脑梗死并肺部感染行纤维支气管镜检查的临床观察

目的 观察脑梗死并肺部感染行纤维支气管镜检查的效果.方法 脑梗死并发肺部感染80例患者随机分为观察组和对照组.2组均给予常规治疗,观察组加用纤维支气管镜进行吸痰和灌洗治疗.对比分析2组临床治疗效果、体温恢复正常时间和感染控制时间.结果 观察组总有效率95.0％,优于对照组的75.0％(x2=6.64,P=0.039);观察组患者的感染控制时间和体温恢复时间均较对照组短(P＜0.05).结论 脑梗死并发肺部感染患者使用纤维支气管镜进行吸痰和灌洗治疗,有助于迅速控制肺部感染.     

马来酸桂哌齐特治疗急性脑梗死的疗效及对血液流变学的影响

目的：观察马来酸桂哌齐特注射液治疗急性脑梗死的临床效果及对血液流变学的影响。方法选择2009-12-2012-12我院内科收治的急性脑梗死患者133例,随机分为治疗组68例和对照组65例。2组均给予常规基础治疗,治疗组在对照组基础上应用马来酸桂哌齐特注射液320 mg加入500 mL 0.9％氯化钠注射液中静滴,1次/d ,共应用14 d ,治疗前后采用改良爱丁堡-斯堪的那维亚量表（SSS ）与日常生活能力（ADL ）量表对2组患者的疗效进行评定。对比治疗前后2组患者血液流变学指标变化。结果治疗7 d、14 d后治疗组SSS评分、ADL评分与对照组比较差异有统计学意义（ P＜0.05）。治疗组治疗前后SSS评分、ADL评分比较差异有统计学意义（ P＜0.05）。2组治疗后总有效率比较差异有统计学意义（ P＜0.05）。治疗组治疗后血液流变学指标均较治疗前有显著改善（ P＜0.05）。结论马来酸桂哌齐特注射液治疗急性脑梗死安全有效,且能显著改善患者的血液流变学指标。     

重组人组织型纤溶酶原激酶衍生物治疗急性脑梗死的疗效观察

目的：探讨重组人组织型纤溶酶原激酶衍生物（rPA ）治疗急性脑梗死的疗效与安全性。方法根据治疗方案将155例急性脑梗死患者分为观察组（84例）与对照组（71例）,观察组在常规治疗基础上给予rPA治疗,对照组在常规治疗基础上给予尿激酶治疗。结果（1）治疗前,2组美国国立卫生院神经功能缺损量表（NHISS）评分、Barthel 指数（BI）相比差异无统计学意义（P＞0.05）。治疗后,观察组 NHISS评分显著低于对照组,BI显著高于对照组,差异有统计学意义（P＜0.05）。（2）观察组治疗效果显著优于对照组,差异有统计学意义（P＜0.05）。（3）观察组不良反应发生率显著低于对照组,差异有统计学意义（P＜0.05）。结论 rPA治疗急性脑梗死的疗效确切、安全性高,是治疗急性脑梗死的理想药物之一。     

补阳还五汤加减治疗脑梗死的疗效观察

目的：探讨补阳还五汤加减治疗脑梗死的临床疗效。方法选择我院2011-03-2013-08收治的120例脑梗死患者的临床资料,对照组60例采用常规治疗,观察组60例在常规治疗基础上采用补阳还五汤治疗,比较2组临床疗效。结果观察组总有效率96.67％,对照组为80.00％,观察组总有效率明显高于对照组,差异有统计学意义（ P＜0.05）,观察组的血液流变学相关指标均较对照组明显改善,差异有统计学意义（ P＜0.05）。结论补阳还五汤对脑梗死患者具有十分显著的治疗效果,可有效缓解患者血液流变学异常,促进脑梗死患者的脑血管再通,疗效确切,且安全可靠。     

阿加曲班治疗进展性脑梗死的疗效分析

目的：探讨阿加曲班治疗进展性脑梗死的疗效。方法将2010-01-2013-08我院收治的134例进展性脑梗死患者随机分为对照组（67例）与观察组（67例）,对照组患者仅接受常规治疗,如调整血压、控制血糖血脂、脑保护、抑制血小板聚集、脱水等,观察组在上述常规治疗基础上联合使用阿加曲班。结果治疗前2组患者美国国立卫生研究院卒中量表（NHISS）评分、日常生活能力量表（ADL）评分、改良Rankin量表（mRS）评分相比差异无统计学意义（P＞0.05）。治疗后观察组NHISS评分、mRS评分显著低于对照组,ADL评分显著高于对照组,差异有统计学意义（P＜0.05）。观察组治疗效果显著优于对照组,差异有统计学意义（P＜0.05）。2组患者血尿、上消化道出血等不良反应发生率相比差异无统计学意义（P＞0.05）。结论阿加曲班可改善进展性脑梗死患者的预后,且安全性高,是治疗进展性脑梗死的理想药物。     

护理干预对神经内科患者院内感染发生率的影响

目的：探讨护理干预对神经内科患者院内感染发生率的影响。方法将124例神经内科患者随机分为观察组与对照组，每组62例，对照组给予常规药物治疗和常规护理模式，观察组在此基础上给予综合护理干预。比较2组患者的院内感染情况和满意度。结果观察组患者的感染率12.9％，对照组48.4％，观察组感染率显著低于对照组，2组比较差异有统计学意义（ P＜0.05）；观察组满意率96.8％，对照组69.4％，观察组满意率显著高于对照组，2组比较差异有统计学意义（ P＜0.05）。结论护理干预能有效的控制神经内科患者院内感染的发生，提高患者满意度，值得临床推广。     

脑梗死后遗症期吞咽障碍患者早期康复探讨

目的：探讨脑梗死后遗症期吞咽障碍患者早期康复的临床效果。方法选取2012‐01—2014‐02入院的脑梗死后遗症期吞咽障碍患者60例，随机分为观察组和研究组各30例，对照组采取常规护理方法，观察组在此基础上采取早期康复训练。分析2组患者效果以及认知度改善情况。结果观察组吞咽困难康复效果明显高于对照组（93.3％ v s.50.0％），2组相比差异有统计学意义（P＜0.05）；观察组患者认知度改善率显著优于对照组（96.7％ vs.63.3％），2组相比差异有统计学意义（P＜0.05）。结论脑梗死后遗症期吞咽困难患者行早期康复训练，明显提高康复效果，改善患者认知度，提升患者生存质量，有重要临床价值。     

虫类中药对急性脑梗死患者神经功能的作用

目的：观察虫类中药对急性脑梗死患者神经功能的影响。方法将100例脑梗死患者随机分为对照组和治疗组，对照组给予维脑路通注射液治疗，治疗组给予虫类中药联合疏血通注射液治疗，2组均治疗2个疗程（28 d ）以评价疗效。结果治疗组总有效率98％，显著优于对照组的76％（ P＜0.05）；治疗后2组患者神经功能缺损程度均比治疗前有所改善（P＜0.05），治疗组改善效果较对照组明显（P＜0.05）。结论虫类中药联合疏血通注射液治疗脑梗死安全有效。     

早期高压氧治疗对急性脑梗死患者神经功能的影响

目的：探讨早期高压氧治疗对急性脑梗死患者的临床疗效及对神经功能的影响。方法118例ACI随机分为2组,均给予常规治疗,治疗组在常规治疗的基础上,在发病早期时（48 h内）,C T证实脑部无活动性出血,生命体征平稳,立即给予高压氧治疗。结果治疗组总有效率86.67％,对照组为63.79％,治疗组优于对照组,差异有统计学意义（ P＜0.05）;治疗后治疗组NIHSS评分较对照组低,差异有统计学意义（P＜0.05）;治疗组MBI评分较对照组低,差异有统计学意义（P＜0.05）。结论早期高压氧治疗ACI效果满意,且可显著改善患者的神经功能缺损,提高日常生活活动能力。     

注射用尤瑞克林治疗心源性脑梗死的早期疗效观察

目的：探讨临床注射用尤瑞克林在心源性脑梗死中的早期疗效。方法将75例心源性脑梗死患者随机分为实验组和对照组。对照组35例应用氯吡咯雷或大剂量肠溶阿司匹林抗血小板聚集等常规治疗,实验组40例在常规治疗的基础上联合应用尤瑞克林,治疗7～10 d后对比2组治疗前后的神经功能缺损评分（NIHSS）和Barthel指数情况及治疗有效率。结果2组治疗前NIHSS与Barthel指数比较,差异无统计学意义（P＞0.05）;实验组治疗后NHSS与Barthel指数与对照组比较差异无统计学意义（P＞0.05）;2组治疗前与治疗后分别比较差异均有统计学意义（P＜0.05）;实验组治疗有效率95.00％,明显高于对照组（77.14％）,差异有统计学意义（ P＜0.05）。结论尤瑞克林早期应用于急性心源性脑梗死,可明显改善脑痉挛,保护脑心功能,提高治疗效果。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.