抑郁症患者的记忆力﹑注意力与执行功能研究

目的：探讨抑郁症患者记忆力、泥意力和执行功能的特点及影响因素。方法：使用霍普金斯词语学习测验修订版（HVLT-R）、简易视觉记忆测验-修订版（BVMT-R）、连线测验（TMTA）、持续操作测验（CPT）、威斯康星卡片分类测验（WCST）、简易认知评估-符号编码、Stroop色词测验对40例抑郁症患者进行测验,并和40例正常人进行比较。结果：研究组抑郁症患者的各组测验都不如对照组正常人,其中记忆测验中霍普金斯词语学习测验修订版（HVLT-R）（t=-5.425,p=0.000）,简易视觉记忆测验-修订版（BVMT-R）（t=-10.153,p=0.000）;泥意测验中连线测验（TMTA）（t=5.318,p=0.000）,持续操作测验（CPT）（t=-5.253,p=0.000）;执行功能测验中威斯康星卡片分类测验（WCST）总应答数（t=-3.809,p=0.000）、正确数（t=2.376,p=0.020）、错误数（t=5.010,p=0.000）、连续错误数（t=4.622,p=0.000）,简易认知评估-符号编码测验（t=-10.478,p=0.000）,Stroop色词测验中的单词测验（t=-8.223,p=0.000）、颜色测验（t=-10.935,p=0.000）、色词测验（t=-8.532,p=0.000）。各项测验中p值均小于0.05,差异非常显著,具有统计学意义。结论：抑郁症患者在记忆力、泥意力与执行功能方面存在缺陷。且文化程度对抑郁症患者的记忆力和执行功能的影响较大。     

首发抑郁症患者认知功能三个月随访研究

目的研究首发抑郁症患者治疗前(第0周)和治疗后(第6周、第3个月)的认知功能改变及特点。方法对62例首发抑郁症患者(患者组),于治疗前和治疗后评定汉密尔顿抑郁量表(HAMD)、重复性神经心理状态(RBANS)测验、威斯康星卡片分类测验(WCST),并与82名健康志愿者(对照组)比较。结果 (1)患者组治疗前后方差分析表明,HAMD总分(F=97.69,P<0.01)、RBANS即刻记忆(F=26.10,P<0.01)、延时记忆(F=11.20,P<0.01)、总分(F=3.81,P<0.05)、WCST的总测验数(F=9.99,P<0.01)、持续错误数(F=21.81,P<0.01)、分类数(F=5.49,P<0.05)均有统计学差异。(2)患者组治疗前HAMD总分(t=29.92,P<0.01),RBANS即刻记忆(t=-4.55,P<0.01)、视觉广度(t=-2.41,P<0.05)、言语功能(t=-3.01,P<0.01)、延时记忆(t=-2.99,P<0.01)、总分(t=-4.52,P<0.01)与对照组之间均有统计学差异;患者组治疗6周后HAMD总分(t=6.37,P<0.01)、RBANS即刻记忆(t=2.73,P<0.01)、WCST的分类数(t=2.49,P<0.05)、总应答数(t=-3.98,P<0.01)、正确应答数(t=2.68,P<0.05)、持续错误数(t=-4.80,P<0.01)均与对照组有统计学差异;患者组治疗3个月后HAMD总分(t=2.20,P<0.05),RBANS即刻记忆(t=4.42,P<0.01),WCST的分类数(t=2.41,P<0.05)、总应答数(t=-3.48,P<0.01)、正确应答数(t=-4.80,P<0.01)、持续错误数(t=-5.46,P<0.01)均与对照组有显著性差异。结论首发抑郁症患者不仅存在情绪症状,认知功能也存在缺陷,经过治疗临床症状和认知功能明显提高。     

稳定期慢性阻塞性肺疾病患者认知功能的初步研究

目的研究慢性阻塞性肺疾病(COPD)患者的认知功能。方法采用8个神经心理测验(共17项)对70例稳定期COPD患者和70例对照组进行有关注意力(数字广度分测验,连线测验A、B)、言语学习和记忆(WMS-R——逻辑记忆分测验)、视觉记忆(WMS-R——视觉再生分测验和再认分测验)和执行功能(威斯康星卡片分类测验WCST,Stroop,言语流利性测验)的测定,用成组t检验的方法比较COPD组和对照组认知功能的差异。结果稳定期COPD患者中几乎所有的神经心理测验成绩均比对照组差(P<0.05或<0.01)。结论稳定期COPD患者伴有明显的焦虑和抑郁,并存在广泛的认知功能损害。     

遗忘型轻度认知功能损害与极轻度阿尔茨海默病患者临床和心理学特征的鉴别

目的：通过对遗忘型轻度认知功能损害（简称轻度认知功能损害）和极轻度阿尔茨海默病的人组条件进行严格的量化界定，分析两组受试者的认知功能和临床表现的差异。 方法：所有病例来源于2004-04／12在复旦大学附属华山医院神经内科“记忆障碍”门诊的就诊者，全部在神经心理研究室完成全套评估。根据诊断标准分为轻度认知功能损害组（n=60），极轻度阿尔茨海默病组（n=32）和轻度阿尔茨海默病组（n=32），另有来源于体检和社区离退休的正常老人60例作为对照。分别采用简明精神状态量表、听觉词语记忆测验、逻辑记忆测验、Stroop色词测验、Rey—Osterrich复杂图形测验、连线测验、言语流畅性测验和临床痴呆量表等评定总体认知功能、记忆、语言、注意、视觉空间能力、执行功能和临床特征。结果：所有调查对象全部进入结果分析。①临床痴呆量表记忆项和总分在轻度认知功能损害组与极轻度阿尔茨海默病组之间比较差异有显著性（P〈0．01）；②轻度认知功能损害受试的情景记忆功能全面减退，其听觉词语记忆测验词语记忆变化曲线与极轻度及轻度阿尔茨海默病相类似，而与正常老人组不同；③除了STROOP色词测验卡片C耗时数和连线测验-A耗时数，其余非记忆指标在轻度认知功能损害组与极轻度阿尔茨海默病组之间差异有显著性（P〈0．01-0．05）；反映执行功能的Stroop色词测验卡片C正确数和言语流畅性测验总分尤其明显。结论：轻度认知功能损害是正常衰老与极轻度阿尔茨海默病的连续演变过程的中间环节，临床痴呆量表总分、延迟回忆得分和执行功能测验是鉴别轻度认知功能损害与极轻度阿尔茨海默病患者的有效方法。     

强迫症患者认知功能的性别差异

目的:了解性别对强迫症患者认知功能的影响。方法:对符合DSM-IV及CCMD-III强迫症诊断标准的52例强迫症患者(男33例,女19例)按性别分组,在用药前或停药5个半衰期以上采用神经心理测验(包括知识、算术、数字符号、木块拼图、数字广度、逻辑记忆、视觉记忆、Strooptest、词汇流畅、划痕测验A、B,汉诺塔、威斯康辛卡片分类改良版)进行评定。53例健康人在年龄、性别、受教育年限与研究组匹配后作为对照组,按性别分组后在同期做相同项目的神经心理测验。结果:强迫症组女性仅stroop-c时间犤(161.90±37.43)s犦一项指标优于男性犤(121.99±33.07)s犦(t=3.86,P<0.01),但逻辑即时记忆,stroop-cw时间,stroop-cw错误数,划痕A错误结果未显示出正常女性的优越性(t=-2.11～3.16,P<0.05～0.01)。结论:女性强迫症患者的语言工作记忆、干扰抑制能力、注意转移及选择性注意的损害重于男性。     

稳定期男性精神分裂症患者吸烟行为 与认知功能的关系

目的：探讨稳定期男性精神分裂症患者吸烟行为与认知功能的关系。方法：纳入稳定期男性精神分裂症患者112例，其中吸烟组52例，非吸烟组60例。采用阳性和阴性症状量表（PANSS）评定患者的临床精神症状，采用重复性成套神经心理状态测验（RBANS）评定患者的认知功能状况，对结果进行统计分析。结果：吸烟组的一般精神病理症状分和PANSS总分均高于非吸烟组（均P<0.05），吸烟组的即刻记忆、延时记忆和RBANS总分均低于非吸烟组（均P<0.05）。吸烟与即刻记忆（β=-0.233,P=0.009）、延时记忆（β=-0.205,P=0.028）及RBANS总分（β=-0.197,P=0.024）相关。结论：吸烟可能会损伤稳定期男性精神分裂症患者的认知功能，尤其是记忆功能。     

酒精使用障碍患者的认知功能研究

目的:探讨酒精使用障碍患者的认知功能损害特点及其相关影响因素。方法:酒精使用障碍患者37例纳入研究组,健康人34例纳入对照组。收集一般临床资料,采用酒精使用障碍筛查量表(AUDIT)评估2组的饮酒风险度,采用公认认知成套测验(MCCB)分别测试2组的认知功能。结果:研究组认知功能总分明显低于对照组总分、因子分连线测试、符号编码、字母编号、迷宫测试、简易视觉空间记忆、持续操作测验研究组均低于对照组(均P0.05)。研究组中认知功能总分与AUDIT评分呈负相关(r=-0.577)。回归分析得出研究组中AUDIT评分对认知功能总分有显著影响(t=-4.176, P0.05)。结论:酒精使用障碍患者存在认知功能损害,其认知功能损害严重程度与酒精使用程度呈正相关。     

抑郁症患者认知功能障碍的比较研究

目的:探讨抑郁症患者认知功能损害特点。方法:对46例符合CCMD-3抑郁症诊断标准抑郁症患者和46名健康自愿者对照组进行威斯康星卡片测验(Wisconsincardsortingtest,WC-ST)、词汇流畅测验、联想学习、相似、领悟和数字广度测验,并对经过6周抗抑郁药治疗的46例抑郁症患者进行治疗前后比较。结果:抑郁症患者WCST的总测验次数82.19±21.55、持续错误数31.56±18.97、随机错误数25.53±11.31、词汇流畅测验41.68±5.96、联想学习19.78±6.21、相似9.68±3.15、领悟9.82±4.33和数字广度测验10.85±2.77,与正常人为53.66±5.87,16.89±12.54,9.48±15.53,56.27±13.34,28.56±5.60,13.91±2.75,13.91±2.75,14.73±2.38相比差异均有显著性意义(P<0.01),WCST的总测验次数、持续错误数、随机错误数与HAMD总分(r=0.35,0.33,0.31,P<0.05)及迟缓(r=0.45,0.41,0.41,P<0.01)、日夜变化(r=0.31,0.29,0.31,P<0.05)两因子分正相关。WCST与其他各项神经心理学测验无明显相关。46例抑郁症患者治疗后,WCST的上述各项指标与治疗前相比差异均有显著性意义(P<0.05)。治疗后WCST的总测验次数、持续错误数、随机错误数的减分率与HAMD的减分率正相关(P<0.05)。结论:抑郁症患者存在认知功能损害,其认知功能损害与病情严重程度和患者     

遗忘型轻度认知功能损害与极轻度阿尔茨海默病患者临床和心理学特征的鉴别

目的:通过对遗忘型轻度认知功能损害(简称轻度认知功能损害)和极轻度阿尔茨海默病的入组条件进行严格的量化界定,分析两组受试者的认知功能和临床表现的差异。方法:所有病例来源于2004-04/12在复旦大学附属华山医院神经内科“记忆障碍”门诊的就诊者,全部在神经心理研究室完成全套评估。根据诊断标准分为轻度认知功能损害组(n=60),极轻度阿尔茨海默病组(n=32)和轻度阿尔茨海默病组(n=32),另有来源于体检和社区离退休的正常老人60例作为对照。分别采用简明精神状态量表、听觉词语记忆测验、逻辑记忆测验、Stroop色词测验、Rey-Osterrich复杂图形测验、连线测验、言语流畅性测验和临床痴呆量表等评定总体认知功能、记忆、语言、注意、视觉空间能力、执行功能和临床特征。结果:所有调查对象全部进入结果分析。①临床痴呆量表记忆项和总分在轻度认知功能损害组与极轻度阿尔茨海默病组之间比较差异有显著性(P<0.01);②轻度认知功能损害受试的情景记忆功能全面减退,其听觉词语记忆测验词语记忆变化曲线与极轻度及轻度阿尔茨海默病相类似,而与正常老人组不同;③除了STROOP色词测验卡片C耗时数和连线测验-A耗时数,其余非记忆指标在轻度认知功能损害组与极轻度阿尔茨海默病组之间差异有显著性(P<0.01～0.05);反映执行功能的Stroop色词测验卡片C正确数和言语流畅性测验总分尤其明显。结论:轻度认知功能损害是正常衰老与极轻度阿尔茨海默病的连续演变过程的中间环节,临床痴呆量表总分、延迟回忆得分和执行功能测验是鉴别轻度认知功能损害与极轻度阿尔茨海默病患者的有效方法。     

精神分裂症患者血清miR-181c miR-30e表达及其与认知功能受损及预后的关系

目的 探讨精神分裂症患者血清微小核糖核酸-181c(miR-181c)、微小核糖核酸-30e(miR-30e)的表达及其与认知功能受损的关系。方法 将138例精神分裂症患者设为观察组,123名健康体检者设为对照组,采用实时荧光定量聚合酶链反应法检测血清miR-181c、miR-30e表达。比较两组血清miR-181c、miR-30e表达水平及认知功能成套测验共识版（MCCB）评分;采用Spearman相关分析法分析精神分裂症患者血清miR-181c、miR-30e表达与认知功能的关系;采用多因素Logistic回归分析探讨精神分裂症患者血清miR-181c、miR-30e表达与预后不良的关系。结果 观察组受试者血清miR-181c、miR-30e表达均高于对照组,MCCB评分低于对照组（P<0.01）。Spearman相关分析显示,血清miR-181c、miR-30e表达与MCCB评分呈显著负相关（P<0.01）。预后不良患者有攻击行为占比、MCCB评分<50分占比及血清miR-181c、miR-30e表达均高于预后良好患者,受教育年限低于预后良好患者（P<0....     

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.     

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.     

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.