重复经颅磁刺激对脑卒中患者认知功能和心理状态影响

目的观察重复经颅磁刺激对脑卒中患者认知功能和心理状态的影响。方法60例脑卒中患者随机分为对照组和观察组。对照组29例,给予常规康复治疗;观察组31例,在常规康复治疗基础上,联合重复经颅磁刺激治疗,均治疗6周。分别采用美国国立卫生研究院卒中.量表(NIHSS)、简易智力状态检查表(MMSE)、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评价治疗前后两组患者的认知功能、心理状态。结果两组患者治疗后NIHSS评分、HAMA评分、HAMD评分均较治疗前降低(P<0.05),观察组改善程度优于对照组(P<0.05)。两组患者治疗后MMSB评分均较治疗前升高(P<0.05),观察组改善程度优于对照组(P<0.05)。结论重复经颅磁刺激能够有效改善脑卒中患者认知功能,缓解患者抑郁和焦虑症状。     

低频电针联合经颅直流电刺激治疗难治性抑郁症的效果分析

目的：探究低频电针联合经颅直流电刺激治疗难治性抑郁症的效果。方法：选择2018年6月~2020年2月于商丘市第二人民医院治疗的90例难治性抑郁症患者作为研究对象，以随机数字表法分为对照组和观察组，各45例。对照组给予经颅直流电刺激治疗，观察组给予低频电针联合经颅直流电刺激治疗，疗程为4周。对比两组治疗前、治疗4周时汉密尔顿抑郁量表（HAMD）评分及脑源性神经营养因子（BDNF）水平。结果：治疗4周，两组HAMD评分均较治疗前降低，且观察组较对照组低（P＜0.05）。治疗4周，两组BDNF水平均较治疗前升高，且观察组较对照组高（P＜0.05）。结论：低频电针联合经颅直流电刺激治疗难治性抑郁症患者的效果较好，可有效改善患者抑郁症状，提高BDNF水平。     

经颅超声-神经肌肉刺激治疗联合依达拉奉对 急性脑梗死患者情绪障碍的影响

目的:研究经颅超声-神经肌肉刺激治疗联合依达拉奉对急性脑梗死患者情绪障碍的影响。方法:急性脑梗死患者80例纳入研究,随机分为2组。在脑梗死常规治疗的基础上,对照组加用依达拉奉,观察组联合使用依达拉奉和经颅超声-神经肌肉刺激治疗。于治疗前、后,采用美国国立卫生院脑卒中量表(NIHSS)评价患者神经功能;采用汉密尔顿抑郁量表(HAMD)17项和汉密尔顿焦虑量表(HAMA)14项版本评估患者的心理障碍情况。结果:观察组的有效率明显高于对照组(P0.05);治疗后,对照组HAMD和HAMA各项评分与治疗前差异无统计学意义(P0.05),观察组HAMD和HAMA各项评分均低于同组治疗前,且低于对照组(P0.05)。结论:依达拉奉联合经颅超声-神经肌肉刺激治疗可以明显改善急性脑梗死患者的神经功能缺损,并有助于缓解情绪障碍。     

经颅直流电刺激治疗轻中度焦虑和抑郁障碍共病患者的随机对照研究

目的：探讨经颅直流电刺激（tDCS）治疗轻中度焦虑和抑郁障碍共病的临床效果。方法：选取焦虑和抑郁障碍共病患者49例,随机分为观察组25例和对照组24例,分别进行经颅直流电刺激和假刺激治疗。比较2组患者治疗前后的汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评分,临床总体疗效及并发症发生情况。结果：与治疗前比较,观察组HAMA、HAMD评分在治疗1周后明显降低（P<0.05）,而且治疗后2、4周呈持续性降低（P<0.05）;对照组患者在治疗2周后才出现明显降低（P<0.05）,治疗后4周亦低于治疗后2周评分（P<0.05）。治疗后1、2、4周观察组的HAMA、HAMD评分均分别低于对照组（P<0.05）。2组患者临床疗效比较,观察组总有效率显著高于对照组（P<0.05）。2组并发症发生率差异无统计学意义。结论：tDCS治疗焦虑和抑郁障碍共病疗效显著,起效迅速,安全性好,值得临床推广应用。     

重复经颅磁刺激对无抽搐电休克所致记忆损害抑郁症患者的效果研究

目的观察重复经颅磁刺激(r TMS)对无抽搐电休克(MECT)所致记忆损害抑郁症患者的效果。方法将80例抑郁症患者随机分为2组,每组40例。对照组采用MECT联合r TMS治疗,观察组采用MECT联合r TMS治疗。比较2组治疗前、治疗1 d、治疗1周、治疗2周、治疗1个月的韦氏记忆量表(WMS)相关维度评分,比较2组治疗前后汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分,统计2组患者治疗期间的不良事件。结果 2组患者治疗1 d时WMS评分中再认、图片、联想及背数维度评分均低于治疗前、治疗1个月时评分,观察组治疗1 d、治疗1周的再认、图片维度评分均高于对照组,治疗1 d、治疗1周、治疗2周的联想、背数维度评分均高于对照组,差异均有统计学意义(P 0.05)。2组患者治疗后HAMD、HAMA评分均低于治疗前,且观察组患者治疗后HAMD、HAMA评分低于对照组患者,差异有统计学意义(P 0.05)。2组患者不良反应发生率差异无统计学意义(P 0.05)。结论抑郁症患者采用r TMS联合MECT治疗的效果更佳,能有效改善患者记忆力损害情况和心理状态,并且不会增加不良事件的发生。     

经颅电刺激联合黛力新治疗脑卒中后抑郁的临床观察

目的观察经颅电刺激联合黛力新治疗脑卒中后抑郁的临床疗效。方法脑卒中后抑郁患者62例,按数字随机法分为联合组和黛力新组各31例,两组患者均给予氟哌噻吨/美利曲辛片剂(黛力新)药物口服,联合组加用经颅电刺激治疗仪治疗。抑郁评分采用汉密尔顿抑郁量表(HAMD)及抑郁自评量表(SDS)评定。结果治疗前两组患者HAMD和SDS评分差异无显著性(P>0.05),治疗后两组患者HAMD和SDS评分均较治疗前明显降低(P<0.05),且联合组优于对照组(P<0.05)。结论经颅电刺激联合黛力新治疗脑卒中后抑郁安全有效,操作简便易行。     

经颅微电流刺激疗法辅助治疗抑郁症的疗效研究

目的:观察抗抑郁药联合经颅微电流刺激疗法(CES)治疗急性期抑郁症患者的疗效和安全性。方法:80例抑郁症患者,随机分为CES组和对照组各40例,2组均给予抗抑郁药,CES组还给予CES,治疗6周。采用17项汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评价症状严重程度,并进行威斯康星卡片分类测验(WCST)评估认知功能,副反应量表(TESS)评价药物不良反应。结果:CES组38例、对照组37例完成研究。2组治疗后HAMD和HAMA评分较治疗前均降低(P<0.01);第6周2组间的有效率和痊愈率差异无统计学意义(P>0.05);第4周CES组的有效率高于对照组,差异有统计学意义(P<0.05)。2组不良反应差异无统计学意义(P>0.05)。结论:CES辅助治疗抑郁症具有较好的安全性,且起效快,疗效确切。     

重复经颅磁刺激对中晚期帕金森病患者睡眠及血浆食欲素-A含量的影响

目的观察重复经颅磁刺激(rTMS)对中晚期帕金森病(PD)患者睡眠及血浆食欲素-A含量的影响, 并探讨血浆食欲素-A含量变化与患者睡眠障碍改善情况的相关性。方法采用随机数字表法将102例中晚期PD患者分为观察组及对照组, 每组51例。2组患者均常规给予抗PD药物治疗, 观察组在此基础上辅以高频rTMS治疗, 磁刺激部位为左侧前额叶背外侧皮质区(DLPFC), 对照组则给予假rTMS治疗。2组患者均每日治疗1次, 每周治疗5 d, 连续治疗4周。于治疗前、治疗4周后分别采用匹茨堡睡眠质量指数(PSQI)、REM睡眠行为异常问卷-香港版(RBDQ-HK)、Epworth嗜睡量表(ESS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和PD生活质量量表(PDQ-39)对2组患者睡眠情况、焦虑-抑郁程度及生活质量等进行评定, 同时采集2组患者清晨空腹静脉血, 检测对比其血浆食欲素-A含量。结果治疗后观察组患者PSQI、RBDQ-HK、ESS、HAMA、HAMD及PDQ-39评分[分别为(8.02±3.01)分、(16.58±6.91)分、(7.27±4.03)分、(13.51±2...     

高、低频重复经颅磁刺激联合舍曲林治疗帕金森病患者伴抑郁的疗效研究

目的比较高频与低频重复经颅磁刺激联合舍曲林治疗帕金森病(PD)患者伴抑郁的临床疗效和安全性。方法70例帕金森病伴抑郁患者在舍曲林治疗基础上以随机数字表分为3组,低频刺激组(n=22)给予左前额叶背外侧rTMS治疗,刺激频率1Hz;高频刺激组(n=25)给予右前额叶背外侧rTMS治疗,刺激频率10Hz;假刺激组(n=23)随机给予左右侧相应部位伪刺激治疗,治疗前及治疗3周末采用汉密尔顿抑郁量表(HAMD-17)和帕金森病统一评分量表(UPDRS)对3组患者进行评分。观察各量表评分相对基线值的变化情况并进行组间比较,记录各组治疗期间的不良反应。结果入组时,3组患者间HAMD得分和UPDRS得分差异无显著性(P>0.05)。干预后,假刺激组无明显改变;低频刺激组和高频刺激组患者HAMD得分和UPDRS得分均明显较入组时改善,差异有统计学意义(P<0.05);而高频刺激组患者HAMD得分比低频刺激组患者更低,差异有统计学意义(P<0.05)。结论前额叶的高频与低频重复经颅磁刺激均具有改善帕金森患者的运动症状及抑郁症状的双重作用,临床疗效确切且不良反应少。     

经颅直流电刺激联合喹硫平治疗酒精使用障碍的疗效及安全性

目的 分析经颅直流电刺激(tDCS)联合喹硫平治疗酒精使用障碍(AUD)的疗效及安全性.方法 选取112例AUD患者,按照随机数字法分为观察组(n=56)和对照组(n=56),对照组给予喹硫平治疗,观察组给予tDCS联合喹硫平治疗,比较两组患者的临床疗效、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评...     

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.     

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.     

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.     

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."