帕罗西汀联合小剂量喹硫平治疗广泛性焦虑障碍对照研究

目的评价帕罗西汀联合小剂量喹硫平治疗广泛性焦虑症的临床疗效和安全性。方法将60例广泛性焦虑症患者随机分为两组,每组30例;研究组口服帕罗西汀联合小剂量喹硫平治疗,对照组口服帕罗西汀治疗,观察8周。于治疗前及治疗2周、4周、8周末采用汉密顿焦虑量表及临床疗效总评量表-病情严重程度分量表评定临床疗效,副反应量表评定不良反应。结果研究组治疗2周末起,对照组治疗4周末起,汉密顿焦虑量表及临床疗效总评量表-病情严重程度分量表评分均较治疗前显著下降（P〈0.05或0．01）,同期研究组均较对照组下降更显著;治疗后两组不良反应较轻微,发生率比较差异无显著性（P〉0．05）。结论帕罗西汀联合小剂量喹硫平治疗广泛性焦虑症患者起效更快,疗效更显著,不增加不良反应,显著优于单用帕罗西汀治疗。     

度洛西汀与氟西汀治疗广泛性焦虑障碍对照研究

目的：探讨度洛西汀与氟西汀治疗广泛性焦虑障碍的疗效和安全性。方法将70例广泛性焦虑障碍患者按照随机数字表法分为两组,研究组口服度洛西汀治疗,对照组口服氟西汀治疗,观察6周。于治疗前后采用汉密顿焦虑量表及临床疗效总评量表‐病情严重程度分量表评定临床疗效,副反应量表评定不良反应。结果治疗1周末起两组汉密顿焦虑量表评分均较治疗前显著下降（ P＜0．05或0．01）,研究组治疗1周、2周末汉密顿焦虑量表评分显著低于对照组（P＜0．01）,其他时点评分两组比较差异均无显著性（P＞0．05）;治疗6周末两组临床疗效总评量表‐病情严重程度分量表评分均较治疗前有显著下降（ P＜0．01）,总有效率均为82．9％。两组不良反应较轻微,研究组发生率为34．3％,对照组为37．1％,两组比较差异无显著性（χ2＝0．06, P＞0．05）。结论度洛西汀与氟西汀治疗广泛性焦虑障碍疗效显著且相当,安全性高,但度洛西汀起效更快,更有利于提高患者的治疗依从性。     

帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍对照研究

目的：探讨帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍患者的疗效和安全性。方法将60例广泛性焦虑障碍患者按随机数字表法分为两组,每组30例,均晨口服帕罗西汀治疗,研究组联合认知行为治疗,观察8周。治疗前后采用汉密顿焦虑量表、汉密顿抑郁量表、症状自评量表评定疗效,副反应量表评定不良反应。结果两组汉密顿焦虑量表、汉密顿抑郁量表总分及症状自评量表躯体化、人际关系、抑郁、焦虑因子分均较治疗前显著下降（P＜0．01）,研究组评分显著低于对照组（ P＜0．05或0．01）;研究组总有效率为93．3％,对照组63．3％,研究组显著高于对照组（P＜0．01）。治疗后两组副反应量表评分及各项不良反应发生率比较差异均无显著性（P＞0．05）。结论帕罗西汀联合认知行为疗法治疗广泛性焦虑障碍患者具有协同增效作用,起效快,疗效显著,安全性高。     

超低频重复经颅磁刺激与帕罗西汀治疗老年抑郁症对照研究

目的 探讨超低频重复经颅磁刺激与帕罗西汀治疗老年抑郁症的临床疗效及安全性.方法 将65例老年抑郁症患者采用随机数字表法分为两组,研究组给予超低频重复经颅磁刺激治疗,对照组口服帕罗西汀治疗,观察6周.于治疗前后采用汉密顿焦虑量表、汉密顿抑郁量表及临床疗效总评量表评定临床疗效,副反应量表评定不良反应.结果 治疗后两组汉密顿焦虑量表与汉密顿抑郁量表评分均较治疗前显著下降(P＜0.05或0.01),治疗1周末研究组各量表评分显著低于对照组(P＜0.05),其他时点评分两组比较差异无显著性(P＞0.05);治疗6周末研究组总有效率为78.8％,对照组为81.3％,两组比较差异无显著性(P＞0.05).治疗后两组临床疗效总评量表评分均较治疗前显著降低(P＜0.05或0.01),同期两组间评分比较差异均无显著性(P＞0.05).研究组不良反应发生率为12.1％,对照组为34.4％,研究组不良反应发生率显著低于对照组(P＜0.05).结论 超低频重复经颅磁刺激治疗老年抑郁症起效快,疗效显著且与帕罗西汀相当,安全性高.     

不同频率rTMS联合帕罗西汀治疗广泛性焦虑障碍临床研究

目的探讨高、低频率重复经颅磁刺激联合帕罗西汀治疗广泛性焦虑障碍患者的疗效.方法将90例广泛性焦虑障碍患者按照治疗方法不同分为低频组、高频组与对照组,每组30例,均常规口服帕罗西汀治疗,在此基础上低频组重复经颅磁刺激频率为1 Hz、高频组重复经颅磁刺激频率为10 Hz,对照组患者置于相同的环境,线圈不通电,既无电流脉冲,只施予同样次数的声音刺激,观察4周.治疗前后采月汉密顿焦虑量表、焦虑自评量表评定焦虑症状改善状况.结果治疗前3组汉密顿焦虑量表、焦虑自评量表评分比较差异均无统计学意义(P>0.05);治疗后3组汉密顿焦虑量表及焦虑自评量表评分均较治疗前显著下降(P<0.01).治疗第1周末高频组、低频组汉密顿焦虑量表评分减分率显著低于对照组(P<0.05),焦虑自评量表评分减分率3组差异无统计学意义(P>0.05);第2周末高频组汉密顿焦虑量表评分显著低于对照组、减分率显著高于低频组及对照组(P<0.05或0.01);治疗第4周末高频组、低频组汉密顿焦虑量表及焦虑自评量表评分均显著低于对照组(P<0.01)、减分率均显著高于对照组(P<0.01).结论低频及高频重复经颅磁刺激联合帕罗西汀治疗广泛性焦虑障碍患者具有协同增效作用,疗效显著,高频治疗起效更快,有利于提高患者的治疗依从性,优于单用抗抑郁剂治疗.     

氟西汀联合重复经颅磁刺激治疗对抑郁症患者疗效及认知功能的影响

目的：探讨氟西汀联合重复经颅磁刺激治疗对抑郁症患者疗效及认知功能的影响。方法将60例抑郁症患者随机分两组,每组30例。研究组口服氟西汀联合重复经颅磁刺激治疗,对照组口服氟西汀联合假经颅磁刺激治疗,观察6周。于治疗前后采用汉密顿抑郁量表评定临床疗效,威斯康星卡片分类测验评估认知功能,副反应量表评定不良反应。结果治疗第2周末研究组有效率显著高于对照组（P＜0．01）,治疗第4周、6周末两组比较差异无显著性（P＞0．05）。治疗后研究组威斯康星卡片分类测验的正确反应数及完成分类数均较治疗前显著升高（P＜0．01）,且研究组显著高于对照组（P＜0．05）;两组汉密顿抑郁量表评分较治疗前显著降低（P＜0．01）,治疗第2周、4周末研究组显著低于对照组（P＜0．05）。治疗过程中,两组均未出现严重不良反应。结论氟西汀联合重复经颅磁刺激治疗抑郁症疗效显著,起效快,安全性高,且能显著改善患者的认知功能,优于单用氟西汀治疗。     

帕罗西汀联合奥氮平治疗难治性抑郁症对照研究

目的：探讨帕罗西汀联合奥氮平治疗难治性抑郁症的临床疗效和安全性。方法将78例难治性抑郁症患者随机分为两组,每组39例,均口服帕罗西汀治疗,在此基础上研究组联合奥氮平治疗,观察8周。采用汉密顿抑郁量表、汉密顿焦虑量表评定临床疗效,副反应量表评定不良反应。结果治疗2周末起两组汉密顿抑郁量表、汉密顿焦虑量表总分均较治疗前显著性下降（P＜0．01）,研究组治疗各时段评分均显著低于对照组（P＜0．01）;治疗8周末研究组有效率为87．2％,对照组为66．7％,研究组显著高于对照组（χ2＝4．62,P＜0．05）。研究组不良反应发生率为43．6％,对照组为46．2％,两组比较差异无显著性（χ2＝0．05,P＞0．05）。结论帕罗西汀联合奥氮平治疗难治性抑郁症起效快,疗效显著,安全性高,依从性好,优于单用帕罗西汀治疗。     

度洛西汀与帕罗西汀治疗广泛性焦虑对照研究

目的探讨度洛西汀与帕罗西汀治疗广泛性焦虑的临床疗效和安全性。方法将26例广泛性焦虑患者随机分为两组各13例，研究组口服度洛西汀胶囊治疗，对照组口服帕罗西汀治疗，观察6w。于治疗前及治疗2w、4w、6w末采用汉密顿焦虑量表和临床疗效总评量表的病情严重程度分量表评定临床疗效，副反应量表评定不良反应。结果两组治疗6w末总有效率均为100％。治疗1w末两组汉密顿焦虑量表总分均较治疗前有显著下降（P〈0．05或0．01），但研究组较对照组下降更显著（P〈0．05），随治疗时间的延续均呈持续性下降；两组治疗后临床疗效总评量表评分均较治疗前有显著下降（P〈0．01）；两组不良反应均较轻微。结论洛西汀治疗广泛性焦虑疗效显著，与帕罗西汀相当，但起效更快，安全性高，依从性好。     

艾司西酞普兰联合认知疗法治疗广泛性焦虑障碍对照研究

目的：探讨艾司西酞普兰联合认知疗法治疗广泛性焦虑障碍的临床疗效和安全性。方法将60例广泛性焦虑障碍患者随机分为两组,每组30例,均口服艾司西酞普兰治疗,研究组在此基础上联合认知疗法治疗,观察8周。于治疗前后采用汉密顿焦虑量表、临床疗效总评量表中疗效总评量表评定临床疗效。结果治疗2周末起两组汉密顿焦虑量表、临床疗效总评量表中疗效总评量表评分均较治疗前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）。两组不良反应发生率比较差异无显著性（P＞0．05）。结论艾司西酞普兰联合认知疗法治疗广泛性焦虑障碍疗效显著,优于单用艾司西酞普兰治疗。     

帕罗西汀联合脑电生物反馈治疗焦虑症对照研究

目的 探讨帕罗西汀联合脑电生物反馈治疗焦虑症的临床疗效.方法 将62例焦虑症患者按照随机数字表法分为两组,每组31例,均口服帕罗西汀治疗,研究组在此基础上联合脑电生物反馈治疗,观察6周.采用汉密顿焦虑量表评定焦虑状态,症状自评量表评定心理健康状况,世界卫生组织生活质量测定量表评定生活质量.结果 治疗6周末,研究组汉密顿焦虑量表总分及症状自评量表躯体化、抑郁、焦虑、敌对、恐惧因子评分显著低于对照组(P＜0.05或0.01),世界卫生组织生活质量测定量表生理领域、心理领域评分显著高于对照组(P＜0.05或o.01);研究组总有效率为93.5％,对照组为71.0％,研究组显著高于对照组(x2=5.42,P＜0.05).结论 帕罗西汀合并脑电生物反馈治疗焦虑症起效快,疗效显著,优于单用帕罗西汀治疗.     

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.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。