首发急性缺血性脑卒中患者认知功能障碍与抑郁状态的相关因素

目的探讨首发急性缺血性脑卒中患者认知功能障碍和抑郁状态的相关影响因素。方法选取急性缺血性脑卒中患者206例,采用蒙特利尔认知评估量表将其分为卒中后认知功能障碍组146例、非卒中后认知功能障碍组60例,采用汉密尔顿抑郁量表将其分为卒中后抑郁组52例、非卒中后抑郁组154例。收集患者的人口学特征及临床指标进行统计学分析。结果卒中后认知功能障碍组年龄、合并高血压比例、同型半胱氨酸(Hcy)、C反应蛋白(CRP)水平显著高于非卒中后认知功能障碍组,男性比例、文化程度、Barthel指数以及血红蛋白(Hb)、空腹血糖(GLU)、肌酐(Cre)水平显著低于非卒中后认知功能障碍组(P 0. 05或P 0. 01)。卒中后抑郁组男性比例、CRP水平显著低于非卒中后抑郁组(P 0. 05);卒中后抑郁组合并高血压、合并冠心病、前部病灶比例以及GLU、丙氨酸转氨酶(ALT)、Cre、Hcy水平均显著高于非卒中后抑郁组(P 0. 05或P 0. 01)。多因素Logistic逐步回归分析显示,年龄、文化程度、Hb、Hcy是首发急性缺血性脑卒中患者认知功能障碍的独立影响因素;性别、Hcy是首发急性缺血性脑卒中患者抑郁的独立影响因素。结论 Hcy水平是首发急性缺血性脑卒中患者认知功能障碍和抑郁的共同影响因素,年龄、文化程度、Hb是认知功能障碍的独立影响因素,性别是抑郁的独立影响因素,应在患者发病早期进行筛查和干预。     

神经行为认知状态检查表信度与效度的初步测定

目的　引进神经行为认知状态检查表 (NCSE)并测定中文NCSE的信度和效度。方法　以康复科住院病人 2 5例为样本 ,间隔 1周评定重测信度。以康复科因脑损伤而住院的患者 5 5例为样本 ,评定效度。结果　绝大部分项目重测信度好 (r >0 .7,P <0 .0 1) ;5 5例脑损伤患者 ,被神经康复专家临床评定分为两组 (正常组和认知功能障碍组 ) ,认知功能障碍组在中文NCSE中的得分低于正常组 (P <0 .0 1) ;中文NCSE的语言项目与CRRCAE 中国康复研究中心失语症检测结果相关性强 ((r =0 .72 -0 .78,P <0 .0 1) ,记忆项目与Rivermead行为记忆能力评定结果的相关性强 (r =0 .72 ,P <0 .0 1) ;以量表给定的临界值为标准 ,中文NCSE对器质性脑损伤患者认知功能障碍的临床诊断灵敏度为 93 .5 % ,特异度为 65 %。结论　中文NCSE经初步测试 ,信度和效度基本满意 ,尤其适用于器质性脑损伤患者的筛选 ,建议扩大样本临床试用。     

脑卒中后认知功能障碍发病情况及预测因素研究

目的总结脑卒中后认知功能障碍发病情况,分析影响脑卒中后认知功能的相关因素。方法我院收治的106例脑卒中患者,记录所有脑卒中后认知功能障碍发病情况,对患者一般情况、年龄、文化程度、有无合并疾病、卒中类型、卒中次数、病变部位、斯堪的纳维亚卒中量表(SSS)、日常生活能力量表(BI)、简易神经状态量表(MMSE)、汉密顿抑郁量表(HAMD)及汉密顿焦虑量表(HAMA)评分进行分析,比较不同认知功能的脑卒中患者上述资料差异,分析影响脑卒中后认知功能的相关因素。结果 106例患者脑卒中后无认知功能障碍50例(47.16%),MMSE评分≥27分,有认知功能障碍56例(52.83%),MMSE评分27分。无认知功能障碍患者SSS、MMSE、BI评分情况优于有认知功能障碍患者(P0.05);年龄45岁、文化程度小学或以下、合并疾病、多发、复发卒中、存在脑白质疏松以及病变部位为额叶的脑卒中患者认知功能障碍发生率明显较高(P0.05);合并疾病、多发性脑卒中、年龄45岁,脑白质疏松、病灶位置在额叶为脑卒中后认知功能障碍的独立预测因素(P0.001)。结论脑卒中后认知功能障碍有较高的发病率,在临床上对于有合并疾病、多发性脑卒中、年龄在45岁以上,脑白质疏松、病灶位置在额叶的患者进行早期全面干预治疗,对改善患者预后情况有着重大意义。     

头颈部肿瘤患者放射治疗后认知功能障碍的影响因素研究

目的研究头颈部肿瘤患者经放射治疗后的认知功能障碍情况及其影响因素。 方法采用神经行为认知状态测试(NCSE)量表对58例经放射治疗后的头颈部肿瘤患者进行认知功能评估,以了解其认知功能状况,并分析影响因素。 结果入选58例患者中发生认知功能障碍者占70.6%（41/58）;NCSE量表8个认知项目中以记忆能力及计算能力的障碍发生率较高;合并高血压、糖尿病或化疗亦会显著增加认知功能障碍发生率;多发病灶及常规放疗患者发生认知功能障碍的比例显著高于单病灶及适形放疗患者。 结论对头颈部肿瘤患者放射治疗后进行认知功能评估,有助于早期发现及防治放射性脑损伤。     

认知护理早期干预对脑卒中后抑郁和认知障碍的影响

目的观察用认知护理早期干预对脑卒中后抑郁状态和认知功能障碍的影响。方法选择脑卒中发病时间≤ 72h患者 2 0 0例 ,随机分为实验组 (10 0例 )和对照组 (10 0例 ) ,对两组患者进行健康教育并给予常规治疗护理 ,对实验组用认知护理早期干预 ,两周后对两组患者用SDS和MMSE评定。结果入组前两组脑卒中评分、日常生活能力表评分差异无意义 ;两周后实验组PSD患者SDS评分明显低于对照组 (P <0 .0 5 ) ,两组PSD患者MMSE评分差异有意义 (P <0 .0 5 )。结论对脑卒中患者早期用认知护理干预可明显改善脑卒中后抑郁状态和认知功能障碍。     

急性缺血性脑卒中患者认知功能障碍与临床特征的相关性研究

目的探讨急性缺血性脑卒中患者认知功能障碍的发生情况及其与临床特征的相关性。方法选取2015年1月—2018年10月我院收治的178例急性缺血性脑卒中,通过蒙特利尔认知评估量表(montreal cognitive assessment scale, MoCA)评估认知功能障碍发生情况,分析不同临床特征与认知功能障碍发生的相关性。结果本研究92例MoCA评分≥26分(认知功能正常组),86例MoCA评分26分(认知功能障碍组),认知功能障碍发生率为48.31%。认知功能障碍组、认知功能正常组MoCA评分分别为(22.12±4.58)分、(27.52±2.38)分,比较差异有统计学意义(t=-9.962,P0.001)。多因素logistic回归分析显示,多病灶、梗死部位为枕叶和丘脑、既往有卒中史及合并糖尿病、高血压、高脂血症为急性缺血性脑卒中患者认知功能障碍发生的独立影响因素(P0.05)。结论急性缺血性脑卒中患者认知功能障碍的发生率较高,且与多病灶、梗死部位为枕叶和丘脑、既往有卒中史及合并糖尿病、高血压、高脂血症的关系密切。     

认知干预对社区脑卒中患者认知障碍的影响

目的探讨认知干预在社区脑卒中患者认知障碍康复中的价值，为社区认知康复干预提供依据。方法将92例符合人组标准的脑卒中后认知功能障碍患者以随机数字表法分为认知干预组与对照组，2组均接受规范、系统的社区康复治疗与指导，认知干预组在此基础上进行专门的认知康复训练。2组患者在人组时及治疗结束后分别采用神经行为认知状态检查（NCSE）量表、综合功能量表（FCA）、改良的巴氏指数（MBI）进行认知功能、运动功能和日常生活活动（ADL）能力的评定。结果认知干预组治疗后，NCSE各领域评分和总分、FCA评分及MBI评分均明显高于治疗前和对照组（均P〈0．05）。结论社区认知干预不仅能改善脑卒中患者的认知功能障碍，而且能促进患者运动功能与ADL能力的恢复。     

维持性血液透析患者认知功能障碍及相关危险因素分析

目的 探讨维持性血液透析(MHD)患者认知功能障碍情况及相关危险因素。方法 76例MHD患者根据蒙特利尔认知评估量表(MoCA)评分结果分为认知功能障碍组及非认知功能障碍组,分析其相关危险因素。结果 76例MHD患者中47例MoCA得分<26分,认知功能障碍发生率为61.84%;2组患者在性别、年龄、受教育年限、Kt/v、糖尿病及脑卒中病史方面存在显著差异(P<0.05);多重逐步回归分析显示,年龄大、教育年限低及脑卒中病史为MHD患者发生认知功能障碍的独立危险因素(P<0.05)。结论 认知功能障碍在维持性血液透析患者中普遍存在,年龄大、教育年限低及脑卒中病史是患者发生认知功能障碍的独立危险因素。     

认知干预对脑卒中患者认知功能障碍的随机单盲法研究

目的探讨认知干预在脑卒中患者认知功能障碍康复中的价值为临床实施认知康复干预提供依据。方法将86例符合入组标准的脑卒中后认知功能障碍患者以随机数字表法分为干预组与对照组,两组均接受物理治疗、常规的作业治疗以及必要的药物治疗,干预组则在此基础上还进行专门的认知康复训练。两组患者出、入院时均采用神经行为认知状态检查(NCSE)量表、简式Fugl-Meyer量表(FMA)、Barthel指数(BI)法分别进行认知功能、运动功能、日常生活活动(ADL)能力的评定。结果NCSE评分:干预组治疗后为44.64±7.82,明显高于治疗前36.26±7.73和对照组治疗后38.73±7.61(t=3.56,14.32,P均0.01);FMA评分:干预组治疗后为52.18±8.61,明显高于治疗前25.14±8.37和对照组治疗后32.76±8.47(t=10.54,14.94,P均0.01);BI评分:干预组治疗后为61.14±12.73,明显高于治疗前31.71±10.32和对照组治疗后32.86±11.96(t=12.63,13.32,P均<0.01)。结论认知干预不仅能改善脑卒中患者的认知功能障碍,而且能促进患者运动功能与ADL能力的恢复。     

脑损害认知障碍与功能恢复的相关研究

目的　探讨脑损害后肢体运动功能和综合功能障碍的恢复是否与认知障碍的程度有关 ,以寻求最佳的认知和运动功能康复方法。方法　采用中文版NCSE评定量表 ,分别评测正常人 2 5例、脑损害患者 2 5例。比较两组分测验得分情况 ,并将NCSE分测验结果与患肢运动功能Brunnstrom分级、综合功能ADL(Barthel指数 )的入、出院得分进行相关分析。结果　 2 5例脑损害患者均有不同程度的认知障碍 ,分测验结果与正常人均有显著差异 (P <0 .0 1)。ADL恢复与MEM、NAM、CALC、JUD相关 (P <0 .0 5或 0 .0 1) ,功能恢复与COMP、NAM、CONST、MEM、CALC、SIM和总分相关 (P <0 .0 5或 0 .0 1)。结论　NCSE是筛查脑损害认知功能障碍的实用方法 ,其结果与脑损害功能恢复相关 ,可以作为估计预后的指标。     

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.