糖尿病性脑梗死对比分析

脑梗死是糖尿病的严重并发症,多发生于非胰岛素依赖性糖尿病患者,糖尿病作为脑梗死的独立危险因素对其发病、转归起着主要作用。我们将2005-03～2007—03我科收治的80例糖尿病性脑梗死（DCI）与同期住院的80例非糖尿病性脑梗死（NDCI）患者的血糖水平与神经功能缺损及预后进行对照分析,报告如下。     

糖尿病性脑梗死对比分析

脑梗死是糖尿病的严重并发症,多发生于非胰岛素依赖性糖尿病患者,糖尿病作为脑梗死的独立危险因素对其发病、转归起着主要作用.我们将2005-03～2007-03我科收治的80例糖尿病性脑梗死(DCI)与同期住院的80例非糖尿病性脑梗死(NDCI)患者的血糖水平与神经功能缺损及预后进行对照分析,报告如下.     

糖尿病并发脑梗死患者血脂水平的变化

目的观察分析糖尿病并发脑梗死患者的血脂水平。方法选取30例糖尿病并发脑梗死患者、30例非糖尿病脑梗死患者及30例健康体检者进行血脂水平检测与神经功能缺损情况观察,同时对所得数据进行统计学处理,然后对其结果进行分析。结果糖尿病并发脑梗死患者血脂水平明显高于非糖尿病脑梗死患者及健康体检者(P<0.05),且神经功能缺损程度也重于非糖尿病脑梗死患者及健康体检者(P<0.05),同时糖尿病并发脑梗死患者中梗死面积较大患者血脂水平高于梗死面积小患者(P<0.05)。结论加强对糖尿病并发脑梗死患者血脂水平的检测及合理降脂对延缓病情的进展及降低致残率和病死率至关重要。     

2型糖尿病并发脑梗死神经功能缺损程度及防治措施

目的探讨2型糖尿病并发脑梗死患者神经功能的缺损程度及预后,探讨防治措施。方法选择2型糖尿病并发脑梗死患者60例为研究对象,同期住院的非糖尿病脑梗死患者为对照组,入院后均给予综合治疗措施,观察组通过口服降糖药或注射胰岛素以及饮食控制等措施控制血糖,比较2组神经功能缺损程度、治疗效果。结果观察组神经功能缺损重度12例(20.00%,12/60),高于对照组的4例(6.67%,4/60)(P0.05);观察组无效8例(13.33%,8/60),高于对照组的2例(3.33%,2/60)(P0.05)。结论 2型糖尿病并发急性脑梗死患者临床症状表现严重,且预后较差,应控制血糖在正常范围,提高生存率,改善预后。还应降低血脂、控制血压,给予适当的抗凝、抗血小板等治疗。     

糖尿病对脑梗死影响的临床探讨

目的 研究糖尿病对脑梗死的影响.方法 对2005-06～2006-06初次患脑梗死住院患者,分别在入院第1d、14d和90d时,观察其临床神经功能缺损程度、梗死面积、治疗效果和预后.并将其分为糖尿病组和非糖尿病组,比较2组的差异,从临床角度研究糖尿病对脑梗死的影响.结果 糖尿病组脑梗死患者,在发病第1d、治疗第14d及90d后的临床神经功能缺损程度较重,脑梗死面积大,治疗效果差,和非糖尿病组相比有显著差异. 结论 糖尿病是脑梗死重要的危险因素,影响着脑梗死的症状、梗死面积、治疗效果和预后,因此认真防治糖尿病是降低脑梗死致残率、改善治疗效果的重要措施之一.     

脑梗死的发病、预后与血糖血脂的关系

目的探讨60例糖尿病并脑梗死患者的血糖、血脂与其梗死灶最大直径、神经功能损伤、临床疗效、并发症和病死率的关系。方法60例糖尿病并脑梗死与60例非糖尿病脑梗死进行比较。结果糖尿病并脑梗死时多为主干支大灶性梗死,且神经功能损伤重,临床疗效差,并发症和病死率高。另外脑梗死面积、并发症和病死率均与血糖、血脂水平呈正相关。结论血糖、血脂水平升高可加重脑梗死损害,积极控制血糖、血脂对脑梗死治疗及预后是有益的。     

腩梗死的发病、预后与血糖血脂的关系

目的探讨60例糖尿病并脑梗死患者的血糖、血脂与其梗死灶最大直径、神经功能损伤、临床疗效、并发症和病死率的关系。方法60例糖尿病并脑梗死与60例非糖尿病脑梗死进行比较。结果糖尿病并脑梗死时多为主干支大灶性梗死，且神经功能损伤重，临床疗效差，并发症和病死率高。另外脑梗死面积、并发症和病死率均与血糖、血脂水平呈正相关。结论血糖、血脂水平升高可加重脑梗死损害，积极控制血糖、血脂对脑梗死治疗及预后是有益的。     

糖尿病对脑梗死影响的临床探讨

目的 研究糖尿病对脑梗死的影响。方法 对2005—06～2006—06初次患脑梗死住院患者，分别在人院第1d、14d和90d时，观察其临床神经功能缺损程度、梗死面积、治疗效果和预后。并将其分为糖尿病组和非糖尿病组，比较2组的差异，从临床角度研究糖尿病对脑梗死的影响。结果 糖尿病组脑梗死患者，在发病第1d、治疗第14d及90d后的临床神经功能缺损程度较重，脑梗死面积大，治疗效果差，和非糖尿病组相比有显著差异。结论 糖尿病是脑梗死重要的危险因素，影响着脑梗死的症状、梗死面积、治疗效果和预后，因此认真防治糖尿病是降低脑梗死致残率、改善治疗效果的重要措施之一。     

消化道出血对急性重症脑梗死患者近期预后的影响

目的观察消化道出血对急性重症脑梗死患者近期预后的影响。方法 63例合并消化道出血的急性重症脑梗死患者为观察组,另选择同时期60例未合并消化道出血的急性重症脑梗死患者为对照组,比较2组预后。结果观察组神经功能缺损评分(NIHSS评分)、意识障碍程度(GCS评分)以及病死率均明显劣于对照组(P0.05);观察组消化道出血24h内NIHSS评分、GCS评分、病死率均明显劣于出血24h后(P0.05)。结论急性重症脑梗死患者合并消化道出血的近期预后较差,出血24h内神经功能损害严重,病死率高,早期积极预防消化道出血利于改善患者预后。     

高尿酸对急性脑梗死患者近期疗效的影响

目的探讨高尿酸对急性脑梗死患者近期疗效的影响。方法回顾性分析160例急性脑梗死(发病<48h)患者血尿酸水平,分为高尿酸血症组80例和尿酸正常组80例,于治疗前及治疗后14d进行神经功能评分。结果高尿酸血症组神经功能缺损评分明显高于尿酸正常组,差异有统计学意义(P<0.05)。脑梗死病死率高尿酸血症组较尿酸正常组高,差异有统计学意义(P<0.05)。结论高尿酸对急性脑梗死患者近期疗效差,测定急性脑梗死患者的血尿酸有助于判断病情及预后。     

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.     

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).     

Treatment of patients with tardive dystonia with olanzapine

Tardive dystonia represents a complication of long-term use of neuroleptics and its treatment is often unsatisfactory. Atypical neuroleptics appear to improve tardive dystonia, and cases of tardive dystonia successfully managed with clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of olanzapine, a new atypical neuroleptic with a low risk of agranulocytosis, in a group of four patients (one man and three women) with tardive cervical dystonia. They developed severe dystonia after several years of neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative. Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in dystonia was observed in all patients, and significant differences were observed in Toronto Western Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of olanzapine in tardive dystonia.     

Collaborative design of accessible information with people with aphasia

ABSTRACT

Background: People with aphasia report preferences for specially formatted health information materials, but there is little evidence that modified materials result in improved comprehension. Potential explanations for this include language included not taking account of aphasic processing difficulties, topics unrelated to aphasia, lack of clarity regarding the use of images, and the lack of end-user involvement in the design. Additionally, no definitive criteria for production of accessible information have been identified.

Aims: The first aim of this study was to collaborate with people with aphasia in an iterative design process to develop and finalise accessible information materials. The second aim was to identify definitive criteria for use in the future production of information materials for people with aphasia.

Methods and procedure: Prototype materials were developed for the study, based on criteria identified from the existing research into aphasia-accessible information, and on the evidence base concerning language processing in aphasia. Fourteen people with aphasia took part in two rounds of consensus group meetings and viewed information about aphasia presented within the prototype materials. Consensus points were identified within the groups through discussion and through ratings using Likert scales. The set of consensus points and ratings were adapted into criteria for graphic designers to incorporate into subsequent designs of the materials, in order to generate a final version, and related criteria.

Outcomes and results: The group discussions and the ratings of materials led to the identification of an agreed layout within which to present information, and specific criteria for the following: information consisting of one proposition expressed via everyday words and canonical syntactic forms; one or two images relating directly to keywords; sans serif typography with keyword emphasis. Individual preferences with regard to image types were identified. Novel criteria were identified in the study, relating to layout, language, images and typography. These were added to the original set of criteria to form definitive criteria for use in the development of accessible aphasia materials.

Conclusions: This study successfully involved people with aphasia in the design process to produce novel materials, and related design criteria. The resulting materials and criteria differ from those previously proposed, by reflecting directly people with aphasia’s views and preferences, and by incorporating language and images suitable for people with aphasia, based on the existing research evidence and the outcomes of this study. The materials and criteria have the potential to improve people with aphasia’s understanding of health information.     

Relapsing polychondritis with features of dementia with Lewy bodies

We describe a 72-year old man with clinical features suggestive of dementia with Lewy bodies (DLB) who proved neuropathologically to have degeneration induced by relapsing polychondritis (RP), an autoimmune inflammatory disorder of cartilaginous tissues. There was lymphocytic infiltration of the leptomeninges, perivascular cuffing, reactive astrocytosis, and activation of microglia in multiple brain areas all consistent with an immunologically mediated process. There was widespread neuronal loss within the hippocampus, entorhinal cortex, and amygdala as well as diffuse myelin pallor of cortical pathways. Elevated levels of complement proteins and endothelial markers of inflammation were observed, which are similar to previous reports in DLB. This study demonstrates that qualitatively similar inflammation-associated neurodegeneration is present in widespread regions of the brain in a RP case presenting clinically as DLB.Senior authors Arnold Starr and David H. Cribbs contributed equally to this project.Funding supported by ADRC P50 AG16573, NIA-AG-20241 P50 AG000658, and NINDS-NS50895 (DHC)