Comparison Between Steroid and 2 Different Sites of Botulinum Toxin Injection in the Treatment of Lateral Epicondylalgia: A Randomized,Double-Blind,Active Drug-Controlled Pilot Study

Objective

To compare the effects of 2 different injection sites of low doses of botulinum toxin type A with steroid in treating lateral epicondylalgia.

脑电双频指数监测在重症加强治疗病房机械通气患者镇静中的应用

目的探讨脑电双频指数(BIS)实时监测在重症加强治疗病房(ICU)机械通气患者镇静中应用的可行性。方法选取30例术后机械通气患者,静脉注射咪唑安定或异丙酚达到合理镇静,采用盲法对患者每隔5min分别记录1次Ramsay镇静分级评分及BIS。比较Ram say镇静分级评分对应BIS中位数的总体差异,分析BIS结果与Ram say镇静分级评分的相关性。计算BIS的敏感度和约登(Youden)指数,确定BIS监测的敏感度和特异度。结果随镇静深度的加深,BIS明显降低,Ramsay分级评分对应的BIS中位数之间差异有显著性(P<0.01);BIS与Ram say分级评分呈负相关(r=-0.794,P<0.01);Ram say分级评分2~5分(为合理镇静)时对应的BIS中位数的95%可信区间(参考值范围)为61~84;当BIS值为81时,BIS监测从镇静合理到镇静不足的Youden指数和敏感度最高;Ram say分级评分为6分(为镇静过度)时对应的BIS中位数的95%可信区间为48~58。结论BIS监测与Ram say镇静分级具有良好的相关性,能实时、客观地监测ICU机械通气患者的镇静状态,并指导镇静治疗。     

Analysis of positive Edinburgh depression scale referrals to a consultation liaison psychiatry service in a two-year period

Antenatal depression is a depressive episode that begins in pregnancy and is often a predictor of postnatal depression. The main aim of this study was to examine the prevalence of antenatal depression and other psychiatric conditions in women referred to a consultation liaison psychiatry service because of positive scores on the Edinburgh Postnatal Depression Scale. The other aim was to review known risk factors in the women and note any significant findings. An audit of all women referred to the psychiatry team because of positive Edinburgh scores during a 2-year period was completed. Information about Edinburgh scores, clinical diagnoses at the time of the psychiatric appointment, and factors such as relationship status, domestic violence, ethnicity, and substance use was noted. According to the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition criteria: 36.5% of the women had an adjustment disorder, 13% had a major depression, 10% had dysthymia, 8% had a recurrent depressive disorder, 2% had post-traumatic stress disorder, and 2% had a borderline personality disorder. The findings demonstrated the usefulness of using a screening tool such as the Edinburgh Postnatal Depression Scale in detecting women requiring psychiatric intervention and highlighted the importance of a psychiatric interview assessment to interpret the scores of screened patients in terms of clinically relevant syndromes.     

膝关节功能评估表的临床研究

目的:研究膝关节功能评分表(百分法)的临床意义。方法:83例患者,男44例,女39例,年龄19-40岁,平均31岁。受伤时间1—28天,平均8天。损伤情况:半月板损伤60例,其中左膝27例,右膝33例:前交叉韧带断裂合并半月板损伤23例,其中左膝9例,右膝14例。患者入院后,统一由一名康复治疗师分别使用膝关节功能评分表(百分法)和Lysholm评分表进行膝关节功能评估。将二组评分值进行双变量相关分析。结果:83例患者采用膝关节功能评估表(百分法)评估、评分为52.58±19.18;采用Lysholm评分表评估,评分为51.86±19.71。将二组评分数值进行双变量相关分析,结果r=0.975,P<0.01,显示二组资料具有显著相关性。结论:膝关节功能评估表(百分法)使用方便,门诊、病房应用时,医、患间易于沟通,符合中国人的生活习惯和对临床问诊问题的理解。临床评分结果经统计学处理,与目前国际上应用效率较高的Lysholm评分法显著相关,因此,具有可靠性和实用性的特点。     

急性脑血管病患者的职业、经济收入对记忆功能的影响

目的研究急性脑血管病(acutecerebrovasculardisease,ACVD)患者的职业、家庭经济收入对其记忆功能的影响。方法用修订韦氏记忆量表(WMS)检测120例ACVD患者的记忆功能。结果ACVD患者的WMS各量表粗分、量表分和MQ值明显低于对照组;工人、农民的WMS各量表粗分、量表分和MQ值明显低于干部和科技工作者,其异常率则明显高于干部和科技工作人员;家庭人均收入与WMS粗分、量表分和MQ呈明显正相关(r=0.21～0.51),大多数量表分、总量表分和MQ均表现为小于或等于500～799元组明显低于大于500～799元组。阳性率则仅小于300元组明显高于800～1199元组。结论ACVD患者瞬时、短时、长时记忆均明显损害;工人、农民的3种记忆损害均较干部、科技工作者重;家庭人均收入少于和等于500～799元者各项记忆损害亦大于500～799元者;干部、科技工作职业、较高家庭收入对记忆功能损害有保护作用。     

脑卒中4种评定量表的效度、信度及可操作性检验

目的比较4种脑卒中评定量表的效度、信度和可操作性。方法103例脑卒中患者同时接受改良爱丁堡—斯堪的那维亚脑卒中评分量表(MESSS)、美国国立卫生研究所脑卒中评分量表(NIHSS)、欧洲脑卒中评分量表(ESS)和加拿大神经功能评分量表(CNS)评分,评分值与Barthel指数(BI)进行相关分析,与不同结局(死亡/生存)进行Logistic回归分析。另外对20例脑卒中患者进行评定,测定各量表的平均评分时间以及评分者间一致性。结果量表与BI的相关系数分别为:MESSS-0.804～-0.815、CNS0.694～0.696,NIHSS和ESS0.721～0.793,MESSS与BI的相关系数高于CNS(P<0.05)。Logistic回归分析表明4种量表均对死亡有充分的预测能力;CNS的评分者间一致性最好,MESSS次之,NIHSS和ESS的一致性最差;评定所需时间为CNS最短,NESSS较长,NIHSS和ESS最长。结论MESSS具有最高的效度,较好的信度和可操作性。故在没有更理想的量表供选择的情况下,推荐选用MESSS。     

Building trophic specializations that result in substantial niche partitioning within a young adaptive radiation

Dietary partitioning often accompanies the increased morphological diversity seen during adaptive radiations within aquatic systems. While such niche partitioning would be expected in older radiations, it is unclear how significant morphological divergence occurs within a shorter time period. Here we show how differential growth in key elements of the feeding mechanism can bring about pronounced functional differences among closely related species. An incredibly young adaptive radiation of three Cyprinodon species residing within hypersaline lakes in San Salvador Island, Bahamas, has recently been described. Characterized by distinct head shapes, gut content analyses revealed three discrete feeding modes in these species: basal detritivory as well as derived durophagy and lepidophagy (scale‐feeding). We dissected, cleared and stained, and micro‐CT scanned species to assess functionally relevant differences in craniofacial musculoskeletal elements. The widespread feeding mode previously described for cyprinodontiforms, in which the force of the bite may be secondary to the requisite dexterity needed to pick at food items, is modified within both the scale specialist and the durophagous species. While the scale specialist has greatly emphasized maxillary retraction, using it to overcome the poor mechanical advantage associated with scale‐eating, the durophage has instead stabilized the maxilla. In all species the bulk of the adductor musculature is composed of AM A1. However, the combined masses of both adductor mandibulae (AM) A1 and A3 in the scale specialist were five times that of the other species, showing the importance of growth in functional divergence. The scale specialist combines plesiomorphic jaw mechanisms with both a hypertrophied AM A1 and a slightly modified maxillary anatomy (with substantial functional implications) to generate a bite that is both strong and allows a wide range of motion in the upper jaw, two attributes that normally tradeoff mechanically. Thus, a significant feeding innovation (scale‐eating, rarely seen in fishes) may evolve based largely on allometric changes in ancestral structures. Alternatively, the durophage shows reduced growth with foreshortened jaws that are stabilized by an immobile maxilla. Overall, scale specialists showed the most divergent morphology, suggesting that selection for scale‐biting might be stronger or act on a greater number of traits than selection for either detritivory or durophagy. The scale specialist has colonized an adaptive peak that few lineages have climbed. Thus, heterochronic changes in growth can quickly produce functionally relevant change among closely related species.     

Combined therapies to treat complex diseases: The role of the gut microbiota in multiple sclerosis

The commensal microbiota has emerged as an environmental risk factor for multiple sclerosis (MS). Studies in experimental autoimmune encephalomyelitis (EAE) models have shown that the commensal microbiota is an essential player in triggering autoimmune demyelination. Likewise, the commensal microbiota modulates the host immune system, alters the integrity and function of biological barriers and has a direct effect on several types of central nervous system (CNS)-resident cells. Moreover, a characteristic gut dysbiosis has been recognized as a consistent feature during the clinical course of MS, and the MS-related microbiota is gradually being elucidated. This review highlights animal studies in which commensal microbiota modulation was tested in EAE, as well as the mechanisms of action and influence of the commensal microbiota not only in the local milieu but also in the innate and adaptive immune system and the CNS. Regarding human research, this review focuses on studies that show how the commensal microbiota might act as a pathogenic environmental risk factor by directing immune responses towards characteristic pathogenic profiles of MS. We speculate how specific microbiome signatures could be obtained and used as potential pathogenic events and biomarkers for the clinical course of MS. Finally, we review recently published and ongoing clinical trials in MS patients regarding the immunomodulatory properties exerted by some microorganisms. Because MS is a complex disease with a large variety of associated environmental risk factors, we suggest that current treatments combined with strategies that modulate the commensal microbiota would constitute a broader immunotherapeutic approach and improve the clinical outcome for MS patients.