Impact of task-oriented training based on acupuncture rehabilitation on upper extremity function and quality of life of patients with early stroke

BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction,especially hand dysfunction,which has a very slow recovery,resulting in economic burden to families and society.AIM To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke.METHODS Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group,each with 50 cases.The control group underwent head acupuncture plus routine upper limb rehabilitation training(acupuncture therapy).In addition to acupuncture and rehabilitation,the observation group underwent upper limb task-oriented training(30 min).Each group underwent treatment 5 d/wk for 4 wk.Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Wolf Motor Function Rating Scale(WMFT),modified Barthel Index(MBI),and Canadian Occupational Performance Measure(COPM).Quality of life was evaluated using the Short-Form 36-Item Health Survey(SF-36).Clinical efficacy of the interventions was also evaluated.RESULTS Before intervention,no significant differences were observed in the FMA-UE,MBI,and WMFT scores between the two groups(P>0.05).After intervention,the FMA-UE,WMFT,MBI,COPM-Functional Mobility and Satisfaction,and SF-36 scores increased in both groups(P<0.05),with even higher scores in the observation group(P<0.05).The observation group also obtained a higher total effective rate than the control group(P<0.05).CONCLUSION Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility,quality of life,and clinical efficacy in patients with early stroke.

Intervention Effect of Lower Limb Rehabilitation Robot with Task-Oriented Training on Stroke Patients and Its Influence on KFAROM Score

Objective: To explore the effect of lower limb rehabilitation robot combined with task-oriented training on stroke patients and its influence on KFAROM score. Methods: 100 stroke patients with hemiplegia admitted to our hospital from January 2023 to December 2023 were randomly divided into two groups, the control group (50 cases) was given task-oriented training assisted by nurses, and the observation group (50 cases) was given lower limb rehabilitation robot with task-oriented training. Lower limb balance, lower limb muscle strength, motor function, ankle function, knee flexion range of motion and walking ability were observed. Results: After treatment, the scores of BBS, quadriceps femoris and hamstrings in the observation group were significantly higher than those in the control group (P Conclusion: In the clinical treatment of stroke patients, the combination of task-oriented training and lower limb rehabilitation robot can effectively improve the lower limb muscle strength, facilitate the recovery of balance function, and have a significant effect on the recovery of motor function, which can improve the walking ability of stroke patients and the range of motion of knee flexion, and achieve more ideal therapeutic effectiveness.

Effect of Resistance Training,Aerobic Exercise Before Doula-Assisted Delivery on the Psychological Well-Being and Labor Duration of Parturients

Objective:To investigate the impact of resistance training and aerobic exercise before doula-assisted delivery on the psychological well-being and labor duration of parturients.Methods:105 cases of parturients who gave birth in our hospital from February 2021 to April 2023 were included in this study.The patients were divided into a control group of 52 cases and an observation group of 53 cases.The patients in the control group received no particular intervention before delivery and only received doula assistance.The patients in the observation group received resistance training,aerobic exercise,and doula assistance prior to giving birth.After delivery,the mothers were observed for 2 hours in the delivery room and then returned to the maternal and infant ward.The observation indicators of the two groups were compared.Results:In comparison to the control group,the observation group exhibited shorter durations in the first,second,and third stages of labor,as well as the total delivery time.Additionally,the amount of postpartum blood loss at 2 hours was smaller in the observation group.The rate of cesarean section was lower,and the rate of vaginal natural delivery was higher in the observation group.Following the intervention,both groups of postpartum women showed decreased SAS and SDS scores compared to before the intervention.Moreover,the observation group had lower scores than the control group.These differences were all statistically significant(P<0.05).Conclusion:Resistance training and aerobic exercise before doula-assisted delivery can effectively improve the psychological state of parturients,shorten labor duration,increase the rate of natural vaginal delivery,and reduce pain and postpartum hemorrhage.

Using Augmented Reality Techniques to Simulate Training and Assistance in Electric Power

In combination with the augmented reality (AR) technology and Hololens device, an electric power work assist system is developed to provide a more realistic and convenient training experience for electric power training. The training effect was improved, and help guidance information was provided in the actual operation of electric power work. Experimental results show that difficulty of electric power work is reduced and the efficiency of actual work is improved.

基于辅助学习与富信息策略的Tri-training算法

针对Tri-training算法利用无标记样例时会引入噪声且限制无标记样例的利用率而导致分类性能下降的缺点,提出了AR-Tri-training(Tri-training with assistant and rich strategy)算法。提出辅助学习策略,结合富信息策略设计辅助学习器,并将辅助学习器应用在Tri-training训练以及说话声识别中。实验结果表明,辅助学习器在Tri-training训练的基础上不仅降低每次迭代可能产生的误标记样例数,而且能够充分地利用无标记样例以及在验证集上的错分样例信息。从实验结果可以得出,该算法能够弥补Tri-training算法的缺点,进一步提高测试率。

Direct Instruction by an Experienced Surgeon Can Shorten the Learning Curve for Laparoscopic-Assisted Distal Gastrectomy

Aim: Laparoscopy-assisted distal gastrectomy (LADG) with regional lymph node dissection is a treatment option for patient with early gastric cancer. However, LADG is a technically complex and advanced procedure, which is challenging for inexperienced surgeons. In this report, we retrospectively evaluated the learning curve for LADG of a single surgeon with no previous experience in LADG and the usefulness of direct instruction by a surgeon experienced in LADG in shortening the learning curve. Patients and Methods: This study was analyzed 80 consecutive patients, who underwent LADG by a single surgeon (first assistant in 10 cases and operator in 70 cases) between January 2008 and December 2012. Patients were divided into 3 sequential groups of 10 (training period), 30 (learning period), and 40 (operating period) cases in each group. Median operation time and estimated blood loss for these 3 groups were determined. Other learning indicators, including transfusion requirement, postoperative complications, number of lymph node harvested, and rate of conversion open gastrectomy, were also evaluated. Results: During the training period, median operation time and estimated blood loss were 219.5 min and 83.0 ml, respectively. During the learning period, the operation time was significantly longer than that of training period. In the operating period, the operation time was significantly lesser than that during the learning period. However, the operation time was not different from that during the training period and reached a plateau. The estimated blood loss during the operating period was significantly lesser than that during the learning period. The difference in the number of lymph nodes retrieved between each group was not significant. Conclusions: Direct instructions by an experienced surgeon can decrease the number of cases required for learning. Because LADG is technically more complex than other laparoscopic procedures, standardization of LADG and an effective training system for performing it should be established.

生物反馈助力电刺激对慢性非特异性腰痛患者下肢步行功能的改善

背景:国内外关于慢性非特异性腰痛生物反馈疗法和三维步态功能分析的相关研究已开展很多,但是对二者结合的研究少有报道。目的:利用三维步态分析采集步态参数数据,研究生物反馈助力电刺激对慢性非特异性腰痛患者步行能力的改变效果。方法:选择2021年6月至2022年9月在广东药科大学附属第一医院收治的60例慢性非特异性腰痛患者,男34例,女26例,年龄32-58岁。采用随机数字表法将60例患者分为对照组(n=30)与试验组(n=30),两组患者均接受腰部动态干扰电的常规治疗(20 min/次,1次/d,每周5次,持续治疗20次),对照组患者在常规治疗的基础上进行仰卧搭桥和俯卧搭桥的悬吊核心肌群训练(每周5次,持续治疗20次),试验组在对照组治疗的基础上进行生物反馈助力电刺激治疗(20 min/次,1次/d,每周5次,持续治疗20次)。比较分析两组患者治疗前后的腰痛评分、肌电信号平均值和步态参数。结果与结论:①两组患者治疗结束后的数字类比表评分、日本骨科协会(JOA)评分、Oswestry功能障碍指数均较治疗前明显改善(P<0.05),试验组治疗结束后的数字类比表评分、JOA评分、Oswestry功能障碍指数均优于对照组(P<0.05);②两组患者治疗结束后的腹直肌、臀大肌、竖脊肌表面肌电平均值均高于治疗前(P<0.05),试验组治疗结束后的腹直肌、臀大肌、竖脊肌表面肌电平均值均高于对照组(P<0.05);③两组患者治疗结束后的步宽、步速、步频、健患侧步长比值、健患侧支撑相比值、患健侧摆动相比值、健患侧髋关节及膝关节矢状面活动度和健患侧足偏角均优于治疗前(P<0.05),试验组治疗结束后的上述指标均优于对照组(P<0.05);④结果表明,生物反馈助力电刺激能明显缓解慢性非特异性腰痛,改善了患者下肢步行功能。

医学临床实践能力培养ASSIST体系的构建与实施

实践性是医学学科的主要特色与核心属性。针对目前临床实践能力培养面临的问题,南京大学医学院自2012年起构建并实施了医学临床实践能力培养ASSIST体系。该教学体系以学生为中心,通过高仿真、沉浸式的模拟教学环境,为学生提供多种学习途径,实现学生随时随地学习的需求,并形成了一套实践能力自主评估系统。该体系有助于激发学生实践能力训练的积极性与自主性,提升训练过程的针对性及有效性,提升学生的临床思维能力,提高学生的临床技能水平。

Assistant skill in gastric endoscopic submucosal dissection using a clutch cutter

BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and grasp the target tissue appropriately;therefore,the assistant’s skill may affect the technical outcomes of ESD-C.AIM To determine how assistant skill level affected the technical outcomes of gastric ESD-C using an ex vivo porcine training model.METHODS In this pilot study,mock lesions of 15-30 mm in diameter were created in the middle or lower third of the porcine stomach.A total of 32 ESD-C procedures were performed by 16 trainees.Each trainee operator performed two ESD-C procedures;one ESD-C was assisted by an expert(ESD-C-E),and the other was assisted by a non-expert(ESD-C-NE).The total procedure time of the ESD was set as the primary outcome,and en bloc resection rate,complete procedure rate,perforation rate,and each procedure time/speed for mucosal incision or submucosal dissection were set as the secondary outcomes.In addition,we investigated factors associated with the difficulty of ESD including incompletion of ESD procedure,a long procedure time(≥20 min)or intraoperative perforation.RESULTS The median total procedure time of the ESD-C-E was significantly shorter than that of the ESD-C-NE(12.9 min vs 21.9 min,P=0.001).The en bloc resection rate was 100%in both groups.Complete resection rates of the ESD-C-E and ESD-C-NE groups were 100%and 93.8%,respectively.No intraoperative perforation was observed in both groups.In the multivariate analysis,assistant skill was significantly associated with the difficulty of ESD,with the highest odds ratio of 16.5.CONCLUSION Assistance by an expert is an important factor when trainees perform ESD-C procedures.

标准化PDCA循环管理在助理全科医生培训中的应用效果

目的:研究助理全科医生培训中应用标准化PDCA循环管理提高教学质量的效果。方法:数据取自蚌埠市第一人民医院2022年1月—2023年12月符合纳入标准的48名助培全科医生,依照双盲法分为参照组、研究组各24例,分别采取常规管理和PDCA循环标准化管理,将两组管理效果比较分析。结果:管理前两组考核成绩、管理质量无差异,P>0.05;管理后较参照组,标准化PDCA循环管理组考核成绩更高、管理质量评分更高,标准化PDCA循环管理组满意率(95.83%)高于参照组(75.00%),P<0.05。结论:标准化PDCA循环管理用于助理全科医生培训中可提高助理全科医生培训的管理质量、考核成绩,获得认可,值得推崇。

医疗护理员培训体验及需求的质性访谈

目的了解医疗护理员培训体验及需求,为完善课程体系提供参考。方法本研究采用目的抽样法,以信息饱和为原则,对揭阳市人民医院2020年8月至12月18名参与“医疗护理员岗位技能培训班”的医疗护理员进行半结构式访谈,了解培训感受及需求。其中,男性5人,女性13人,年龄(44.12±5.12)岁。采用Nvivo20.0进行资料分析,总结归纳访谈主题。结果形成医疗护理员培训后体验和需求的5个相关主题,包括“教学组织与培训效果”“考核组织体系”“职业价值感”“内源性不足”和“其他培训需求”。结论本次课程培训实用性强,医疗护理员培训体验良好。未来将结合医疗护理员培训需求,完善培训方案。通过多样的评价形式反映医疗护理员的核心能力,使职业教育和培训管理方案更具科学性、先进性和实用性。

基于态靶辨治代谢疾病智能辅助诊疗系统的研究与设计

目的:基于“态靶辨证”中医诊疗思维,利用人工智能技术为代谢病中医辅助诊疗提供智能化支持。方法:通过自然语言处理技术,对医学文献和专家经验进行信息抽取和实体识别,构建包含疾病状态、治疗靶点及相关辨证规则的术语知识库。在此基础上,利用图数据库和深度学习算法,构建态靶辨证知识图谱,表达不同疾病状态与治疗靶点之间的复杂关系。结果:通过模型训练和知识推理,结合病例的具体症状和体质,推荐相应的中医治疗方案,提高了代谢病辅助诊疗的准确性和效率。结论:本研究为中医辨证施治提供了新的方法和思路,不断迭代优化算法,拓展临床应用,推动中医药辅助诊疗的发展和完善,为中医药传承创新奠定良好的技术基础。

机器人辅助手术系统在新生儿外科住院医师规范化培训中的应用

目的探讨机器人辅助手术系统在新生儿外科住院医师规范化培训中的应用效果。方法选取浙江大学医学院附属儿童医院新生儿外科轮转的32名住院规范化培训医师作为研究对象,随机分成观察组和对照组,每组16名学员。观察组应用机器人辅助手术系统教学,对照组应用传统腹腔镜手术系统教学。出科时对两组学员进行考核,并对教学效果实施问卷调查评价。结果观察组学员的手术技能评分明显高于对照组,差异有统计学意义(t=6.97,P<0.05),观察组学员对机器人手术教学的满意度高于对照组,差异有统计学意义(χ^(2)=4.57,P<0.05)。观察组学员在提高自主学习能力、有助于消化道畸形理论知识与手术技能的衔接、有助于增加医学兴趣3个方面的教学效果评分高于对照组,差异均有统计学意义(t分别=4.95、3.35、6.79,P均<0.05)。结论机器人辅助手术系统在新生儿外科住院医师规范化培训临床教学中有一定的优势,主要体现在帮助住院规范化培训学员将理论知识与临床技能衔接、提高学习主动性和兴趣等方面。应用机器人辅助手术系统在日常教学中有助于新医科背景下的新生儿外科学科建设。

融合GPT和知识图谱的洪涝应急决策智能问答系统研究

为提高生成式预训练语言大模型(generative pre-trained transformer, GPT)的应急管理信息分析能力,以实现洪涝灾害应急处置过程中的在线辅助决策,提出融合GPT和知识图谱的应急决策智能问答系统(KG-GPT)。改进GPT架构以识别问题中的关键信息,利用知识图谱推理应急领域知识并生成具有逻辑性的回答;结合洪涝灾害的实际应急决策问答数据集并编制演练脚本,使用自动评估和专家评估方法将本系统与GPT进行对比实验。研究结果表明:该系统成功融合应急领域知识图谱和GPT模型,能够深刻理解问题的背景信息并生成流畅回答;与GPT相比,该系统可为决策者提供更快速准确的在线辅助决策工具。研究结果可提升洪涝灾害应急信息分析和决策效率。

“省属县用”改革下助理全科规培基地“分层督导式”教学门诊的实践研究

目的:探讨“分层督导式”教学门诊提升指导医师的教学能力的实践效果。方法:在助理全科规培基地开展“分层督导式”教学门诊,比较培训前后指导医师的SOAP病历批改及门诊带教能力的差异。结果:培训后指导医师在SOAP病历批改及门诊带教能力上均有显著提升。结论:“分层督导式”教学门诊可提升指导医师的教学能力。

家庭辅助训练联合分阶综合运动干预对注意缺陷多动障碍患儿核心症状及认知功能的影响

目的探讨家庭辅助训练联合分阶综合运动干预在注意缺陷多动障碍(ADHD)患儿中的应用价值。方法选取2021年1月至2023年2月九江市妇幼保健院收治的80例ADHD患儿作为研究对象,根据随机数字表法分为观察组(40例)和对照组(40例)。观察组采取家庭辅助训练联合分阶综合运动干预,对照组采取分阶段综合运动干预。比较两组的核心症状、认知功能、生活能力、家庭功能、干预效果及家属满意度。结果两组干预前的核心症状、认知功能、生活能力及家庭功能比较,差异无统计学意义(P>0.05)。干预后,观察组的Conners父母症状问卷(PSQ)评分低于对照组,父母养育方式评价量表(EMBU)评分高于对照组分,差异有统计学意义(P<0.05);瑞文标准推理测验(RSPM)评分低于对照组,婴儿-初中社会生活能力量表评分高于对照组,差异有统计学意义(P<0.05);观察组干预总有效率高于对照组,差异有统计学意义(P<0.05);观察组家属满意度高于对照组,差异有统计学意义(P<0.05)。结论家庭辅助训练联合分阶综合运动干预可以改善ADHD核心症状与认知功能,并提高生活能力、家庭功能,改善家属满意度。

基于虚拟现实技术的腹腔镜模拟操作训练与传统训练在小儿泌尿微创手术教学中的应用对比

目的:比较基于虚拟现实技术的腹腔镜模拟操作训练与传统训练在小儿泌尿微创手术教学中的应用效果。方法:回顾性分析2020年9月至2023年9月在上海交通大学医学院附属瑞金医院(传统组)及中国人民解放军总医院第七医学中心(混合组)参加小儿泌尿外科微创技术培训的学员参训数据,共24名学员纳入研究,其中传统组10名,混合组14名,均无腹腔镜主刀手术经验。传统组全程以传统腹腔镜训练模拟器进行训练,混合组采用传统腹腔镜结合LapSim虚拟现实技术进行训练。比较两组学员基线数据、项目结业考核手术操作及患者围术期数据,手术操作视频评分参考整体腹腔镜技能评分表(GOALS),由同一位考官进行评估。统计学方法采用t检验、卡方检验和Fisher精确检验。结果:两组学员的年龄、性别、学历、职称比较差异均无统计学意义(P值分别为0.576、1.000、1.000、0.615)。两组参加培训项目时长均为3个月(其中48学时操作训练)。考核手术为腹腔镜下睾丸下降固定术,两组平均手术时间、患儿术后1周超声情况比较差异均无统计学意义(P值分别为0.070、0.417);两组学员GOALS评分传统组平均为(16.4±1.3)分,混合组平均为(17.9±1.0)分,差异有统计学意义(t=3.312,P=0.003);两组GOALS评分分项双手协调性、操作效率、组织损伤控制、独立完成手术能力比较差异无统计学意义(P值分别为0.636、0.862、0.089、0.278);传统组深度感知评分平均为(3.2±0.6)分,混合组平均为(3.8±0.7)分,两组比较差异有统计学意义(t=2.103,P=0.047)。结论:综合利用传统腹腔镜训练模拟器结合虚拟现实模拟操作训练可以更加高效地进行儿童泌尿外科微创技术训练,具有一定的临床推广意义。

基于语料库的智能英语翻译研究

语料库研究强调客观性,智能英语翻译研究兼具主观性和客观性,决定了基于语料库的智能英语翻译研究面临知识结构有待完善、专业教育有待实施、人才核心竞争力有待提升等问题。鉴于智能英语翻译研究关乎国家话语权构建,需要国家、社会、高校、个人等主体各自发力,在储备智能翻译技术、语料库和英语翻译知识,提升跨文化沟通能力,促进语料库构建等方面发挥积极价值,推进中国智能英语翻译研究进一步发展。

早期悬吊保护下智能助行训练对脑卒中后运动和行走功能的效果

目的探讨脑卒中偏瘫患者早期应用悬吊保护下智能助力步行对下肢运动功能的康复效果。方法2020年10月至2023年3月,北京博爱医院脑卒中偏瘫早期住院患者42例,随机分为对照组(n=21)和试验组(n=21)。两组均接受常规康复,对照组在天轨悬吊保护下行常规步行训练,试验组在天轨悬吊保护下穿戴智能助力步行器进行训练,共4周。治疗前后,采用Fugl-Meyer评定量表(FMA)、FMA-平衡功能(FMA-B)和无线传感三维步态分析进行评定。结果训练后,两组患侧肢体FMA和FMA-B评分,步频、步速、患侧步长、患侧单支撑相、髋关节屈曲最大角度、膝关节屈曲最大角度均改善(|t|>2.230,P<0.05),且试验组优于对照组(|t|>2.140,P<0.05)。结论早期介入智能助力步行训练能更好提高脑卒中偏瘫患者运动、平衡和行走功能。

辅助坐站转移训练对重度脑瘫儿童运动功能的影响

目的:探讨辅助坐站转移训练对重度脑性瘫痪儿童运动功能的影响,为改善重度脑瘫儿童的运动功能提供临床依据。方法:纳入重度脑瘫儿童30例,按照随机数字表法分为研究组和对照组,每组15例。对照组采用目标导向性训练(GDT),研究组在GDT的基础上加用辅助坐站转移训练。治疗前及治疗1个月、3个月时对2组儿童进行粗大运动功能量表88项评估(GMFM-88)中的仰卧位与俯卧位(A区)和坐位(B区)、精细功能评估(FMFM)中视觉追踪(A区)和上肢关节活动(B区)和坐位能力(LSS)进行评估;比较2组儿童治疗前及治疗1个月、3个月后GMFM-88(A区与B区)、FMFM(A区与B区)及LSS评分的差异性。结果:2组患儿GMFM-A区、GMFM-B区、FMFM-A区、FMFM-B区及LSS评分结果显示组别与时间存在交互作用(F=158.406、326.724、462.387、698.547、177.029,均P<0.01)。治疗1个月及3个月后,2组的GMFM-A区、GMFM-B区、FMFM-A区、FMFM-B区及LSS评分均高于治疗前评分(P<0.05)。治疗1个月后,研究组LSS评分高于对照组(P<0.05);2照组在GMFM-88中A区与B区评分和FMFM中A区与B区评分的差异均无统计学意义。治疗3个月后,研究组的各项评分均高于对照组(P<0.05)。结论:辅助坐站转移训练可以提高重度脑性瘫痪儿童的粗大运动功能、坐位能力及精细运动功能。