問到的方面均顯示出高得分。與AE對照組相比,JME患者并未顯示出更差的社會心理結局;JME患者的大學入學率和學位獲得率甚至更高(70% vs 34%,P=0.001)。JME患者顯示出高水平的生活質量,當前或既往精神合并癥與較低的總體生活質量得分顯著相關(P=0.02)。對于JME患者的長期研究顯示出與以往研究不同的有利社會心理結局。這是第一個對JME和另外一個遺傳決定形式的癲癇進行對比的研究。JME和AE患者的相似結局對于JME可能引起社會缺陷的特定神經生物學改變提出了質疑。在JME患者中,生活質量降低與精神合并癥相關。

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    • Effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay

      Objective To investigate the effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay (GDD). Methods A total of 40 children with GDD admitted to the Department of Rehabilitation Medicine, Children’s Hospital of Nanjing Medical University were selected as the research subjects. By envelope method, the children were randomly and equally divided into experimental group and control group, with 20 cases in each group. The experimental group received children’s crawling-promotion-training-robot combined with conventional rehabilitation therapy, while the control group received manual crawling training combined with conventional rehabilitation therapy. Before and after treatment, the scores of Gross Motor Function Measure Scale-88 (GMFM-88) and Gesell Developmental Scale (GDS) were respectively used to evaluate gross motor function and cognitive function. Results There was no significant difference in gender (χ2=0.100, P=0.752) and age (t=0.053, P=0.962) between the two groups. Before treatment, there was no significant difference in GMFM-88 and GDS scores between the two groups (P>0.05). After treatment, there were statistically significant differences in GMFM-88 and GDS scores between the two groups (P<0.05). The comparison within the group showed that there were statistically significant differences in GMFM-88 and GDS scores between the two groups before and after treatment. Conclusion Children’s crawling-promotion-training-robot is more effective than manual crawling training in improving gross motor function and cognitive function in children with GDD.

      Release date:2022-12-23 09:29 Export PDF Favorites Scan
    • Lennox Gastaut綜合征和表型——繼發性腦網絡癲癇

      Lennox-Gastaut綜合征(Lennox-Gastautsyndrome, LGS)是一種嚴重的多病因且具有特征性電生理特征的癲癇表型。前驅研究發現常見的腦網絡與特征性的發作間期放電:慢棘慢復合波(Slow spike-and-wave, SSW)和陣發性快活動(Paroxysmal fast activity, PFA)。一些患者有Lennox-Gastaut樣表型和皮質病灶。現旨在探討腦網絡和病灶的相互作用。選取6例具有Lennox-Gastaut表型和結構病灶的患者為研究對象, 采用3T腦電圖-功能磁共振(Electroencephalography-functional magnetic resonance imaging, EEG-fMRI)進行檢測。SSW和PFA時間監測用于事件相關fMRI分析, 以分析關鍵區域的血流動力學時間進程。結果:①PFA發生時, 額葉和頂葉的聯合皮層區、丘腦和腦橋的fMRI信號增強, 且注意和靜息態腦網絡均同時增強, 這是一個少見的模式; ②SSW發生時, 表現為混合性的fMRI信號增強和減弱, 聯合皮質區和丘腦在放電發生前信號增強, 而在放電后顯著減弱, 在初級皮層區fMRI信號減弱; ③在PFA和SSW放電期間, 病灶區表現為不同的fMRI信號增強。3例患者在病灶切除術后1年無癇性發作。研究認為Lennox-Gastaut表型是一種網絡癲癇, 且主要的腦網絡自發不穩。Lennox-Gastaut表型和LGS的癲癇樣活動, 似乎通過聯合皮質區放大和表達, 這可能是由于基本的腦網絡, 注意和靜息態網絡廣泛地相互作用。接受病灶切除術后癲癇患者無癲癇發作表明皮質損傷能建立并保持這種非正常的不穩定腦網絡。LGS可能是繼發性腦網絡癲癇, 因為其統一的癲癇臨床表現, 包括PFA和SSW, 反映出腦網絡功能異常而非特定的觸發過程

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    • Highfrequency stimulation of mediodorsal thalamic nucleus inhibits pentylenetetrazole-induced seizures in rats

      ObjectiveThe optimal target of deep brain stimulation (DBS) for treating intractable epilepsy is still undefined. Cumulative studies suggest that the mediodorsal thalamic nucleus (MD) is involved in seizure activity, the purpose of this study was to investigate the effect of high frequency stimulation in MD on pentylenetetrazole (PTZ)-induced seizures in rats. MethodsThe experimental rats (Male Sprague-Dawley rats 280-350 g) were all provided by Experimental Animal Center, Zhejiang Academy of Medical Science, Hangzhou, China. The rats were given unilateral or bilateral stimulation of the MD at 100 Hz (HFS group) and sham stimulation, others were given unilateral stimulation of the MD at 1 Hz (LFS group). EEGs in the cortex and seizure behavior were recorded with the Neuroscan system at the same time. ResultsNeither LFS nor HFS of the MD changed the latency to the first spikes or EEG manifestations for stage 3 and stage 5 seizures; animals receiving unilateral or bilateral HFS of the MD decreased the number of stage 5 EEG seizure synchronized with the convulsive episodes; LFS and sham stimulation showed multiple periods of continuous spikes which accompanied stage 5 or stage 4 seizures. HFS of unilateral or bilateral MD, but not LFS, decreased the seizure stage, the number of clonic movement episodes, and the duration of acute PTZ-induced seizures. The average latency to onset of myoclonic jerks did not differ among groups. Unilateral and bilateral HFS of the MD had a similar antiepileptic effect. ConclusionHFS of the MD may be of value as a new antiepileptic approach for patients with generalized epilepsy, besides, the seizure model, should be fully considered in clinical application.

      Release date:2016-10-02 06:51 Export PDF Favorites Scan
    • 特發性全面性癲癇易感基因的研究

      隨著生物信息學的飛速發展, 特發性全面性癲癇(Genetic generalized epilepsy, GGE)發病被證實與遺傳因素密切相關, 越來越多的易感基因被發現, 同時其發病機制亦陸續被深入研究。大部分的突變基因為編碼離子通道蛋白的基因, 但離子通道基因突變僅能解釋GGE的少數家系或散發病例, 故對GGE的易感基因與發病機制進行闡明, 有利于GGE的后續遺傳學研究。

      Release date:2017-01-22 09:09 Export PDF Favorites Scan
    • Ⅲ期臨床試驗非盲延期階段聯合使用吡侖帕奈的局灶性癲癇患者的四年藥物安全性、耐受性及發作結局:307 號研究

      評估 307 號研究(臨床試驗驗證碼:NCT00735397)Ⅲ期非盲延期階段(OLEx)聯合使用吡侖帕奈的局灶性癲癇患者的藥物安全性、耐受性及癇性發作結局。患者在完成任一 III 期雙盲試驗后均可進入非盲延期階段(Open-labelextension,OLEx)。對所有 OLEx 隊列中有同樣最小吡倫帕奈暴露劑量的局灶性癲癇和繼發全面性癲癇(Secondarily generalized seizures,SGS)的患者進行藥物安全性及耐受性和癇性發作結局(每 28 d 中位癇性發作減少率、反應率和無發作率)的分析。另外,針對 OLEx 的早期失訪進行了額外的敏感性分析。從 1 480 例雙盲試驗中隨機分組的患者共納入 1 218 例。大部分患者(65.4%~80.9%)僅用吡侖帕奈 12 mg,每日一次,進行治療,并在相同劑量下完成長期的檢測,或是相對基線聯合使用少量抗癲癇藥物(AEDs)。長期的藥物安全性及耐受性結果與雙盲研究一致。導致超過 1% 的患者研究中斷治療的緊急不良反應事件(Treatment-emergent adverse events,TEAEs)包括眩暈、易激、疲勞。有臨床意義的 TEAEs 穩定期為 4 年。所有隊列中患者的癇性發作結局隨時間持續改善。對于接受 3 年(n = 436)、4 年(n = 78)藥物治療的患者 28 d 中位癇性發作減少率分別為 62%、70.6%,相應的 50% 反應率為 59.6%、67.9%。最大 28 d 中位癇性發作減少率發生于基線水平的 SGS 患者,接受 3 年(n = 190)、4 年(n = 28)藥物治療分別為 88.0% 和 100.0%。在這些隊列中分別有 40.0% 和 53.6% 的患者達到了無 SGS。排除早期失訪后的 28 d 中位癇性發作減少率結果類似。長期吡侖帕奈聯合用藥(≤4 年)不會導致新的藥物安全性及耐受性問題,并且可以很大程度地減少癇性發作,特別是基線水平的 SGS 患者。

      Release date:2020-03-20 08:06 Export PDF Favorites Scan
    • Establishment of the cerebral cortex thickness atlas in early Idiopathic Generalized Epilepsy

      ObjectiveTo construct a map of cerebral cortex thickness in Idiopathic Generalized Epilepsy (IGE) diagnosed at the first visit, using T1-weighted brain magnetic resonance imaging and advanced image analysis software. MethodsHigh-resolution three-dimensional T1 images were obtained from 27 IGE patients diagnosed at the first visit and 29 normal controls in Shouguang People's Hospital from January 1, 2022 to December 31, 2021. The location recognition calculation system of the Freesurfer software was used to calculate the values of cortical thickness in each brain region, and the cortical thickness values were transformed into a brain atlas using the image analysis software. A differential brain atlas was generated using the two-sample t-test to analyze the difference in cortical thickness between IGE patients and normal controls. Paired t-test was used for within-group comparison to explore changes of cortical thickness laterality. ResultsIn the IGE brain atlas, the brain regions with higher cortical thickness were the right left temporal pole, the right left entorhinal cortex, the head of the right anterior cingulate gyrus, the right and left insular lobe, the right and left middle temporal gyrus, the right inferior temporal gyrus, the head of the left anterior cingulate gyrus, the left tail of the anterior cingulate gyrus, the left inferior temporal gyrus, the left and right fusiform gyrus, and the left frontal pole. The areas with lower cortical thickness were the right and left paracalcaric gyrus, the right and left cuneiform lobe, the left and right lingual gyrus, the left and right posterior central gyrus, the left lateral occipital gyrus, and the right and left superior parietal gyrus. The distribution of cortical thickness of the IGE group was comparable to the cortical thickness atlas of the normal control. Compared with normal control, the areas with changes of cortical thickness in the IGE group were bilateral superior frontal gyrus, bilateral posterior central gyrus, bilateral anterior central gyri, bilateral lingual gyri, left cuneiform lobe, bilateral entorhinal cortex and temporal pole. The brain areas with laterality of cortical thickness between hemispheres in the IGE group were the tail of anterior cingulate gyrus, cuneiform lobe, inferior parietal gyrus, lateral occipital gyrus, posterior central gyrus, head of anterior cingulate gyrus, and superior marginal gyrus. Compared with normal control, the IGE group has decreased number of brain regions with laterality of cortical thickness. ConclusionThe present study revealed the distribution and laterality of cerebral cortical thickness map in early idiopathic generalized epilepsy, which provides imaging structural basis for brain research in the future.

      Release date:2023-03-13 02:15 Export PDF Favorites Scan
    • 禁忌用藥對 Dravet 綜合征認知結局的影響及初次非高熱性癇性發作年齡對 SCN1A 相關癇性發作表型的臨床預測作用

      SCN1A 致病性變異可引起不同嚴重程度的疾病表型,而這在疾病初期可能難以辨別。研究組致力于探究有助于預測癇性發作分別向 Dravet 綜合征演變和預測 Dravet 綜合征認知結局的臨床特征,分析了禁忌用藥對認知減退的可能調節作用。評估由 164 例 SCN1A 相關癇性發作的荷蘭患者組成的隊列研究。臨床數據通過醫療記錄和半結構式電話回訪獲得。認知功能由一名兒童神經科醫師、一名神經心理醫師和一名臨床基因學家測評分類。通過單因素和多因素回歸分析多項臨床變量(包括在病程前 5 年禁忌用藥的持續時間)發現,起病前 5 年內更長時間的禁忌用藥與納入研究時更差的認知結局顯著相關,同時與 Dravet 綜合征患者第一個 5 年病程后更低的內插智商值和發育智商值有關。多因素線性回歸分析提示,禁忌用藥是認知結局的一個重要預測因素。此外,初次發現發育遲緩的年齡和初次非高熱性癇性發作年齡也是其重要的預測因素。而在完整的隊列中,初次非高熱性癇性發作年齡是癇性發作向 Dravet 綜合征演變最準確的預測因素。比研究數據提示病程前 5 年內更長時間的禁忌用藥對 Dravet 綜合征患者的認知結局有負面影響。早期診斷對于避免使用這些禁忌藥物極為重要。研究還發現初次非高熱性癇性發作年齡是癇性發作向 Dravet 綜合征演變以及 Dravet 綜合征疾病嚴重程度的重要預測因素,這些都可為 SCN1A 相關癇性發作年幼患者的父母提供建議。

      Release date:2019-11-14 10:46 Export PDF Favorites Scan
    • 使用表皮肌電監測來檢測全面強直-陣攣發作

      該前瞻性多中心Ⅲ期臨床試驗的目的在于評估在癲癇監測單元(Epilepsy monitoring unit,EMU)中使用可穿戴的表皮肌電圖(surface electromyographic,sEMG)監測系統來檢測全面強直-陣攣發作(Generalized tonic–clonic seizures,GTCS)的性能和耐受性。199 例有 GTCS 病史的患者被收入 11 個Ⅳ級癲癇中心的 EMU 中,在進行臨床視頻腦電圖(VEEG)監測的同時,也通過在肱二頭肌上佩戴可穿戴設備接受了 sEMG 監測。所有 sEMG 數據記錄都使用先前開發的檢測算法在中心站點處理。將 sEMG 檢測到的 GTCS 與 3 名評審專家驗證的發作事件進行比較。在所有受試者中,檢測算法共檢測到了 46 次 GTCS 中的 35 次[76%,95%CI(0.61,0.87)],陽性預測值(Positive predictive value,PPV)為 0.03,平均誤報率(False alarm rate,FAR)為 2.52/24 h。對于在肱二頭肌中線上方記錄到的數據,系統檢測到了全部的 29 例 GTCS[100%,95%CI(0.88,1.00)],檢測時間平均延遲 7.70 s,PPV 為 6.2%,平均 FAR 為 1.44/24 h。28%(55/199)報告了輕至中度的不良事件,并導致 9% 的研究中止(17/199)。這些不良事件主要是電極貼片引起的皮膚刺激反應,這種情況未經治療即可緩解。研究中無嚴重不良事件報告。在肱二頭肌上使用 sEMG 監測裝置來檢測 GTCS 是可行的。正確放置該裝置對于檢測準確性至關重要,但是對于一些患者而言,減少誤報數仍有一定難度。

      Release date:2018-05-22 02:14 Export PDF Favorites Scan
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