氦氖激光血管内照射治疗腔隙性脑梗死所致抑郁状态的疗效研究

目的 探讨氦氖激光血管内照射（ＩＬＩＢ）治疗腔隙性脑梗死所致抑郁状态的效果。方法 将６８例患随机分为两组，研究组（３４组）和对照组（３４例）。研究组采用抗抑郁药合并氦氖激光治疗，对照组则单纯采用同样的抗抑郁药物。用汉密顿抑郁量表（ＨＡＭＤ）和临床疗效总评量表（ＣＧＩ－ＧＩ）评定疗效。结果 研究组有效率为９４．１％，对照组为７６．４％，研究组疗效明显优于对照组（Ｐ〈０．０５）。结论 ＩＬＩＢ能有效     

作业疗法在抑郁症病人中的应用研究

[目的]探讨作业疗法对抑郁症病人的作用.[方法]将74例抑郁症病人随机分为两组,研究组和对照组各37例.在抗抑郁药选择性5-羟色胺再摄取抑制剂(SSRI)治疗的基础上,研究组给予作业疗法,对照组仅给予常规疗法,疗程6周.应用抑郁自评量表(SDS)和汉密尔顿抑郁量表(HAMD)评定治疗效果.[结果]治疗4周、6周后疗效均以研究组显著.[结论]抗抑郁药配合作业疗法能迅速减轻抑郁症状,提高疗效,缩短疗程.     

重复经颅磁刺激联合帕罗西汀治疗精神分裂症后抑郁对照研究

目的:探讨重复经颅磁刺激(rTMS)联合西酞普兰治疗精神分裂症后抑郁的临床疗效及安全性.方法:采用随机数字表法将68例精神分裂症后抑郁的患者分为观察组和对照组各34例,对照组采用西酞普兰加伪刺激治疗,观察组在服用西酞普兰基础上辅用rTMS治疗.采用简明精神病量表、汉密顿抑郁量表评定临床疗效,副反应量袁评定不良反应,分别在治疗开始时,治疗第10次,第30次各评定一次.结果:所有患者完成了为期6周的治疗,并完成了所有的评估项目.第6周末研究组抑郁症状总有效率为82.5％,对照组为32.5％,两组差异有极显著性(x2=21.04,P＜0.01).同期研究组汉密顿抑郁量表(HAMD-17)及阳性与阴性症状量表(PANSS)评分均较对照组下降显著(P均＜0.01 ～0.05).副反应量表评分,两组间差异无显著性(P＞001).结论:辅助使用rTMS治疗能显著改善精神分裂症后抑郁,而且安全性良好.     

作业疗法在抑郁症病人中的应用研究

[目的]探讨作业疗法时抑郁症病人的作用。[方法]将74例抑郁症病人随机分为两组,研究组和对照组各37例。在抗抑郁药选择性5-羟色胺再摄取抑刺剂（SSRI）治疗的基础上,研究组给予作业疗法,对照组仅给予常规疗法,疗程6用。应用抑郁自评量表（SDS）和汉密尔顿抑郁量表（HAMD）评定治疗效果。[结果]治疗4周、6周后疗效均以研究组显著。[结论]抗抑郁药配合作业疗法能迅速减轻抑郁症状,提高疗效,缩短疗程。     

N-乙酰半胱氨酸辅助治疗双相障碍抑郁症状的对照研究

目的 观察N-乙酰半胱氨酸(NAC)联合丙戊酸钠和帕罗西汀治疗双相障碍抑郁发作的疗效.方法 收集双相障碍抑郁发作患者50例,随机分为两组,在充分应用心境稳定剂丙戊酸钠和抗抑郁药帕罗西汀基础上,研究组(28例)加用NAC治疗,对照组(22例)不加用NAC,分别于治疗前及治疗第4周、第8周和第10周采用汉密尔顿抑郁量表(HAMD-17)评定疗效,采用不良反应量表(TESS)评定治疗中出现的不良反应.结果 两组间HAMD-17评分在治疗第8周和第10周差异均有统计学意义(t分别=2.49、3.47,P均＜0.05),研究组第10周临床治愈率(89.29％)高于对照组(63.64％),差异有统计学意义(x2=4.72,P＜ 0.05).两组TESS评分比较差异无统计学意义(t=0.13,P＞ 0.05).结论 N-乙酰半胱氨酸对双相障碍抑郁发作有一定的辅助治疗作用.     

柴胡龙骨牡蛎汤联合抗抑郁药治疗脑卒中后抑郁的效果观察

目的观察柴胡龙骨牡蛎汤联合抗抑郁药应用于脑卒中后抑郁患者中的临床效果。方法选择70例脑卒中后抑郁患者作为研究对象,采用随机数字表法分为对照组与研究组,每组35例。2组均接受常规治疗,对照组口服盐酸氟西汀胶囊治疗,研究组则在对照组基础上加用柴胡龙骨牡蛎汤治疗。比较2组临床疗效、不良反应情况和治疗前后汉密顿抑郁量表(HAMD)评分、美国国立卫生研究院卒中量表(NIHSS)评分、日常生活能力(ADL)评分、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、白细胞介素-6(IL-6)]水平。结果研究组的治疗总有效率为94.3%,高于对照组的74.3%,差异有统计学意义(P 0.05);治疗后,研究组HAMD、NIHSS评分低于对照组,ADL评分高于对照组,差异有统计学意义(P 0.01);治疗后,研究组TNF-α、IL-1与IL-6水平均低于对照组,差异有统计学意义(P 0.01);治疗期间,研究组药物不良反应发生率为8.6%,对照组为5.7%,差异无统计学意义(P 0.05)。结论柴胡龙骨牡蛎汤联合抗抑郁药应用于脑卒中后抑郁患者中安全有效,可改善抑郁状态,提高日常生活能力,降低炎症因子水平。     

认知疗法治疗抑郁性神经症的对照研究

目的探讨认知疗法对抑郁性神经症的治疗作用。方法抑郁性神经症患者随机分为研究组和对照组,在均服用阿米替林等药物的基础上,仅对研究组病人进行认知疗法治疗,分别进行临床疗效评定,并在治疗前后用汉密顿抑郁量表(HADM)、抑郁自评量表(SDS)、焦虑自评量表(SAS)进行评定。结果研究组显效率为84.6％,显著高于对照组85.3％,治疗后两组各量表得分均显著低于治疗前得分,研究组各量表减分明显高于对照组。结论在药物治疗的基础上合并认知疗法,可显著提高抑郁性神经症的疗效。     

西肽普兰治疗肿瘤患者伴发焦虑抑郁情绪对照研究

目的探讨西肽普兰治疗肿瘤患者伴发焦虑抑郁情绪的临床疗效及安全性。方法将100例肿瘤伴发焦虑抑郁情绪患者随机分为两组,每组50例,两组患者均接受常规抗肿瘤治疗,研究组在此基础上联合西肽普兰治疗,观察4周。于治疗前及治疗4周未采用焦虑自评量表、抑郁自评量表评定焦虑抑郁情绪,副反应量表评定不良反应。结果治疗4周末研究组焦虑情绪改善率为72．34％,抑郁情绪改善率为76．60％,对照组分别为8．70％,4．35％,研究组显著高于对照组（P〈0．01）;研究组焦虑自评量表、抑郁自评量表评分均较对照组下降显著（P〈0．01）;两组不良反应无差异性。结论西肽普兰治疗肿瘤患者伴发的焦虑抑郁情绪效果显著,安全性高,可显著提高患者的生活质量,促进肿瘤的帮体治疗。     

圣约翰草提取物治疗脑卒中伴抑郁和焦虑68例

为探讨脑卒中伴抑郁和焦虑的发病率，评价药物疗效，用汉密顿焦虑量表(HAMA)和抑郁量表(HAMD)对2001-01／2003—06收治的206例脑卒中患进行评定，其中伴发抑郁和焦虑68例(33％)。将这68例患按病历号分为治疗组和对照组，对照组给予常规治疗和康复训练，不用抗焦虑和抗抑郁药物；治疗组在此基础上给予圣约翰草提取物(商品名：路优泰)。4周后：对照组焦虑性障碍有效率79％，抑郁性障碍有效率84%；治疗组焦虑性障碍有效率84%，抑郁性障碍有效率86％。提示路优泰确能促进脑卒中后抑郁焦虑症状的好转。     

米氮平治疗焦虑抑郁障碍共病临床研究

目的探讨米氮平治疗焦虑抑郁障碍共病的临床疗效及安全性。方法将49例焦虑抑郁障碍共病患者随机分为两组,研究组23例,脱落1例,对照组26例,脱落3例。研究组服用米氮平治疗,对照组服用阿米替林治疗。观察6w。于治疗前及治疗6w末采用汉密顿焦虑量表,汉密顿抑郁量表,副反应量表评定临床疗效及不良反应。结果研究组显效率为68%,对照组为65%(χ2=0.044,P>0.05);汉密顿焦虑量表、汉密顿抑郁量表评分,两组治疗6w末较治疗前均有极显著性下降(P均<0.01),同期两组间比较均无显著性差异(P均>0.05)。研究组不良反应发生率显著低于对照组(P<0.05或0.01)。结论米氮平治疗焦虑抑郁障碍共病疗效与阿米替林相当,但安全性更高,依从性好。     

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.     

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.     

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.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.