脑外伤患者的认知功能训练

目的 观察认知训练对脑外伤患认知功能的影响，为患全面康复提供帮助。方法 46例脑外伤患分为两组，治疗组采用记忆训练、综合分析能力训练等认知训练方法；对照组不进行认知训练，其余治疗措施两组相同。于入院时和2个月后对两组患进行采用韦氏成人智力测验（WAIS－RC）测评。结果 治疗组治疗前后、治疗组与对照组相比较，WAIS－RC得分均明显提高，差异有显性意义（P＜0．01）。对照组各成分得分首次与第二次相比较差异无显性意义（P＞0．05）。结论 认知训练能改善脑外伤患的认知功能，有助于患全面康复。     

精神分裂症患者内隐记忆变化临床实验研究

目的 探讨精神分裂症患者的内隐记忆变化.方法 将80例精神分裂症患者设为研究组,抽取同期社区健康志愿者80名设为对照组,采用修正的加工分离记忆实验程序测评两组记忆功能.结果 研究组文字概念和图像概念驱动实验的内隐记忆成绩显著低于对照组(P＜0.01),文字知觉和图像知觉驱动实验的内隐记忆成绩与对照组比较差异无显著性(P＞0.05);文字概念、图像知觉和图像概念驱动实验的外显记忆成绩均显著低于对照组(P＜0.01),文字知觉驱动实验的外显记忆成绩与对照组比较差异无显著性(P＞0.05).两组不同性别被试各驱动实验的内隐记忆成绩差异均无显著性(P＞0.05).结论 精神分裂症患者的内隐记忆存在不同程度的受损.     

脑卒中后抑郁对早期神经功能康复的影响

目的：研究脑卒中后抑郁（PSD）对早期神经功能康复的影响，方法：根据汉密尔顿抑郁量表（HAMD）标准将64例初发脑卒中患分为抑郁组和非抑郁组进行研究，4周后比较简式Fugl_Meyer(FMA),Barthel指数（BI），临床神经功能缺损程度（CNS），认知功能（MMSE）量表的评分，结果：抑郁组和非抑郁组比较CNS评分无显性差异（P＞0．05），而MA和BI，MMSE评分有显性差异（P＜0．05和P＜0．01），结论：PSD对患早期日常生活活动能力（ADL），认知功能及运动功能的恢复有明显的负面影响，临床上应重视PSD的早期防治。     

无症状性脑梗死患者智能、记忆和情感的相关性

目的：探讨无症状性脑梗死（asymptomatic cerebral infarction,ACI)与智能、记忆和情感的关系。方法：采用龚氏修订的韦氏成人智力量表中国版、记忆量表中国版、抑郁及焦虑自评量表，对60例ACI患及相匹配的40例正常对照组以及50例症状性脑梗死（symptomatic cerebral infarction,SCI)组进行检查研究。结果：ACI组大部分分测验值明显低于正常对照组（P＜0．01－0．05），但与SCI组无显差异；38例智力低于正常，其中14例出现智能障碍；47例记忆力低于正常，其中记忆障碍25例；不同梗死区域及数量有认知功能损害的特点；ACI组抑郁发生率及SDS标准分均明显高于正常对照组（P＜0．01），SAS标准分与正常对照组比较无差异；有抑郁症状29例；抑郁组各智商及记忆商显低于正常组（P＜0．01），非抑郁组语言智商（verbal intelligence quotient,VIQ)显低于正常组（P＜0．05）。结论：ACI患存在明显认知功能障碍，多发性梗死、双侧梗死和抑郁情绪更易产生认知功能障碍。     

脑弥漫性轴索损伤康复疗效的探讨

目的：探讨脑弥漫性轴索损伤的康复疗效。方法：对24例住院的脑弥漫性轴索损伤患者，分别于康复治疗前及治疗1个疗程（3个月)后进行肢体运动功能、步行能力、日常生活活动能力（ADL）及认知功能的评定。结果：康复前后手运动功能无明显变化（P＞0．05），上肢运动功能改善有显著性差异（P＜0．05），下肢运动功能及步行能力改善有高度显著性差异（P＜0．01），ADL能力及认知功能改善有非常高度显著性差异（P＜0．001）。结论：综合性康复治疗对患侧手运动功能改善不明显，对患侧上、下肢运动功能及步行能力改善明显，并可提高ADL能力及认知功能。     

老年脑卒中偏瘫患者的早期康复疗效观察

目的：观察早期主动性康复治疗对老年脑卒中偏瘫患运动功能恢复的影响。方法：选择符合研究条件的老年脑卒中患62例，康复组32例，对照组30例。在残损和残疾两个水平上评测患功能，比较康复治疗后两组间的功能。结果：初次评测的各主要指标两组间无明显差别（P＞0．10）；末次评测：Fugl-Meyer测评（FMA）上肢、FMA下肢和反应运动功能（FIM运动）等项目，两组间有显性差异（P＜0．05）。结论：早期主动性的康复治疗可以促进老年脑卒中偏瘫患的运动功能的改善。     

脑外伤记忆康复的新途径——内隐记忆

目的：本研究探讨脑外伤患内隐记忆和外显记忆，为心理康复训练提供理论依据。方法：用1：1配对法对25例脑外伤患及相应的正常人进行模糊图辨认和再认的记忆测验。结果：与正常对照组相比，脑外伤患再认成绩明显下降．模糊图辨认成绩无显差异。结论：脑外伤患外显记忆受损．内隐记忆存在。     

石杉碱甲对轻度认知损伤患者记忆功能的影响

目的：研究百杉碱甲对遗忘型轻度认知损伤(mild cognitive impairment.MCI)患者内隐和外显记忆功能的影响,为MCI患者的记忆功能康复训练提供理论依据。方法：共入选20例遗忘型MCI患者，为2002—01／2003—01解放军总医院南楼冲经科收治患者，随机分为治疗组和非治疗组各10例。两组均维持既往基础用药，治疗组10例在此基础上每日口服石杉碱甲0.mg，连续12周，用药前后均行外显和内隐记忆功能评定。结果：遗忘型MCI患者存在语义性启动效应和知觉性启动效应，用药后治疗组的自由回忆正确率变化幅度(0．07&;#177;0．04)较非治疗组(0.01&;#177;0.05)大，差异有显著性意义(P&;lt;0.05)，再认正确率的变化幅度(0.08&;#177;0.06)较非治疗组(0．03&;#177;0.04)大，差异有显著性意义(P&;lt;0.05)，而语义启动效应、知觉启动效应的变化幅度则差异没有显著性意义(P&;gt;0．05)。结论：石杉碱甲对遗忘型MCl患者外显和内隐记忆具有不同影响，提示多重记忆系统的存在，同时也为MCI患者的记忆康复治疗提供理论依据。     

综合康复对脑损伤患者恢复期功能及能力的影响

目的 探讨综合康复对脑损伤患恢复期功能及能力的影响。方法 90例患被随机分3组，每组30例。综合康复组（C组）接受综合康复治疗（药物＋OT＋PT＋ST＋认知＋高压氧）。单一康复治疗组（B组）只接受部分康复项目，不接近认知训练。单纯治疗组（A组）只接受单纯药物治疗。结果 3个月后C组较B组有A组在认知及日常生活能力方面有非常显性差异（P＜0．01），在肢体功能上有显性差异（P＜0．05）。结论 综合康复对脑损伤患恢复期功能及能力的影响较单一康复和单纯药物治疗有非常显的疗效。     

脑卒中康复运动功能评定量表的临床应用分析

目的：运动脑卒中康复运动功能评定量表（stroke rehabilitation assessment of movement,STREAM）比较脑卒中偏瘫患者患侧上、下肢运动功能损害程度、恢复结果以及不同临床特征偏瘫患者运动功能恢复的差异。方法：用STREAM方法对114例脑卒中偏瘫患者治疗前、后进行评定并进行统计分析。结果：康复治疗前、后STREAM平均上、下肢运动分无明显差异（P＞0．05），平均下肢改变值和恢复效率高于上肢（P＜0．05）。病程≤1个月的脑卒中患者其治疗后的平均STREAM总分、改变值和效率均高于病程＞1个月的患者（P＜0．05）。年轻患者（＜65岁）的平均STREAM改变值和恢复效率均高于年老组（≥65岁）。脑出血患者平均STREAM改变值高于脑梗死患者（P＜0．05）。男、女患者间以及不同偏瘫侧患者间的运动功能恢复结果无明显差异（P＞0．05）。结论：脑卒中偏瘫患者偏瘫侧下肢运动功能恢复的幅度和速度都高于上肢。早期康复的结果和治疗效率要好于延迟康复的患者。年轻患者运动功能恢复的幅度和速度要优于年老患者。故在康复治疗初期，制定训练计划和进行训练时应考虑脑卒中患者偏瘫侧上、下肢恢复的差异以及患者病程、年龄等因素的差异。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.