脑卒中后抑郁及其对神经功能康复的影响

目的:观察脑卒中后抑郁(Post-Stroke Depression,PSD)的发生率和相关因素;探讨选择性5-HT抑制剂对脑卒中后抑郁神经功能康复的影响.方法:选取急性脑脑卒中患者132例(脑梗死78例,脑出血54例),分别在病程2周、1,3,6,12月时给每一位入组患者行PSD诊断、神经功能缺损评分、日常生活能力评分(Activity of Daily Living Scale,ADL)、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分;同时完成Zung's抑郁自评量表(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS).结果:①脑卒中患者中约44.70%出现抑郁症状;②脑卒中类型和性别与PSD发生率无相关性(P＞0.05);③PSD的发生率和严重程度与神经功能缺损和日常生活能力下降程度有关.④PSD与病变部位、病灶大小、病灶单侧性均无明显相关(P＞0.05);⑤氟西汀抗抑郁治疗能明显改善病程3、6个月时的神经功能缺损,病程12月时不仅抑郁症状减轻,日常生活能力改善,神经功能缺损减轻尤为显著.结论:脑卒中后抑郁是急性脑血管病患者常见的长期并发症,并可影响患者功能康复的速度和程度.抗抑郁剂治疗能在抑郁症状明显改善的同时,促进患者日常生活能力和神经功能的恢复.     

脑卒中后抑郁患者抗抑郁治疗对照研究

目的 :了解恢复期抑郁对脑卒中病人远期疗效的影响以及帕罗西汀在脑卒中合并抑郁治疗中的作用。方法 :12 1例恢复期脑卒中合并抑郁病人 ,按抑郁程度分为轻、中、重度 ,并随机分为两组 ,两组病人在进行康复和原发病治疗同时 ,治疗组 64例 ,给予帕罗西汀 (赛乐特 ) 2 0mg d抗抑郁治疗 ,对照组 5 7例 ,给予安慰剂治疗 ,4个月后对两组病人抑郁状况和远期疗效 (日常生活活动能力量表即ADL评分 )进行评定对比。结果 :恢复期脑卒中合并抑郁的程度与神经功能缺损呈明显正相关 ,帕罗西汀治疗卒中病人抑郁 ,治愈率为 48 4% ,有效率为 87 5 % ,治疗组ADL评分 69 6± 8 1分 ,与对照组有明显差异 (P <0 0 5 )。结论 :提示恢复期脑卒中病人合并抑郁对远期疗效有明显影响 ,赛乐特可以改善脑卒中病人抑郁状况和远期疗效     

抗抑郁治疗对颅骨骨折后抑郁的患者疗效及生活质量的影响

目的观察抗抑郁治疗对骨折后抑郁患者的疗效及生活质量的影响。方法将颅骨骨折后抑郁的患者122例随机分为米氮平治疗组(60例)和对照组(62例),于治疗前后进行汉密尔顿抑郁量表(HAMD)和神经功能缺损量表(CSS)、日常生活能力量表(ADL)评定。结果①治疗前两组的HAMD评分比较无显著性差异,治疗后的2、4、8周治疗组HAMD评分明显低于对照组(t=4.3,5.34,4.64;P0.01);②治疗前两组的CSS评分比较无显著性差异。治疗后的第6、8周评分较治疗组与对照组比较均明显降低(t=5.51,8.71,P0.001);③治疗前两组的ADL评分无显著性差异(t=0.74,P0.05),治疗后的第6、8周治疗组ADL评分明显高于对照组(t=20.83,12.88;P0.001)。结论抗抑郁剂治疗有利于颅骨骨折后抑郁患者神经功能康复,提高生活能力,减少并发症。     

西酞普兰合并心理干预治疗脑卒中后抑郁症的疗效研究

目的评价西酞普兰合并心理干预对脑卒中后抑郁(PSD)的疗效。方法将60例脑卒中后抑郁患者随机分为研究组和对照组,分别给予西酞普兰合并心理干预(研究组)、单用西酞普兰(对照组)进行治疗,分别在治疗前、治疗6周末,用汉密尔顿抑郁量表(HAMD)评定疗效,用日常生活能力量表(ADL)评定患者生活质量,用副反应量表(TESS)评定副反应。结果治疗6周后,两组治疗PSD均有效,有效率差异无显著性(χ2=0.14,P>0.05),研究组显愈率(73.33%)明显高于对照组(46.67%),差异有显著性(χ2=4.44,P<0.05);两组间比较,治疗6周末,研究组HAMD评分显著低于对照组(t=2.34,P<0.05),研究组HAMD分数差值显著高于对照组(t=2.26,P<0.05);两组在治疗6周后日常生活能力均有提高,研究组在治疗6周末ADL评分较对照组显著下降(t=2.22,P<0.05);两组不良反应的发生率无显著性差异(χ2=0.42,P>0.05)。结论西酞普兰合并心理干预治疗脑卒中后抑郁的疗效较好。     

早期康复治疗对脑卒中患者的影响

目的探讨早期康复治疗对脑血管病偏瘫患者肢体功能恢复及日常生活活动(ADL)能力的作用。方法选择急性脑血管偏瘫患者110例,均为首发病,随机分为康复组及对照组。康复治疗组患者在神经科常规治疗基础上给予简单常规的兼得治疗,以运动疗法为主,对照组给予神经科常规治疗。每例患者在治疗前,治疗后2 w、1个月及6个月时分别用Fugl-Meyer运动功能(FMA)量表测试运动功能、改良Barthel指数量表(MBI)测试ADL能力和神经功能缺损评分。结果早期康复治疗组患者1个月及6个月时ADL运动功能恢复明显优于对照组。结论早期康复治疗对脑卒中偏瘫患者运动功能和日常生活活动能力具有良好的促进作用,可提高其生活质量,减少日后并发症。     

舞动治疗对脑卒中后抑郁患者自我效能、心理状态及生活质量的影响

目的:探究舞动治疗对脑卒中后抑郁(PSD)患者自我效能、心理状态及生活质量的影响。方法:研究对象为我院自2014年4月-2018年1月收治的脑卒中患者,按纳入排除标准筛选64例恢复期抑郁自评量表评分(SDS)50分患者作为研究对象,并将其按平衡指数最小原则分为观察组(n=30)与对照组(n=32),对照组均给予PSD常规综合治疗,观察组则联合舞动治疗,对比两组治疗前、疗程结束后美国国立卫生院卒中量表(NIHSS)、Fugl-Meyer量表(FMA)、脑卒中康复自我效能量表(SSEQ)、阳性和阴性症量表(PANSS)及脑卒中患者生活质量疾病专用量表(SIS)量表评分。结果:干预后,观察组NIHSS评分下降及FMA评分上升幅度显著大于对照组(t=-3.239,3.749;P0.05);日常生活活动效能、自我管理效能等维度分值显著高于对照组(t=4.737,4.842;P0.05);PANSS量表各维度分值分值显著低于对照组(t=-18.190,-20.936,-15.291,-3.782;P0.001),SIS量表各维度分值显著高于对照组(t=4.385,4.484,4.823,3.352,2.565,3.189,2.586,2.304;P0.05)。结论:舞动治疗PSD患者可促进其神经功能、运动功能恢复,提升自我效能感,改善其心理状态及生活质量。     

脑卒中后抑郁患者心理护理治疗作用探究

目的 探讨脑卒中后抑郁(PSD)患者的心理护理及治疗方法.方法 选取符合入组标准的脑卒中后抑郁患者146例,有针对性心理护理并予抗抑郁药物干预,对比治疗前后汉密顿抑郁量表(hamilton depression scale)、神经功能缺陷程度评分(neurological defteiencyscoye,NDS)、Barthel指数(Barthel index,BI)、患者日常生活活动能力(activity of daily living,ADL)变化.结果 与结论通过针对性抗抑郁药物治疗以及综合护理干预措施尤其是加强心理干预可以明显改善患者的抑郁状态,促进患者神经功能恢复,更有利于脑卒中后抑郁的康复.     

卒中后抑郁的识别及氟西汀联合黛力新早期抗抑郁治疗的效果

目的:研究脑卒中后抑郁症(post-stroke depression,PSD)的识别及氟西汀联合黛力新早期抗抑郁治疗的效果。方法:选择2015年4月-2016年10月,在北京市平谷区医院被诊断为卒中后抑郁的患者共128例,以随机数字的方法分成观察组(64例)和对照组(64例),对照组给予氟西汀加安慰剂治疗,观察组给予氟西汀联合黛力新加安慰剂治疗,对比两组患者治疗前后疗效、抑郁障碍程度、神经功能与日常生活能力及不良反应。结果:治疗后观察组患者总有效率75.00%(48/64)显著高于对照组42.19%(27/64)(χ~2=14.201,P0.05),观察组的治疗效果也优于对照组,数据差异具有统计学意义(Z=2.907,P0.05);进行治疗后,两组患者的汉密尔顿抑郁量表(HAMD)评分,日常生活能力量表(ADL)评分,Barthel指数均出现了改善,观察组患者改善的幅度高于对照组患者,数据差异均具有统计学意义(P0.05);治疗过程中两组患者头痛头晕、口干便秘及食欲不振等各项不良反应的数据差异无统计学意义(P0.05)。结论:氟西汀联合黛力新加安慰剂提升了对卒中后抑郁的识别,同时治疗早期PSD患者疗效显著,对降低卒中后患者抑郁程度及改善患者神经功能效果明显,另外治疗还有效提升了患者的生存质量,且安全性较高。     

米氮平治疗脑梗死伴发抑郁患者的疗效及其对神经功能康复的影响

目的:观察米氮平对脑梗死伴发抑郁患者的疗效及其对神经功能康复的影响。方法:选取经临床体格检查、神经影像学检查确诊为脑梗死,符合CCMD-2-R抑郁症诊断标准的患者117例,随机分为米氮平组57例和对照组60例。米氮平组除了服用米氮平外,其他治疗与对照组相同。分别在基线、治疗1周、3周、7周和6月时,进行汉密尔顿抑郁量表(HAMD)、Zung抑郁自评量表(SDS)、神经功能缺损量表(SSS)和日常生活能力量表(ADL)评定。结果:研究结束时,抗抑郁疗效,米氮平组57例(100%)全部达到有效,且痊愈41例(71·9%);对照组达到有效以上的共8例(13·4%),其中痊愈4例(6·7%)。神经功能康复,米氮平组显效率78·9%(45例),对照组显效率51·7%(31例)。从第3周起,米氮平组的日常生活能力就好于基线情况(31·2±11·2/39·2±15·8),到研究结束时,更是明显好于对照组(15·7±5·4/21·8±9·7,t=4·17,P<0·01)。结论:米氮平对脑梗死后抑郁具有很好的疗效,在抑郁症状改善的同时,促进患者神经功能和日常生活能力的恢复。     

卒中后抑郁对神经功能康复的影响

目的 探讨卒中后抑郁对卒中患者神经功能康复的影响。方法 运用漠密尔顿抑郁量表（HAMD）、神经功能缺损量表（NFDS）、日常生活能力量表（ADL）对198例脑卒中患者进行现状调查．结果 （1）卒中后抑郁的发生率为36．86％；（2）卒中后抑郁患者HAMD、ADL．和NFDS评分高。结论 卒中后抑郁发生率较高，不利于卒中患者的康复。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

HLA genes in Amerindians from Mexico San Vicente Tancuayalab Teenek/Huastecos

Huastecos or Teenek Amerindians are presently living at North East Mexico (San Luis Potosi State). They have probably one of the most ancient culture of Mexico and Central America together with Mayas and Olmec groups with which also show close relationships. Proximity to Atlantic Ocean/Mexican Gulf originated that Spaniards had very early contact with them at about 1519 CE or before. In the present paper we have aimed to study HLA gene profile which may be useful for HLA and disease epidemiology and transplant programs in Teeneks. HLA-DRB1*04:07, -DRB1*14:06 and -DRB1*04:11 have been found in high frequency like in other Amerindian groups. High frequency typical Amerindians HLA extended haplotypes have been found, such as A*02-B*35-DRB1*04:07-DQB1*03:02; A*68-B*39-DRB1*04:07-DQB1*03:02 and A*02-B*39-DRB1*04:07-DQB1*03:02; also new haplotypes have been described, like A*02-B*52-DRB1*04:11-DQB1*03:02, A*68-B*35-DRB1*14:02-DQB1*03:01 and A*68-B*40-DRB1*16:02-DQB1*03:01. Genetic proximity is observed not only to linguistically close Mayans, but also to Mazatecans, Mixtecans and Zapotecans, who speak an altogether different languages; it shows once more that genes and languages do not correlate. This population was greatly diminished after European contact between 1500 and 1600 years CE; in fact, North and South America First Inhabitants population was brought from 80 down to 8 million people because of diseases (i.e.: measles, smallpox or influenza), slavery and war.     

État de l’art : nouveaux anticoagulants et transfusion

Direct oral anticoagulants (DOAC) are indicated for stroke prevention in atrial fibrillation and for the prevention and treatment of venous thromboembolism. As any anticoagulant, they are associated with a bleeding risk. Management of DOAC-induced bleeding is challenging. Idarucizumab, antidote for dabigatran, is currently available and is part of the therapeutic strategy, whereas antidotes for anti-Xa agents are under development. Activated or non-activated prothrombin concentrates are proposed, although their efficacy to reverse DOAC is uncertain. We propose an update on DOAC-associated bleeding management, integrating the availability of idarucizumab and the critical place of DOAC concentration measurements.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.