氟西汀治疗脑卒中后抑郁76例

为探讨氟西汀(商品名百优解)治疗脑卒中后抑郁(PSD)的疗效。将76例脑卒中后抑郁(post-strokedepression,PSD)患者随机分为两组,分别应用常规治疗和加用氟西汀治疗4周,治疗前后应用汉密尔顿抑郁量表(HAMD)、简易精神状态检查表(MMSE)、自评抑郁量表(SDS)进行疗效评定。氟西汀组HAMD,MMSE,SDS评分的减分率明显优于对照组(P<0.01)。提示氟西汀治疗PSD有明确疗效。     

氟西汀治疗脑卒中后抑郁76例

为探讨氟西汀(商品名百优解)治疗脑卒中后抑郁(PSD)的疗效。将76例脑卒中后抑郁(post—stroke depression，PSD)患者随机分为两组，分别应用常规治疗和加用氟西汀治疗4周，治疗前后应用汉密尔顿抑郁量表(HAMD)、简易精神状态检查表(MMSE)、自评抑郁量表(SDS)进行疗效评定。氟西汀组HAMD，MMSE，SDS评分的减分率明显优于对照组(P&;lt;0．01)。提示氟西汀治疗PSD有明确疗效。     

卒中后抑郁的相关因素研究

目的分析卒中后抑郁(PSD)的发生率、相关因素及相关度。方法对68例急性脑卒中患者,采用自制一般情况调查表、Zung抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD)、简易精神状态量表(MMSE)、斯堪的纳维亚卒中量表(SSS)、美国国立卫生研究院卒中量表(NIHSS)、Barthel Index(BI)评分和改良的Rankin量表(mRS)评分,并用逐步Logistic回归统计方法对各相关因素进行分析。结果脑卒中发病2周时伴发PSD的发生率为32.4%,其中轻度抑郁27.9%,中度抑郁2.9%,重度抑郁1.5%;离异或丧偶、独自居住、性格内向,脑卒中病灶数量多、面积大,伴随冠心病及高C-反应蛋白,神经功能缺损程度高、日常生活能力差的患者,发生PSD的可能性更大。结论卒中后抑郁在脑卒中患者中较为常见,以轻中度为主,是生物、心理和社会因素共同作用的结果。     

缺血性脑卒中后抑郁患者现况及影响因素分析

目的:调查缺血性脑卒中后抑郁患者的现况及影响因素。方法:选取2018年4月1日～2020年6月1日治疗的缺血性脑卒中患者,于卒中后4周采用患者卒中后抑郁(PSD)发病率及9条目患者健康问卷(PHQ-9抑郁自评量表)、美国国立卫生研究院卒中量表(NIHSS)、日常生活活动能力评定量表(BI)、社会支持评定量表(SSRS)进行调查。将患者分为PSD组和非PSD组,比较两组患者临床资料,采用多元Logistics回归分析导致患者出现PSD的危险因素,并建立缺血性脑卒中患者发生PSD风险预测模型。结果:本研究纳入231例缺血性脑卒中患者,卒中后4周出现PSD者95例,发生率为41.13%;PSD组独居、自费、家庭人均月收入≤3000元、PHQ-9评分9分、NIHSS评分4分、BI评分60分、SSRS评分20分比例多于非PSD组(P0.05);经多元Logistics回归分析,独居、自费、家庭人均月收入≤3000元、NIHSS评分4分、BI评分60分、SSRS评分20分是导致缺血性脑卒中患者出现PSD的危险因素(P0.05),缺血性脑卒中患者出现PSD的多因素Logistics回归预测模型为P=1/(1+e~((0.537-0.293X_1-0.328X_2-0.402X_3-0.377X_4-0.631X_5-0.579X_6)))。结论:缺血性脑卒中患者PSD发生率为41.13%,独居、自费、家庭人均月收入≤3000元、NIHSS评分4分、BI评分60分、SSRS评分20分是导致缺血性脑卒中患者出现PSD的危险因素。     

氟西汀治疗急性脑卒中后抑郁症的临床观察

目的采用氟西汀(百优解)治疗脑卒中后抑郁症(PSD),观察百优解对PSD的疗效。方法PSD患者63例,按入院先后顺序随机分为2组,百优解治疗组42例,对照组21例。对照组给予常规脑血管病治疗,治疗组在此基础上加用百优解20mg,1次/d,连续口服4周。于治疗前后分别进行汉密顿(HAMD)评定量表、改良爱丁堡-斯堪的那维亚卒中量表(MESSS)评分进行评估。结果治疗组总有效率81.0%,对照组总有效率23.8%,经统计学处理有显著性差异(χ2=37.63,P<0.01)。结论氟西汀治疗卒中后抑郁症的效果较好,不但能改善患者的抑郁症状,还有利于患者神经功能缺损的康复。     

氟西汀治疗急性脑卒中后抑郁症的临床观察

目的 采用氟西汀（百优解）治疗脑卒中后抑郁症（PSD），观察百优解对PSD的疗效。方法 PSD患者63例，按入院先后顺序随机分为2组，百优解治疗组42例，对照组21例。对照组给予常规脑血管病治疗，治疗组在此基础上加用百优解20mg，1次/d，连续口服4周。于治疗前后分别进行汉密顿（HAMD）评定量表、改良爱丁堡-斯堪的那维亚卒中量表（MESSS）评分进行评估。结果 治疗组总有效率81.0%，对照组总有效率23.8%，经统计学处理有显著性差异（x^2=37.63,P&;lt;0.01）。结论 氟西汀治疗卒中后抑郁症的效果较好，不但能改善患者的抑郁症状，还有利于患者神经功能缺损的康复。     

卒中单元病房综合治疗脑卒中后抑郁状态的疗效

目的：探讨卒中单元病房综合治疗对脑卒中后抑郁状态的疗效。方法：随机抽取卒中单元病房的脑卒中患者450例为卒中组和普通神经内科住院的脑卒中患者180例为对照组,均采取常规药物治疗;卒中组同时配合综合康复治疗,包括肢体运动康复、语言训练、心理康复和健康教育等。将2组患者的PSD发生率进行比较,对有PSD患者进行治疗,并比较疗效。结果：治疗2周后,卒中组患者PSD的发生率低于对照组（P〈0.01）;治疗8周后,卒中组PSD患者汉密尔顿抑郁量表（HAMD）评分与治疗前及与对照组PSD患者比较均明显降低（P〈0.01）。结论：在卒中单元病房综合康复治疗能降低卒中后PSD的发生率,并能显著改善PSD患者HAMD评分,提高临床疗效。     

老年脑卒中后抑郁患者28例心理康复治疗

为研究老年人脑卒中后抑郁(post-strokedepressionPSD)的发生率及心理康复对其治疗效果。对80例脑卒中患者用老年抑郁量表(GDS)和Zung氏抑郁自评量表(SDS)进行评定,对抑郁患者心理康复治疗6周后再行GDS和SDS评定。80例脑卒中患者中,28例(35%)并发抑郁,经心理康复治疗6周后,28例中24例评分恢复正常,有效率86%。老年人PSD发生率相当高,心理康复治疗PSD疗效显著。     

综合康复治疗脑卒中后抑郁的临床观察

目的：探讨脑卒中后抑郁(PSD)的发生率及综合康复治疗的疗效。方法：采用Zung抑郁自评量表(SDS)和汉密尔顿抑郁量表(HAMD)对120例脑卒中患者进行抑郁状态评定．对其中患有PSD的患者进行康复训练、康复护理和药物等综合治疗。采用Fugl—Meyer运动功能和Barthel指数积分法评测治疗前后的疗效。结果：120例患者中有38例PSD（31．67％），综合康复治疗后PSD患者HAMD评分明显改善，Fugl-Meyer评分和Barthel指数显著提高。结论：PSD严重影响脑卒中患者的康复，综合康复治疗能显著改善PSD症状．提高临床疗效。     

氟西汀对脑卒中后抑郁及神经功能康复的影响

目的：观察抗抑郁剂氟西汀（百优解）对脑卒中后抑郁及神经功能康复的影响。方法：对46例脑卒中后抑郁患者,随机分为氟西汀治疗组（23例）和对照组（23例）。在治疗前和治疗后3周、6周分别进行改良爱丁堡-斯堪的那维亚卒中量表（MESSS）和汉密尔顿抑郁量表（HAMD）评分。结果：与对照组相比,治疗组HAMD评分和MESSS评分的减分率均较高,疗效明显优于对照组。结论：氟西汀可明显改善脑卒中后抑郁症状,也能促进神经功能的康复,且副作用小。     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.