目的 统计分析2011—2014年我院分离的肠杆菌科细菌数据,探讨耐碳青霉烯肠杆菌科细菌(CRE)的流行特征。方法 收集肠杆菌科细菌,根据药敏结果筛选出CRE菌株,并对相关临床资料进行统计分析。结果 共分离得到CRE菌株187株,标本来源依次为尿液(32.6%)、痰液(28.9%)和血液(10.7%)。从科室分布来看,39.0%的菌株来自重症监护室病区,23.0%的菌株来自泌尿外科病区,在其它病区呈散发分布。菌株的种属分布方面,肺炎克雷伯菌的比例为39.6%, 大肠埃希菌的比例为20.9%;从病人年龄构成来看,50岁以上高龄患者的分离比例达74.4%。CRE的分离数目随年份的递增而不断升高。结论 耐碳青霉烯肠杆菌科细菌的流行率呈现逐年递增的趋势,临床应合理使用相关抗生素,预防和控制CRE在医院环境中的流行。

Objective To investigate the epidemiological features of carbapenem resistant Enterobacteriaceae in a collection of clinical Enterobacteriaceae strains isolated during 2011-2014 from our hospital. Methods The Enterobacteriaceae strains were collected and CRE strains were screened by their resistance to carbapenems. Clinical information was analyzed to characterize the epidemiological traits of CRE strains. Results The total number of CRE isolates was 187. These CRE strains were isolated from various clinical specimens, including urine(32.6%), sputum (28.9%), blood (10.7%), and so on. These strains were frequently isolated from intensive care units (ICU) (39.0%) and department of Urology (23.0%). The most frequently isolated species were Klebsiella pneumoniae (39.6%), Escherichia coli (20.9%). The isolation rate is much higher in elderly patients more than 50 years old (74.4%). The percentage of CRE isolates were kept on increasing by years. Conclusion The prevalence carbapenem resistant Enterobacteriaceae in our hospital is increasing every year and it is important to prevent and control the transmission and outbreaks of CRE in the hospital by proper use of related antibiotics in clinical treatment.

目的 探讨锥形纤维桩核与金属铸造桩核在残冠残根修复治疗中的临床效果。方法 65例患者共计69颗残冠残根经完善的根管治疗后采用锥形玻璃纤维桩树脂核和全冠修复,另外32例41颗牙经铸造桩核冠修复,观察疗效对比。结果 所有病例每年复查一次,平均随访期为2年,69颗纤维桩修复患牙未发现牙根折裂,其中66颗全冠与桩核固位稳定,无主诉不适、牙周健康、患者对修复体美学效果与咀嚼功能均感满意。3例失败病例分别为全冠、纤维桩核松动脱落各1颗,有1颗纤维桩折断,成功率为95.6%。金属铸造桩核组41颗患牙失败4例,其中根折2例,均已拔除,牙龈炎伴牙龈及修复体颈缘变色1例,改用纤维桩修复,继发龋1例,成功率为90.2%。结论 纤维桩树脂核具有美学效果好,机械性能好,无腐蚀,耐疲劳,易拆除,不易根折等优点,可替代铸造桩核作为理想的冠、残根桩核修复材料。

目的 观察肌内效贴联合物理治疗急性踝关节扭伤的临床疗效。方法 将52例急性踝关节扭伤患者随机均分为肌内效贴联合物理治疗组(观察组)和常规物理治疗组(对照组),分别于治疗前及治疗后第5、10天时观察患部肿胀程度和VAS评分及踝关节kofoed评分。结果 治疗后第5、10天时两组肿胀程度和VAS评分较治疗前好转(P＜0.05),kofoed评分较治疗前升高(P＜0.05)。观察组在肿胀改善、VAS评分及kofoed评分方面均优于对照组(P＜0.05)。结论 肌内效贴联合物理治疗改善急性踝关节伤患者临床症状,改善踝关节功能,临床疗效优于单纯物理治疗。

Objective The purpose of this pilot study was to investigate the effectiveness of kinesio taping combined with conventional physiotherapy for acute ankle sprain patients. Methods 52 acute ankle sprain patients were randomly divided into kinesio taping combined with conventional physiotherapy group(observation group) and the conventional physiotherapy group(control group),and to observe the changes of the affected part of swelling and the visual analogue scale(VAS)and the extent of the ankle joint function recovery situation at the fifth day and the tenth day respectively. Results Two groups suffering from swelling part and the VAS was improved after the treatment at the fifth day and the tenth day (P<0.05), and the ankle kofoed scores were increased too (P<0.05). The observation group in improving the swelling, VAS and kofoed score were significantly better than the control group (P< 0.05). Conclusion Kinesio taping combined with conventional physiotherapy can be a more effective therapeutic technique for treating acute ankle sprain.

目的 评估关节松动联合运动疗法对颞下颌关节慢性不可复性盘前移位患者的疗效。方法 采用随机对照方法,将46例慢性不可复性盘前移位患者随机分为联合治疗组(n=24)及对照组(n=22), 对照组仅接受传统治疗(包括超短波、超声波、软组织按摩及健康教育),治疗组在传统治疗的基础上应用关节松动联合运动疗法。在治疗前和治疗后2周采用最大张口度(maximal interincisal opening,MIO)、目测类比法(visual analog scale,VAS)、口腔健康影响程度量表(health impact profile-14,HIP-14)评价疗效。结果 治疗前两组患者一般情况类似。治疗后两组颞下颌关节MIO、VAS、HIP-14得分较治疗前改善(P<0.05),组间比较,治疗组在MIO、VAS、HIP-14评分比对照组改善(P<0.05)。结论 关节松动联合运动疗法治疗颞下颌关节慢性不可复性盘前移位疗效明显,值得推广。

Objective To evaluate the effectiveness of joint mobilization combined with therapeutic exercise in patients with chronic anterior disc displacement without reduction of temporomandibular joints. Methods 46 patients with chronic anterior disc displacement without reduction were randomly divided into two groups. The treatment group of 24 cases received joint mobilization combined with therapeutic exercise and conventional therapy (ultrashort-wave diathermy, ultrasound therapy, soft tissue massage, health education), 22 cases in the control group received conventional treatment.The treatment was administered for 2 weeks. The baseline and endpoint outcome assessment measures were maximal interincisal opening (MIO),visual analogue scale(VAS)score and oral health impact profile (HIP-14). Results After the treatment, significant improvements were observed in the two groups of all the outcome measurements (P<0.05).Maximal interincisal opening, visual analogue scale and oral health impact profile were improved significantly in the treatment group than in the control group (P<0.05). Conclusion Joint mobilization combined with therapeutic exercise can improve the symptoms of chronic anterior disc displacement without reduction.

本文从康复治疗学专业课程体系、实践教学、学生创新能力和职业素养的培养、考核体系四个方面对康复治疗学本科人才培养模式的构建进行探讨,以期为丰富康复治疗学专业教学实践提供思路。

This paper is to investigate the construction of undergraduate educational talent cultivation mode of rehabilitation therapeutics from the following aspects: Curriculum system, practice teaching, cultivating students' innovative ability and professional quality and the assessment system, aimed to provide a reference for rehabilitation therapeutics teaching practice.

目的 探讨术中控制性减压对儿童重型颅脑损伤的治疗作用。方法 122例儿童重型颅脑损伤需要开颅手术减压患者,术中随机分成控制性减压手术研究组(60例)和常规手术治疗对照组(62例)进行治疗,观察两组患者术后脑梗死的发生率及预后。结果 研究组术后脑梗塞发生率为6.7％(4例),低于对照组的17.7％(11例)(P<0.05);术后6个月采用GOS标准进行预后判定,治疗组不良预后(重残、植物状态、死亡)有9例占15.0%,低于对照组的23例(37.1%)(P<0.05)。结论 术中采用控制性减压能减少儿童重型颅脑损伤患者术后脑梗塞的发生率及明显改善患者的预后。

Objective To investigate the clinical efficacy of intraoperative controlling decompression in treating of severe craniocerebral injuries in children. Methods 122 cases of severe craniocerebral injuries in children who needed surgical decompression by craniotomy were randomly divided into control decompression surgical group(60 cases)and conventional surgical group(62 cases).The incidence of postoperative cerebral infarction and the outcome according to GOS scores after 6 months were observed in two groups. Results The incidence of postoperative cerebral infarction was 6.7% in controlling decompression surgical group and 17.7% in conventional surgical group. The differences between two groups were statistical significant(P<0.05); The all poor prognosis patients(severely disabled, vegetative state and death) were 9 cases in controlling decompression surgical group and 23 cases in conventional surgical group. The differences between two groups were statistical significant(P<0.05). Conclusion Intraoperative controlling decompression can significantly reduced the incidence of postoperative cerebral infarction and improved the poor prognosis patients of severe craniocerebral injuries in children.

目的 探讨盆底肌康复仪配合中药补中益气汤对盆底功能障碍性疾病的治疗疗效。方法 对300例女性盆底功能障碍性疾病(FPFD)的患者采用盆底肌康复仪同时配合中药补中益气汤协同治疗从而弥补单纯盆底康复治疗不足。结果 产后一年内的早期盆底肌力松弛治愈率达83.82%; SUI组治疗后的临床症状控制效果及盆底肌力、持续时间优于POP组,P＜0.01。结论 产后及时、早期干预盆底肌功能可有效防止盆底功能障碍性疾病的不良发展,同时配合经典方补中益气汤可益气、升阳举陷调理脏腑机能产生协同作用。

目的 探讨传统术式联合骶主韧带复合体交叉悬吊术与骶棘韧带悬吊术（SSLF）在前盆腔膨出方面的相对疗效与价值。方法 回顾性分析2019年1月—2021年3月安徽医科大学附属六安医院收治的80例重度盆腔器官脱垂（POP）患者临床资料。将接受传统经阴道子宫切除术、阴道前后壁修补术及骶棘韧带悬吊术的40例患者纳入对照组,在上述术式基础上加行骶主韧带复合体交叉悬吊术的40例患者纳入观察组。所有纳入研究的POP患者的盆腔器官脱垂定量评估（POP-Q）评分结果为Ⅱ~Ⅳ度。对比两组患者的围术期指标,包括手术时间、术中出血量、术后病率（定义为术后24 h内连续2次、相隔4 h体温超过38 ℃）、术后留置导尿时间、术后住院时间,以及术中和术后并发症等。此外,术后对患者分别进行了电话随访及门诊复查,随访时间为术后3个月、6个月、1年和2年。生活质量评价采用盆底功能障碍性疾病症状问卷（PFDI-20）和盆底疾病生命质量影响问卷（PFIQ-7）。结果 两组患者手术时间、术中出血量、术后留置导尿时间比较差异均有统计学意义（P<0.05）,观察组术中出血量少于对照组,手术时间短于对照组,尿管留置时间短于对照组;两组患者术后住院时间、术后病率（手术后24 h内连续2次、相隔4 h体温超过38℃）比较差异无统计学意义（P>0.05）。两组间术前PFIQ-7和PFDI-20评分比较差异无统计学意义（P>0.05）;术后2年评分观察组高于对照组（P<0.05）。结论 经阴道子宫切除+阴道前后壁修补+骶棘韧带悬吊术及在上述术式基础上行骶主韧带复合体交叉悬吊术,均为临床治疗重度POP的常用手术方式。后者在治疗重度POP的主、客观治愈率上高于传统修补术式,且复发率更低,疗效更加持久。此外,骶主韧带复合体交叉悬吊术在改善单纯SSLF术后前盆腔膨出方面具有显著优势,为临床上POP的治疗与预后提供了新的思路。

Objective To explore the relative efficacy and value of the combination of traditional surgical methods with cross suspension of the sacro–uterine ligament complex and sacrospinous ligament suspension（SSLF）in preventing the recurrence of anterior pelvic prolapse after surgery. Methods This study retrospectively analyzed the clinical data of 80 patients with severe pelvic organ prolapse in Lu’an Hospital Affiliated to Anhui Medical University from January 2019 to March 2021. In the control group,patients received traditional transvaginal hysterectomy,repair of the anterior and posterior vaginal walls,and sacrospinous ligament suspension, while in the observation group, cross suspension of the sacro–uterine ligament complex was added on the basis of traditional surgical methods. The patients participating in the study were divided into the observation group（40 cases）and the control group（40 cases）according to different surgical methods. All patients with pelvic organ prolapse（POP）included in this study had POP–Q scores of grade II to IV. We compared the perioperative indicators of the two groups,including operation time, intraoperative blood loss, postoperative morbidity （defined as a body temperature exceeding 38°C for two consecutive times within 24 hours after surgery,separated by 4 hours）, postoperative indwelling catheterization time, postoperative hospital stay, and intraoperative and postoperative complications. In addition, patients were followed up by telephone and outpatient reexamination after surgery at 3 months, 6 months, 1 year, and 2 years. The quality of life was evaluated using the Pelvic Floor Dysfunction Symptom Questionnaire （PFDI–20） and the Pelvic Floor Disease Quality of Life Impact Questionnaire （PFIQ–7）. Results Comparing the operation time, intraoperative blood loss, and postoperative indwelling catheterization time of the two groups, there were statistically significant differences, P<0. 05. The intraoperative blood loss in the observation group was less than that in the control group, the operation time was shorter than that in the control group, and the indwelling catheter time was shorter than that in the control group. There was no statistically significant difference in postoperative hospital stay and postoperative morbidity（within 24 hours after surgery, two consecutive times with a body temperature exceeding 38°C separated by 4 hours）between the two groups, P>0. 05. There was no statistically significant difference in preoperative PFIQ–7 and PFDI–20 scores between the two groups（P>0. 05）, however, the scores of the observation group were higher than those of the control group 2 years after surgery, and the difference was statistically significant（P<0. 05）. Conclusions Traditional transvaginal hysterectomy + repair of the anterior and posterior vaginal walls + sacrospinous ligament suspension and cross suspension of the sacro–uterine ligament complex based on traditional surgical methods are both common surgical methods for the clinical treatment of severe pelvic organ prolapse. Studies have shown that the latter has a higher subjective and objective cure rate and a lower recurrence rate in the treatment of severe pelvic organ prolapse, with a more durable therapeutic effect. In addition,cross suspension of the sacro–uterine ligament complex has significant advantages in improving anterior pelvic prolapse after simple SSLF, providing new ideas for the treatment and prognosis of pelvic organ prolapse in clinical practice.

       目的   探讨运动干预联合治疗性聆听对孤独症谱系障碍儿童社会交往功能的影响。方法   选取黄河三门峡医院2020年1月—2023年10月收治的100例孤独症患儿，应用随机数字表法分为两组，各50例。对照组患儿实施常规护理，观察组在对照组基础上增加运动干预联合治疗性聆听。分别在干预前及干预6个月后采用孤独症治疗评价量表（ATEC）、儿童感觉统合发展评定量表、格塞尔发育量表（GDS）及中国韦氏儿童智力量表（WISC-R）评价两组患儿社会交往能力、感觉统合发展水平、神经发育水平及智力水平变化。结果   干预后两组患儿的ATEC各部分评分，包括健康/生理/行为、感知/认知能力、社交能力、语言表达/沟通能力及ATEC总分均降低，观察组低于对照组（P＜0.05）；干预后两组患儿学习能力发展、本体感觉、触觉防御、前庭功能及儿童感觉统合发展评定量表总分均升高，观察组高于对照组（P＜0.05）；干预后两组患儿动作能、应物能、言语能、应人能相关神经发育情况评分均升高，观察组高于对照组（P＜0.05）；干预后两组患儿言语智商、操作智商、总智商相关WISC-R评分均升高，观察组高于对照组（P＜0.05）。结论  运动干预联合治疗性聆听对孤独症谱系障碍儿童应用效果显著，可提升其社会交往能力，促进感觉统合发展，进而促进其神经发育及智力水平提升。

       Objective  To  explore the  effect  of  exercise intervention  combined with therapeutic listening  on  social communication function in children with autism spectrum disorder．Methods  A total of 100 autistic children who were admitted to our hospital from January 2020 to October 2023 were selected and divided into two groups by random number table method，with 50 children each．The control group received routine care，while the observation group  received exercise intervention combined with therapeutic listening in addition to routine care．The Autism Treatment Evaluation Scale （ATEC），Children’s Sensory Integration Development Scale，Gesell Development Scale，and Wechsler Intelligence Scale for Children-Revised by China （WISC-R）were used before and 6 months after the intervention to evaluate the social communication ability，sensory integration development level，neural development level，and intellectual level changes of the two groups of children．Results  After intervention，the score of every dimension in ATEC including the health/physiology/behavior，perception/cognitive ability，social ability，language expression/communication ability，and total ATEC score of the two groups of children decreased，and the observation group was lower than the control group （P＜0.05）．After intervention，the total scores of the learning ability development insufficient，proprioceptive dysfunction，excessive tactile defense，vestibular dysfunction，and children’s sensory integration development assessment scale in both groups of children increased，with the observation group being higher than the control group （P＜0.05）．After intervention，the neurological development scores related to motor，adapt，language，and social ability in both groups of children increased，and the observation group was higher than the control group （P＜0.05）．After intervention，the WISC-R scores related to verbal intelligence，operational intelligence，and total intelligence in both groups of children increased，and the observation group was higher than the control group （P＜0.05）．Conclusions  The combination of exercise intervention and therapeutic listening has asignificant effect on children with autism spectrum disorder，which can enhance their social communication ability，promote sensory integration development，and ultimately promote their neural development and intellectual level improvement．

       目的 评价不同间变性淋巴瘤激酶（ALK）抑制剂联合安罗替尼治疗非小细胞肺癌（NSCLC）的疗效。方法 收集ALK突变阳性NSCLC患者的临床资料，筛选服用ALK抑制剂疗效不佳再加用安罗替尼的病例。根据不同的用药方案分为阿来替尼+安罗替尼，塞瑞替尼+安罗替尼和克唑替尼+安罗替尼三个组别。记录患者联合用药前最近一次的影像学检查结果，并以此为基线按Recist1.1评价疗效，以病情进展、患者死亡、停药、改变治疗方案为终点计算各组患者的无事件生存期（EFS），收集肿瘤标志物、血常规和肝功、心功能、肾功能生化检测等指标数据，统计分析患者联合用药前后各项指标的变化。结果 经筛选，共纳入49例患者的临床数据。阿来替尼+安罗替尼组有23例，疾病控制率（DCR）为86.96%；平均EFS为（10.8±3.6）个月，中位EFS为8.3个月；塞瑞替尼+安罗替尼组有14例，DCR为71.43%；平均EFS为（6.5±2.9）个月，中位EFS为5.6个月；克唑替尼+安罗替尼组有12列，DCR为66.67%；平均EFS为（7.7±3.2）个月，中位EFS为7.2个月。阿来替尼+安罗替尼组的平均EFS长于另外两组（P＜0.05）。各研究组肿瘤标志物仅有CyFra21-1在克唑替尼+安罗替尼组在联合用药后升高（P＜0.05），生化检测和血常规指标在用药前后差异无统计学意义（P＞0.05）。结论  ALK抑制剂与安罗替尼联用，疗效最好为阿来替尼，其次为塞瑞替尼，最后为克唑替尼。三种ALK抑制剂与安罗替尼联用后，均未导致心、肝、肾功能和血细胞损害。

      Objective  To evaluate the efficacy of different anaplastic lymphoma kinase（ALK）inhibitors combined with anlotinib in the treatment of non-small cell lung cancer（NSCLC）．Methods  Clinical data of drug resistant NSCLC patients with ALK positive mutation was collected who were treated with ALK inhibitors and anlotinib synchronously．According to different regimens，three groups were set，alectinib+anlotinib，ceritinib+anlotinib，and crizotinib+anlotinib．The latest imageological examination  results of the patient before the synchronous therapy was set as the baseline to evaluate the therapeutic effect according to Recist1.1．The event free survival（EFS）of each group was calculated with disease progression，patient death，treatment discontinuation and changing regimen as endpoints．Data of tumor markers，hematology test，liver function，cardiac function，renal function biochemical examination was collected and analyzed statistically before and after the combination therapy，with P＜0.05 as the statistically significant difference．Results  After screening，clinical data of 49 patients were collected．Twenty-three patients in the alectinib+anlotinib group，with a disease control rate（DCR） of 86.96%；mean EFS was（10.8±3.6）months，median EFS of 8.3 months；14 patients in the ceritinib+anlotinib group，with a DCR of 71.43%，mean EFS was（6.5±2.9）months，median EFS was 5.6 months；12 patients in the crizotinib+anlotinib group，with a DCR of 66.67%，mean EFS was（7.7±3.2）months，median EFS was 7.2 months．EFS of alectinib+anlotinib group was longer significantly than the other two groups（P＜0.05）．Only CyFra21-1，increased significantly after the combination of crizotinib and anlotinib（P＜0.05）．No statistically significant difference in biochemical test and hematology test before and after the treatment（P＞0.05）．Conclusions  The therapeutic effect of ALK inhibitors with anlotinib was ordered，alectinib being the most effective，followed by ceritinib and finally crizotinib．The combination of ALK inhibitors with anlotinib did not cause any abnormal results in the examination of heart，liver，kidney and blood cells．