依达拉奉(MCI-186)治疗急性脑梗死的临床观察

目的:观察依达拉奉(MCI 186)治疗急性脑梗死(ACI)的临床疗效。方法:选择发病72 h内的ACI患者72 例,随机分为依达拉奉治疗组33例和对照组39例。治疗组应用依达拉奉静脉给药,剂量为30mg,2次/d,共计14d,余治疗与对照组相同。治疗前后对患者进行改良爱丁堡斯堪的那维亚量表(SSS)及日常生活能力(ADL)的测定。结果:治疗14 d后,治疗组SSS由治疗前的(20.83±11.36)下降到治疗后的(7.83±8.72),具有显著差异(p<0.01);对照组SSS由治疗前的(21.56±10.27)下降到治疗后的(12.56±7.36),具有显著差异(p<0.05);两组治疗后相比具有显著差异(p<0.05)。治疗组ADL由治疗前的(35.36±23.45)上升到治疗后的(68.46±28.43),具有显著差异,(p<0.01);对照组ADL由治疗前的(33.53±20.70)上升到治疗后的(52.72±24.81),具有显著差异,(p<0.01);两组治疗后相比具有显著差异(p<0.05)。治疗组无不良反应。结论:依达拉奉治疗急性脑梗死安全有效。     

依达拉奉(MCI-186)影响大鼠局灶性脑缺血组织氧化还原蛋白表达的作用

目的:通过自由基清除剂依达拉奉(MCI-186)对大鼠局灶性缺血性脑组织中氧化还原蛋白的表达以及对局灶性脑梗死面积的影响探讨其对大脑缺血性损伤的保护机制。方法:实验于2004-05/09在第一军医大学珠江医院全军神经医学研究所进行。取健康雄性SD大鼠60只,其中的12只被随机分为MCI-186组和对照组,每组6只,用于脑梗死面积的比较;余下的48只,随机分为正常组,假手术组,脑缺血1,6,12,24,48h组及MCI-186组8组,每组6只,用于免疫组织化学观察。除正常组和假手术组外,其他48只大鼠均采用线栓法制成局灶性脑缺血模型,两个MCI-186组于脑缺血术后30min及12h由鼠尾静脉注射MCI-186(0.3mg/kg)。采用TTC染色、免疫组织化学染色等技术,观察MCI-186对脑梗死面积、半暗带区脱嘌呤脱嘧啶核酸内切酶(DNA修复的多功能蛋白酶)/氧化还原因子1蛋白(氧化还原因子)表达水平的影响。结果:经随机补充后60只大鼠进入结果分析。①脑梗死面积:MCI-186组较对照组明显缩小[(31.2±2.3),(46.5±8.6)mm2,t=4.236,P=0.002]。②半暗带脱嘌呤脱嘧啶核酸内切酶/氧化还原因子1蛋白的表达:自缺血1h始,其表达即开始减少,至48h减少达到高峰,与正常组比差异显著[(25.9±4.7),(74.8±7.3)个/mm2,F=99.4,P=0.000297],MCI-186能增加其阳性表达[(45.8±4.3)个/mm2,P<0.05]。结论:MCI-186可通过上调缺血脑组织中脱嘌呤/脱嘧啶核酸内切酶的表达水平,增强脑组织对缺血引起的氧自由基损伤的修复能力,缩小梗死范围,因而对缺血性脑损伤具有保护作用。     

Cerebrolysin改善缺血性脑卒中患者神经功能和生活能力的随机双盲研究

目的:评价Cerebrolysin对缺血性脑卒中后早期、恢复期的临床疗效。方法:对60例缺血性脑卒中患者在早期恢复期行随机、双盲及安慰剂对照的前瞻性研究。分为Cerebrolysin组(A组)和安慰剂组(B组),以临床神经功能缺损量表(CSS)、简易智力状态量表(MMSE)、日常生活能力量表(ADL)、总的生活能力状态(TLS)的变化为评价指标;并以副反应量表(DOTES和TWIS)评定药物的副反应。结果:60例患者脱落2例(脱落率3%,2/60),剔除1例(剔除率2%1/60)。治疗后两组间比较,MMSE评分治疗组优于对照组(22.2±5.比22.0±6.6,P=0.0314)。其他3项量表差异无显著性意义。组内治疗前后比较:CSS(A组:23.7±6.3比15.1±8.8;B组:25.2±6.8比16.0±8.1);ADL(A组:46.3±7.0比39.6±12.8;B组:45.7±9.4比39.7±11.6);TLS(A组:4.4±0.8比3.7±1.3;B组:4.5±0.8比3.5±1.3);MMSE(A组:17.8±5.2比22.2±5.6;B组22.0±7.0比22.0±6.6),差异均有非常显著性意义。结论:Cerebrolysin对缺血性卒中后早期恢复期的认知功能的恢复有益。     

脑白质疏松症对脑梗死康复的影响

目的　探讨脑白质疏松症 (LA)对脑梗死康复的影响。方法　 74例脑梗死偏瘫患者根据MRI有否LA分为两组 :脑梗死合并LA组 (A组 ) 36例 ,脑梗死不伴LA组 (B组 ) 38例 ,均采用综合康复治疗 ,治疗前及治疗 8周后评定偏瘫肢体运动功能 ADL能力 步行能力和高级脑机能。结果　康复治疗前长谷川智能评分 ,A组 2 3 .8± 4 .6 ,B组 2 7.3± 4 .8,两组差异有显著性 (P <0 .0 5) ;肢体运动功能 ADL能力和步行能力两组差异均无显著性 (P >0 .0 5)。治疗 8周后A组不能步行从治疗前 75 %下降至治疗后 2 2 % ,独立步行从 0 %提高至 2 5 % ,B组不能步行从 74%下降至 1 3 % ,独立步行从 0 %提高至 40 % ,两组比较差异有显著性 (P <0 .0 5) ;两组偏瘫肢体运动功能较治疗前明显改善 ,均P <0 .0 5 ,但偏瘫肢体运动功能恢复两组差异无显著性 (P >0 .0 5) ;ADL积分A组从 31 .6± 1 0 .7提高至 64 .1± 1 6 .8,B组从 32 .3± 1 1 .4提高至 71 .5± 1 8.3 ,差异有显著性 (P <0 .0 5) ;A组的康复效率 (0 .54± 0 .0 8)明显低于B组 (0 .65± 0 .0 9) ,差异有显著性(P <0 .0 5)。结论　LA能够影响脑梗死患者日常生活能力和步行能力的恢复     

针刺结合功能训练对脑梗死恢复期患者日常生活能力的影响

目的:探讨针刺百会穴结合功能训练对脑梗死患者ADL能力的影响。方法:96例恢复期脑梗死患者随机分为A、B组各48例,均按脑梗死常规处理,并结合康复程序进行功能训练;A组同时加以针刺治疗,以百会穴为主。于治疗前、治疗30、90d时采用神经功能缺损评定量表和改良Barthel指数评定患者神经功能缺损程度和ADL。结果:2组患者神经功能缺损评分在治疗后30及90d时分别与前一次评分比较均明显降低(均P<0.01);改良Barthel指数评分均明显提高;2组间比较,A组均优于B组(P<0.05)。结论:脑梗死患者在药物及功能训练的基础上结合针刺百会穴可显著提高临床疗效,降低神经功能缺损程度,促进ADL自理能力的提高。     

奥扎格雷钠联合疏血通治疗急性脑梗死疗效观察

目的:研究奥扎格雷钠联合疏血通治疗急性脑梗死的临床疗效.方法:将2006年1月至2008年12月发病时间在6～72 h以内的急性脑梗死患者100例随机分成A、B两组各50例,分别接受奥扎格雷钠联合疏血通治疗及复方丹参联合银杏叶治疗10～14 d,并适当脱水、降压等对症治疗.对两组治疗前及治疗后90d的神经功能缺损程度评分(NIHSS)、日常生活能力评分(ADL)及不良反应进行比较.结果:治疗后90 d时,A组NIHSS评分、ADL评分均明显优于B组,P均<0.05;两组均无明显不良反应.结论:奥扎格雷钠联合疏血通治疗急性脑梗死可明显改善神经功能,提高日常生活能力.     

长春西汀对老年急性脑梗死患者血流动力学及神经功能缺损程度的影响

目的:观察长春西汀治疗老年急性脑梗死的临床疗效及可能作用机制。方法:中南大学湘雅二医院老年病和神经内科收治70例老年急性脑梗死患者(排除并发脑出血,低血压患者)随机分为治疗组和对照组,治疗组给予长春西汀治疗,对照组用维脑路通治疗。治疗前后分别测定双侧大脑中动脉(MCA)血流动力学参数,进行神经功能缺损评分及日常生活能力评价,并观察临床疗效。结果:长春西汀治疗组治疗后MCA血流动力学参数有明显改善(P<0.01),神经功能缺损评分和日常生活能力评价(ADL评分)分别是7.14±1.33和93.05±1.77,较治疗前16.74±2.13和53.02±1.81有明显改善(P<0.01),临床疗效较维脑路通佳(P<0.05)。结论:长春西汀对老年脑梗死者MCA血流动力学参数有明显改善,是治疗老年脑梗死安全有效的药物。     

MRI指导下急性脑梗死降纤治疗规范探讨

目的:探讨在MRI指导下规范化巴曲酶治疗急性脑梗死的临床疗效及安全性评价。方法:符合人选及排除标准的6-72h内急性脑梗死患者30例,根据本研究制定的规范方案分别接受20-30U的巴曲酶治疗(治疗组),并与同期未接受巴曲酶治疗的30例急性脑梗死患者(对照组)对比研究。分别观察治疗前后的ESS评分、Barthel指数评定、MRI和MRA变化并进行安全性评价。结果:①治疗前治疗组的ESS评分是66.98±16.99,对照组的ESS评分是65.32±16.48,无显著差异(P>0.05);治疗7d后两组的ESS评分分别为77.91±18.62和68.14±17.56(P<0.05);治疗21d后两组的ESS评分分别是84.12±17.18和76.89±19.32(P<0.01);治疗90d后两组的ESS分别为91.76±14.05和80.07±15.90(P<0.01),两组之间具有极显著差异。②治疗前治疗组和对照组的梗死面积分别为3.17±2.87cm2和2.81±2.33cm2(P>0.05)。治疗后治疗组和对照组的梗死面积分别为2.43±2.51cm2和2.70±2.41cm2,治疗组治疗前后梗死面积比较有显著差异(P<0.05),对照组治疗前后梗死面积比较无明显差异(P>0.05)。③在治疗组有4例患者在治疗前MRA显示大脑中动脉(MCA)阻塞,治疗后MRA均显示血管再通。④巴曲酶治疗组无一例并发症发生。结论:在MRI指导下,利用巴曲酶进行急性脑梗死的规范化降纤治疗是安全、有效的。     

重复经颅磁刺激治疗脑卒中后复杂性区域性疼痛综合征的疗效观察

目的 观察重复经颅磁刺激(rTMS)治疗脑卒中后复杂性区域性疼痛综合征(CRPS)患者的疗效。 方法 选取2015年6月至2017年7月在我院康复科住院治疗的脑卒中后CRPS患者40例,按照随机数字表法将患者分为对照组和治疗组,每组20例。治疗组接受rTMS结合肢体康复治疗,对照组接受肢体康复治疗和rTMS假刺激。治疗前、治疗4周及6周后,采用视觉模拟评分法(VAS)、Fugl-Meyer量表（FMA）、日常生活活动（ADL）能力量表对2组患者进行评定。 结果 2组患者治疗前VAS、FMA、ADL评分比较,差异无统计学意义（P>0.05）。与组内治疗前比较,治疗组治疗4周后及6周后VAS评分显著较低（P<0.05）、FMA评分及ADL评分显著较高(P<0.05）。对照组治疗4周后及6周后VAS评分与组内治疗前比较,差异无统计学意义（P>0.05）。对照组治疗4周后FMA评分、ADL评分与组内治疗前比较,差异无统计学意义（P>0.05）,治疗6周后FMA评分、ADL评分显著高于组内治疗前（P<0.05）。治疗组患者治疗4周后VAS评分［（4.35±1.63）分］显著低于对照组(P<0.05)、FMA评分［（31.95±10.96）分］及ADL评分［（53.45±12.83）分］及6周后VAS评分［（4.65±1.53）分］显著低于对照组(P<0.05)、FMA评分［（33.25±10.90）分］及ADL评分［（53.78±11.05）分］显著高于对照组(P<0.05)。 结论 rTMS对脑卒中后CRPS患者的肢体运动功能和疼痛有良好的改善作用。     

高频与低频重复经颅磁刺激对脑梗死患者认知功能的影响

目的观察高频3Hz与低频0.5Hz重复经颅磁刺激(rTMS)对脑梗死后认知障碍患者认知功能的影响。 方法采用随机数字表法将90例脑梗死后认知功能障碍患者分为低频(0.5Hz)rTMS组、高频(3Hz)rTMS组及对照组，每组30例。3组患者均给予常规药物治疗及认知功能训练，低频rTMS组、高频rTMS组在此基础上分别给予相应频率rTMS治疗，对照组则给予rTMS假刺激治疗，均持续治疗4周。于治疗前、治疗4周后分别采用蒙特利尔认知评估量表（MoCA）及改良Barthel指数（MBI）对各组患者认知功能及日常生活活动（ADL）能力进行评定，同时检测入选患者事件相关电位P300潜伏期及波幅改善情况。 结果治疗前3组患者MoCA、MBI评分、P300潜伏期及波幅组间差异均无统计学意义(P>0.05)；治疗后3组患者MoCA、MBI评分及P300潜伏期、波幅均较治疗前明显改善(P<0.05)；并且治疗后高频rTMS组、低频rTMS组MoCA评分［分别为(29.6±6.6)分、(28.2±6.7)分］、MBI评分［分别为(55.7±6.1)分、(54．3±6.3)分］、P300潜伏期［分别为(346.4±18.5)ms、(348.7±18.4)ms］及P300波幅［分别为(9.8±3.5)μV、(9.1±3.6)μV］均显著优于对照组水平，组间差异均具有统计学意义（均P<0.05）；治疗后高频rTMS组与低频rTMS组上述指标组间差异仍无统计学意义（P>0.05）。 结论0.5Hz及3Hz rTMS均能显著改善脑梗死患者认知功能，提高其ADL能力，该疗法值得临床推广、应用。     

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.     

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.     

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.     

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.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."