关于Pusher现象遥症状学研究

目的:探讨脑中风时Pusher现象的症状发生规律. 方法: 调查中枢性瘫痪患者的病灶、运动功能及半侧空间忽略等,将出现Pusher现象的患者分为二组,一组采用作者提出的整体性训练方法,另一组采用常规训练方法.结果: 脑中风Pusher现象发生率为23%,其中左侧瘫占62.5%,右侧瘫占37.5%. Pusher现象的责任病灶多与两个以上脑叶受损有关,其中均包括颞叶.Pusher现象有75%在发病1个月内出现.采用不同训练方法的二组Rivermead运动指数有显著差异.Pusher现象伴有单侧空间忽略症的发生比率为56.3%. 结论: 大面积脑损伤时 Pusher现象发生率增高,认为其产生原因与大脑整合障碍有关,半侧空间忽略症是否为独立存在的症状尚无定论.右脑损伤时出现Pusher现象机会多,可能与功能定位有关.整体性训练法有助于出现Pusher现象患者的康复.     

低频重复经颅磁刺激治疗半侧空间忽略的临床研究

目的探讨低频重复经颅磁刺激治疗半侧空间忽略症的临床疗效。方法将40例脑卒中所致半侧空间忽略症患者分为治疗组及对照组各20例,并对治疗组进行为期2周的低频重复经颅磁刺激治疗。在治疗前后,采用半侧空间忽略评估量表分别对两组患者进行评定。结果治疗前,两组患者半侧空间忽略程度无显著性差异(P>0.05);治疗后,治疗组半侧空间忽略程度较对照组改善(P<0.05);治疗后,治疗组中重度异常率较治疗前明显降低(P<0.05),对照组无显著性差异(P>0.05)。结论通过低频重复经颅磁刺激治疗,脑卒中所致半侧空间忽略程度明显改善。     

中风后单侧空间忽略的发病情况及有关因素

目的 研究脑中风后单侧空间忽略的发病情况及有关因素。方法 自１９９８年３月至１９９９年３月,对入住我院康复科及神经内科的全部脑中风患进行评价。去除意识障碍,感觉性失语及不合作,进入研究共１３８例,评测内容包括：患一般资料,单侧空间忽略评测,采用方法为（１）删除试验;（２）二等分线试验;（３）数字消去法;（４）临摹试验。对评测结果与相关因素的关系进行了分析比较。结果 １３８例脑中风患发生单侧空间忽略５５例,占３９．８５％,左半球发生率为２９．１０％（１６／５５）,右半球发生率为４６．９％（３９／８３）,二差异有显性意义（ｘ＾２＝４．５,Ｐ〈０．０５）。脑中风后单侧空间忽略的发生与患的性别、年龄、职业、病变性质、有无伴发病、病程、上下肢的运动功能及日常生活活动能力无关;与虱的化程度、智力水平、病     

重度半侧空间忽略症的临床分析(附5例临床病案分析)

目的研究重度半侧空间忽略症的临床表现、病变部位、可能机制，分析其康复疗效。方法分析5例合并重度半侧空间忽略症且不伴有偏盲的脑卒中患者康复治疗前后的临床检测数据。结果5例患者均合并明显的左侧空间忽略，均为右利手，康复治疗前后的半侧空间忽略检测差异有显著性意义（P〈0.05）。结论多项半侧空间忽略检测可了解残存视空间注意能力，其中Albent测验检出率最高；康复治疗对半侧空间忽略症有明确疗效。     

压力性溃疡危险因素的评估

压力性溃疡危险因素的评估５２７３００广东省云浮市卫生学校于青５５０００２贵阳医学院于兰压力性溃疡（Ｐｒｅｓｓｕｒｅｕｌｃｅｒｓ，Ｐｕ）即褥疮，是临床常见并发症之一，一般医院的发生率为２．５％～８．８％，甚至高达１１．６％［１，２］。Ｐｕ感染引起败血症...     

Ｌｏｇｉｓｔｉｃ 回归和 Ｆｉｓｈｅｒ 判别分析模型在冠心病鉴别诊 断中的临床价值

摘要：目的 探讨基于常规实验室检查建立的 Ｌｏｇｉｓｔｉｃ 回归和 Ｆｉｓｈｅｒ 线性判别分析模型在冠状动脉粥样硬化性心脏病鉴别诊 断中的临床应用价值。方法 选取昆明医科大学第一附属医院 ２０１８ 年 ３ 月至 ２０１９ 年 ２ 月以胸闷、胸痛为主诉就诊的 １７８ 例 患者为研究对象，根据冠状动脉造影结果分为冠心病组和非冠心病组，回顾性分析患者的常规实验室指标，建立诊断冠心病 的Ｌｏｇｉｓｔｉｃ回归和 Ｆｉｓｈｅｒ 判别分析模型，并验证模型诊断和预测的准确率，进一步评价其在临床应用中的实际意义。结果 建 立的 Ｌｏｇｉｓｔｉｃ 回归方程为：Ｌｏｇｉｔ（Ｐ）＝ －２４．６４１＋０．１０５×年龄＋１．５２０×糖尿病＋０．２８６×ＢＭＩ＋１．２０９×ＬＤＬ Ｃ＋０．６１４×ＰＤＷ＋４．１３１× （Ｍｏｎｏ ／ ＨＤＬ Ｃ）；建立的 Ｆｉｓｈｅｒ 分类判别分析函数为：１（冠心病）＝ － ６９．３１４＋ ０．６２９×年龄＋ ２．３７８×ＢＭＩ＋ １．９８５×ＰＤＷ＋ ５．１２３× ＬＤＬ Ｃ＋０．３０４×Ｌｎ（ＴＧ）＋１．９７２×Ｌｎ（ＨＤＬ Ｃ），２（非冠心病）＝ －５２．１８４＋０．５２７×年龄＋２．１６４×ＢＭＩ＋１．６６０×ＰＤＷ＋４．１０４×ＬＤＬ Ｃ－ ０．１４９×Ｌｎ（ＴＧ）＋３．８１８×Ｌｎ（ＨＤＬ Ｃ）。Ｌｏｇｉｓｔｉｃ 回归模型对冠心病和非冠心病的诊断准确率分别为 ９３．０％和 ８４．０％，预测准确率 分别为 ９１．４％和 ７０．０％；回顾法、留一法交叉验证及外部数据验证法检验 Ｆｉｓｈｅｒ 判别函数的判别正确率分别为 ８２．０％、８１．５％ 和 ８１．３％。结论 Ｌｏｇｉｓｔｉｃ 回归和 Ｆｉｓｈｅｒ 线性判别分析模型在冠心病鉴别诊断中均具有较好的鉴别和预测价值。     

应用BIT检测脑血管病患者半侧空间忽视发生率

目的：应用行为忽视检查法(BIT，日本版)检测脑血管病患者的半侧空间忽视发生率，并探讨BIT检查法的适用性。方法：以22例脑血管病患者(右半球损伤16例、左半球损伤6例)为对象，进行BIT检查。结果：22例脑血管病患者的半侧空间忽视发生率为36．4％(8例)，16例右半球损伤患者的半侧空间忽视发生率为31．3％(5例)，6例左半球损伤患者的半侧空间忽视发生率为50．0％(3例)。结论：未见半侧空间忽视发生率与脑血管病患者的性别、年龄、病程、受教育年限之间有相关性。     

脑中风患者的高压氧治疗及护理

目的：探讨高压氧治疗对脑中风患者的疗效。方法：将80例脑中风患者分为高压氧治疗组与对照组，进行疗效比较及护理观察。结果：高压氧治疗组有效率达90％。结论：高压氧治疗脑中风可明显改善脑中风后脑损伤的预后，降低病死率；在高压氧治疗中，做好护理，对患者康复有重要意义。     

脑卒中后半侧空间忽略的临床研究

目的：对34例脑卒中患者进行半侧空间忽略（HSN）检测及SPECT局部脑血流（rCBF）显像，探讨脑卒中后HSN的发生、临床特征、影像学定位及神经解剖机制。方法：对临床确诊的34例单侧脑卒中患者进行HSN组合试验检测，包括直线平分试验、星星删除试验、图画复制试验，计算忽略评分。对忽略患者行SPECT rCBF显像，分析脑灌注降低的部位、范围、病灶数、病灶rCBF及降低百分比、病灶缺血体积及病灶总像素数，及其与忽略评分的相关性。结果：共30例患者有HSN表现。HSN可发生于左、右侧脑卒中患者，左、右侧脑卒中患者发生HSN、对侧忽略（CN）和同侧忽略（IN）均无差异。SPECT显像示HSN患者的损伤部位多见于额叶，其次是顶叶、枕叶、颞叶及基底节和丘脑。2个或2个以上部位的联合损伤更易出现忽略，最明显的部位是颞顶枕交界处。HSN患者的忽略评分与病灶范围、病灶数、病灶体积、像素数成正相关，r=0.543（P<0.01），0.462（P<0.05），0.429（P<0.05），0.437（P<0.05）；与病灶rCBF、病灶rCBF降低百分比相关性不明显（r=-0.175，0.266，P均＞0.05）。CN和IN患者在忽略评分、病灶范围、病灶数、病灶rCBF、rCBF降低百分比、病灶体积及病灶的总像素数方面均无明显差异。结论：HSN可发生于左、右侧脑卒中患者。HSN患者病灶范围越大、累及病灶数越多，病灶缺血体积越大，病灶像素数越大，忽略表现越严重。CN与IN在临床发生情况、忽略表现、SPECT显像方面均无明显差异。HSN可发生于多个大脑部位的损伤，多部位联合损伤忽略程度更明显。     

脑卒中患者半侧忽视的评估

探讨脑卒中患半侧忽视的评估。半侧忽视主要表现为：（1）运动性忽视；（2）感觉性忽视，包括视觉、听觉和躯体感觉；（3）半侧空间忽视。半侧忽视评估的主要检测手段有：（1）线条抹消试验；（2）字母删除试验；（3）直线二等分试验；（4）两点辨识能力测验；（5）临摹画图；（6）自行画图；（7）翻转能力测验；（8）朗读；（9）书写；（10）表象测试和地志定向。通过上述各项测试手段并结合日常生活活动行为的观察可以检出半侧忽视症。某些病例尚可参考感觉对消现象、半侧连续动作困难、半侧躯体失认、偏瘫失主和偏瘫否认等现象综合判断。偏侧忽视评估有助于病灶定位和病情严重程度的评估，也可用于功能康复疗效的观察和判断。     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.