头皮针刺联合语言康复增强脑卒中失语症的疗效

目的:观察头皮针刺联合语言康复治疗脑卒中失语症的疗效。方法:脑卒中失语症患者100例,随机分为观察组和对照组各50例。2组均予常规语言康复治疗,观察组配合给予fMRI技术观察的多穴位头皮针刺治疗。应用功能性语言沟通能力检查法(CFCP)和失语生活质量检查评分值(SAQOL-39)评价语言功能恢复情况,采用BOLD-fMRI技术对患者的中枢激活脑区进行评定。结果:观察组治疗的有效率为86.00%,高于对照组的60.00%(P=0.015)。与对照组治疗后相比,观察组的阅读能力、口语表达能力、听语理解评分和CFCP、SAQOL-39评分上升更明显,针刺即刻后SMl、颞叶、枕叶、基底核区激活出现率均较治疗前明显提高(P<0.05)。结论:头皮针刺联合语言康复训练可促进脑卒中失语症患者的语言功能恢复。     

督脉取穴针刺联合Schuell语言康复训练对脑卒中后失语症患者言语功能、MoCA评分及语言中枢活动功能的影响

目的探讨督脉取穴针刺联合Schuell语言康复训练对脑卒中后失语症患者言语功能、MoCA评分及语言中枢活动功能的影响。方法前瞻性选取2018年3月至2019年3月贵州中医药大学第二附属医院收治的96例脑卒中后失语症患者,按随机数字表法分为对照组和治疗组,每组各48例。对照组单纯进行Schuell语言康复训练,治疗组在对照组基础上采取督脉取穴针刺治疗。比较2组患者临床疗效、言语功能、认知功能及语言中枢活动功能。结果治疗后,治疗组总有效率(91.67%)高于对照组(75.00%),差异有统计学意义(P<0.05)。2组患者言语功能及蒙特利尔认知评估量表(MoCA)评分均较治疗前升高,差异有统计学意义(P<0.05),且治疗组言语功能及MoCA评分[(138.15±6.85)、(22.93±4.71)分]均高于对照组[(85.21±6.07)、(18.19±5.06)分],差异均有统计学意义(P<0.05)。治疗组右侧梭状回、右侧额下回、右侧内侧颞叶、左侧楔前叶、左侧额上回、左侧小脑的局部一致性值与对照组相比均较高(P<0.05),左侧颞下回、右侧舌回、右侧中央前回的局部一致性值与对照组相比较低(P<0.05)。结论对脑卒中后失语患者进行督脉取穴针刺联合Schuell语言康复训练治疗,疗效显著,对患者言语功能及认知功能改善作用明显。其原因和有效调节右侧梭状回、右侧额下回、左侧楔前叶、左侧额上回、左侧颞下回、右侧舌回、右侧中央前回等脑区有关。     

针刺联合言语康复训练对脑卒中后失语症患者的影响

目的:分析针刺治疗联合言语康复训练对脑卒中后失语症患者语言功能的影响.方法:择取2019年5月至2021年5月收治的82例脑卒中后失语症患者,随机分成对照组和观察组,各41例.对照组予以言语康复训练,观察组予以言语康复训练联合针刺治疗.治疗8周,比较两组临床疗效,治疗前后汉语标准失语症检查(CRRCAE)、实用性语言交...     

脑卒中后运动性失语发生机制的功能磁共振成像研究

目的利用血氧水平依赖性功能磁共振成像（BOLD-fMRI）技术研究脑卒中后运动性失语患者语言任务下脑区的激活特征,探讨运动性失语的发生机制。 方法选择符合条件的运动性失语患者9例设为病例组,接受汉语标准失语症检查及图片命名任务状态下BOLD-fMRI检查。采用SPM8软件对fMRI数据进行图像预处理及统计分析,并与年龄相近的健康成人组作对比,分析两组间激活脑区的差异。 结果健康成人组激活脑区一致性较好,均为视觉、语言、认知相关脑区,包括双侧额下回、颞上回、岛叶、基底核;左侧额上回、额中回、中央前回、丘脑、颞中回（P＜0.005）。脑卒中后运动性失语患者的激活脑区差异较大,可见如下特点：①所有患者左侧或/和右侧视觉处理有关皮质区（额中回、颞中回、舌回、梭状回等）均有激活;②左侧半球激活体积较对照组健康人明显较少（P＜0.01）;③左侧额下回（Broca′s区)、左侧额中回、右侧额下回（Broca镜像区）等与语言相关的脑区仅有部分激活,且激活较对照组健康人减弱;④右侧颞上回、双侧顶上小叶、左侧颞下回等脑区较对照组健康人激活增强（P<0.05）。 结论语言表达过程可能与多个相关脑区组成的网络有关,右侧半球参与了正常语言的产生过程。脑卒中后失语是由于病变通过直接破坏语言功能区或远隔效应所致,左侧半球多个脑区及右侧额下回（Broca镜像区）激活减弱,右侧半球部分脑区激活相对增强。右侧额下回在失语后不同的时期中所起的作用可能不同。     

重复经颅磁刺激联合言语康复训练治疗脑梗死后失语症的临床研究

目的观察重复经颅磁刺激(r TMS)联合言语康复训练治疗脑梗死后失语症的临床疗效。方法选取120例脑梗死后失语症患者作为研究对象,采用随机数表法分为言语训练组、假刺激组和联合组,每组40例。言语训练组采用常规言语康复训练,假刺激组采用言语康复训练联合r TMS假刺激,联合组采用言语康复训练联合低频r TMS康复治疗,3组均持续治疗观察4周。治疗前和治疗4周后采用汉语失语成套检查(ABC)评估3组患者的康复疗效,采用西方失语症成套测验(WAB)计算失语指数(AQ)评分,同时对中枢激活脑区进行功能性磁共振(f MRI)检查,比较选定感兴趣区(ROI)的激活情况。结果联合组的康复总有效率为82.50%,高于言语训练组、假刺激组的57.50%、62.50%,差异有统计学意义(P 0.05);治疗后,联合组AQ评分高于言语训练组、假刺激组,差异有统计学意义(P 0.05); f MRI检查显示,治疗后,联合组大脑皮质感觉运动区(SM1)、枕叶、颞叶和基底核区的激活率均高于言语训练组、假刺激组,差异有统计学意义(P 0.05)。结论 r TMS联合言语康复训练能充分激活脑梗死后失语症患者大脑语言功能区,减轻失语症严重程度,促进言语功能恢复。     

静息态下脑卒中失语症患者脑区之间的功能连接观察

目的通过功能性磁共振技术(fMRI)观察静息态下脑卒中后失语症患者脑区之间功能连接变化,分析神经网络在脑卒中后失语症患者脑功能损伤中的作用。方法选取脑卒中后失语症患者24例,设为病例组,同时选取无脑血管病史的受试者22例,作为对照组。采用fMRI对2组受试者进行静息态fMRI扫描,对扫描结果进行独立样本t检验,然后选取差异脑区作为感兴趣区,分析其与全脑区的功能连接。结果病例组左侧楔前叶低频振幅(ALFF)显著低于对照组,差异有统计学意义(Brodmann分区7,体素14,MNI坐标X=-6,Y=-57,Z=72,T=-5.82,P<0.01)。选择病例组左侧楔前叶作为感兴趣区,与全脑进行功能连接分析,结果显示,左侧额上回中部与左侧楔前叶功能连接减弱(Brodmann分区19,体素8,MNI坐标X=-18,Y=-90,Z=30,T=5.59,P<0.01);左侧楔叶与左侧楔前叶功能连接增强(Brodmann分区8,体素19,MNI坐标X=0,Y=36,Z=51,T=-5.49,P<0.01)。结论脑卒中后失语症患者默认网络的内在连接减弱,可能是由于默认网络负向调节网络的抑制作用所致。脑卒中后失语症患者左侧楔前叶神经元活动的减弱及其与左侧额上回中部功能连接的减弱,可能都是默认网络负向调节网络作用的结果;而楔叶和楔前叶两个相邻脑区功能连接的增强,是否是由于代偿的启动为患者部分语言功能的改善提供了基础,尚需更多的研究来证实。     

针药联合言语康复训练治疗脑卒中后失语症患者的疗效探究

目的：探讨针药联合言语康复训练治疗对脑卒中后失语症患者的治疗效果。方法：将2020年1~12月收治的脑卒中患者中选取失语患者82例纳入研究对象,根据治疗方法不同分为对照组40例和联合组42例,对照组给予言语康复训练,联合组给予针药联合言语康复训练。比较两组临床疗效、治疗前后语言功能及神经功能改善情况。结果：对照组治疗总有效率为72.50%（29/40）,低于联合组的90.48%（38/42）,差异有统计学意义（P＜0.05）;治疗前两组语言功能各项评分（听理解能力、复述能力、阅读能力、书写能力）及神经功能评分对比,差异无统计学意义（P＞0.05）;治疗后联合组语言功能各项评分（听理解能力、复述能力、阅读能力、书写能力）及神经功能评分高于对照组,差异有统计学意义（P＜0.05）。结论：脑卒中后失语症患者采用针药联合言语康复训练有助于语言功能障碍及神经功能缺损情况得到有效改善,促进临床疗效的提升,较单纯言语康复训练的治疗效果更佳。     

电针通里、悬钟穴对1例皮质下失语症患者语言功能和fMRI改变的作用

目的：通过对1例皮质下失语症患者针刺通里、悬钟前后的语言学评估，观察此穴位配伍的语言学疗效及探索语言功能的改善与皮质激活效应的关系和意义。方法：试验1：对1例皮质下失语症志愿者在针刺通里、悬钟前后用汉语标准失语症检查表进行语言学评价。试验2：分别电针左、右通里、悬钟，试验采用组块设计模式，静息阶段与刺激阶段交替；运用fMRI中的BOLD技术及SPM2软件分析方法来显示脑皮质功能区的激活情况。结果：电针左侧通里、悬钟后出现右侧颞上回、颞横回、额下回、岛叶、海马旁回、中央前后回、小脑扁桃体等部位的激活．电针右侧通里、悬钟后左侧颞上回、颞下回、海马旁回、角回、岛叶、顶上小叶、顶下小叶、中央后回等脑区出现激活：其中电针左侧的通里、悬钟后出现双侧颞叶的皮质激活效应。结论：针刺通里、悬钟可以激活脑语言功能区，从而证实针刺此组穴位可以改善失语症患者的语言功能。通过观察针刺单侧穴位后的侧别交叉激活和双侧皮质激活推测语言功能的双侧性。     

不同频率重复经颅磁刺激对脑卒中后非流畅性失语的影响及其血氧水平依赖-功能性磁共振成像的表现

目的 探讨不同频率(10 Hz、1 Hz)重复经颅磁刺激(rTMS)刺激右侧大脑半球Broca区镜像区对脑卒中后非流畅性失语患者语言功能恢复的影响及其作用机制.方法 对2例脑卒中后非流畅性失语患者分别进行低频rTMS治疗(1 Hz)和高频rTMS治疗(10 Hz),2例患者均于治疗前和治疗2周后(治疗后)行西方失语症成套检查量表(WAB)测试及fMRI检查.结果 治疗后,2例患者的语言功能均治疗前均明显改善,病例1的AQ评分由治疗前37.2分提升至66.6分,病例2的AQ评分由36.2分提升至60.8分.治疗前,病例1词汇朗读任务主要激活脑区有左侧中央前回,左侧额中回,此外左侧的枕叶下部也有少量激活;治疗后,词汇朗读任务主要激活脑区有左侧额叶内侧面,左侧额下回,左侧额前区,左侧岛叶前部,左侧顶下小叶,左侧颞叶中下回前中部.治疗前,病例2词汇朗读任务主要激活脑区有双侧颞叶内侧面,双侧中央前回;治疗后,词汇朗读任务主要激活脑区有双侧额中回和额叶内侧面,右侧额下回,左侧额前区,双侧顶上小叶,右侧颞上、中回.结论 rTMS治疗可显著改善脑卒中后非流畅性失语患者的语言功能,左侧半球语言区病灶较小的患者可能发生同侧半球功能重组,左侧半球病灶语言区较大的患者则可能发生双侧半球功能重组.     

基于局部一致性算法的周围性面瘫针刺治疗静息态功能MRI研究

目的：研究在静息状态下周围性面瘫患者临床针刺治疗不同病程状态下的脑区局部一致性(regional homogeneity,ReHo)变化特点,探讨针刺治疗周围性面瘫的可能中枢整合机制。材料与方法采用静息态fMRI技术,采集32例健康志愿者及47例面瘫患者临床针刺治疗不同病程状态下(面瘫早期组、后期组及治愈组)的BOLD数据,采用ReHo的数据后处理方法进行分析,将面瘫早期组、后期组及治愈组分别与健康志愿者ReHo值比较,获取有统计学意义的差异脑区。结果(1)面瘫早期组ReHo增高的脑区有右侧额上回、额中回、额下回,左侧楔前叶、后扣带回和颞上回,ReHo值减低脑区有右侧颞下回、楔叶和楔前叶;(2)面瘫后期组ReHo增高的脑区有左侧SII、颞上回、额上回、中央旁小叶、楔叶、楔前叶和右侧额下回;(3)面瘫治愈组ReHo增高的脑区有左侧中央旁小叶、梭状回和颞上回。结论大脑皮层运动前区(PMA)、辅助运动区(SMA)是周围性面瘫患者脑功能重组及代偿的关键区域,也是针刺治疗周围性面瘫患者重要的调制和关键代偿区域。     

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."