卒中后失语患者非语言性认知功能特点的临床研究

目的 探讨卒中后失语患者的非语言性认知功能特点.方法 纳入30例卒中后失语患者和30例卒中后非失语患者,对失语组采用汉语失语检查量表（Aphasia Battery of Chinese,ABC）进行失语评估,并用非语言性的认知功能评定量表（The Non-language-based Cognitive assessment,NLCA）评估卒中后失语患者和非失语患者的认知功能.用卒中后失语患者抑郁问卷（医院版）（Stroke Aphasic Depression Questionnaire Hospital Version,SADQ-H）评估卒中后失语患者的抑郁情绪,比较失语患者的抑郁情绪与认知功能损伤之间的关系.结果 失语组的NLCA总分（50.01±14.01）分显著低于非失语组（66.13±5.95）分,差异具有统计学意义（P＜0.05）;失语组的NLCA总分及其各亚项分值均与ABC总分及其各亚项分值具有相关性（P＜0.01,P＜0.05）;失语组SADQ-H总分（21.83±7.37）分显著高于非失语组SADQ-H总分（16.13±5.84）分,差异具有统计学意义（P＜0.01）;失语组SADQ-H评分与NLCA总分呈显著负性相关（r=-0.468,P＜0.05）.结论 卒中后失语患者存在非语言性认知功能障碍,并且失语患者抑郁情绪的严重程度对认知功能的损伤有影响.     

Clinical Application of Loewenstein Occupational Therapy Cognitive Assessment Battery-Second Edition in Evaluating of Cognitive Function of Chinese Patients with Post-stroke Aphasia

Objective To investigate the clinical application value of Loewenstein Occupational Therapy Cognitive Assessment （LOTCA） battery in Chinese patients with post-stroke aphasia. Methods Cognitive fimctions of 59 Chinese patients with aphasia following a stroke were assessed with the Chinese version of the second edition of LOTCA battery and their linguistic functions were tested with the Western Aphasia Battery （WAB） Scale, respectively. The results of LOTCA were analyzed and compared across different groups, in the light of gender, age, educational background, the length of illness, and the degree of aphasia.     

Development of a disease-specific health-related quality of life questionnaire for patients with post-stroke spasticity

OBJECTIVE:This study was designed to develop a disease-specific health-related quality of life(HR-QOL) measure for patients with post-stroke spasticity.METHODS:Based on responses from 20 patients with post-stroke spasticity and an extensive literature search,items potentially used to measure these patients’ recovery status were identified and the Apoplexy Spastic-Paralysis Questionnaire(ASPQ) was formed.A sample of 106 patients was then tested twice using the ASPQ,the Self-rating Depression Scale(SDS) and the Stroke-specific Quality of Life(SS-QOL).Clinicians also examined all the patients using the Ashworth Scale(AS).Internal reliability was assessed using Cronbach’s coefficient α,while construct validity was determined using principal component analysis(PCA).Empirical validity was evaluated between patients with depression and those without depression by single factor analysis.Sensitivity was examined by calculating the Spearman correlation coefficient between the changes in scores of the ASPQ,the AS and the SS-QOL.RESULTS:The ASPQ had adequate internal consistency reliability(α=0.874) and sensitivity,with significant correlations between the changes in scores of the AS,the SS-QOL and the ASPQ,with three domains.In a construct validity test,six factors were extracted;the overall variance explained by all factors was 72.6%.For empirical validity,mean values of 19 items and 3 domains were all higher in the depressive patients than in the non-depressive patients.CONCLUSION:The ASPQ is a reliable and valid self-rating scale for measuring the HR-QOL in patients with post-stroke spasticity.     

Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

Objective： To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40% -57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central india to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods： Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders （ total duration of illness 〉 3 months） were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results： Out of 68 patients evaluated, 36 （53%） were found out to be suffering from depression. Female gender （80%） was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease （COPD） patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 〈 30 yrs of age, 53% are between 30-60 yrs of age and 52% are 〉 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion： Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.     

Difficulties in post-stroke gait improvement caused by post-stroke depression

Background Depression is a common problem impeding post-stroke rehabilitation.Up to 70% of patients show depression symptoms during the first twelve months after stroke onset.However,the depression and its effect on functional recovery can be difficult to diagnose.The purpose of this study was to use gait analysis as a tool to compare the recovery after stroke in patients with and without depression and to assess the impact of the initiation time of rehabilitation after stroke onset.Methods One hundred and forty five consecutive patients after first ever stroke admitted for designed rehabilitation program within 2 to 31 months after stroke onset participated.All patients received 4 weeks treatment program included comprehensive rehabilitation consisted of multipurpose activities 5 days a week.These included individual and group exercises,physiotherapy,occupational therapy and gait training.Gait analysis with Kistler force plates was employed to assess gait pattern symmetry before and after the treatment.Gait symmetry was evaluated based on seven gait parameters.Regaining of gait pattern symmetry was assumed as a measure of rehabilitation outcome.Results After rehabilitation program gait symmetry w（）ined in patients without depression.Gait asymmetry remained unchanged in patients diagnosed with depression.No major differences in outcome from rehabilitation were noted in regards to the initiation time of rehabilitation after the stroke onset.Conclusions Depression limits gait recovery after stroke.The time of initiation of rehabilitation after stroke onset does not limit the motor recovery after rehabilitation program.     

Clinical Characteristics of Abnormal Savda Syndrome Type in Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome Patients: A Cross-Sectional Investigation in Xinjiang, China

Objective: To investigate the distribution of abnormal hilit syndromes in traditional Uighur medicine (TUM) among human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) patients, and to find out the clinical characteristics of abnormal savda syndrome type HIV/AIDS patients. Methods:Between June and July in 2012, 307 eligible HIV/AIDS patients from in-patient department and out-patient clinics of Xinjiang Uighur Autonomous Region the Sixth People''s Hospital in Urumqi were investigated. TUM syndrome differentiation was performed by a senior TUM physician. Each participant completed a Sign and Symptom Check-List for Persons Living with HIV/AIDS (SSC-HIV) questionnaire. Depression was evaluated by using Hamilton Rating Scale for Depression Questionnaire. Blood specimen was collected from each participant to test the levels of blood chemicals. Results: Of 307 HIV/AIDS patients, 189 (61.6%) were abnormal savda syndrome type, 118 (38.4%) were non-abnormal-savda syndrome type. Mean CD4 counts of abnormal savda syndrome type patients was (227.61±192.93) cells/μL, and the prevalence of anemia, thrombocytopenia, and elevated cystatin C were 49.7%, 28.6%, and 44.7%, which were significantly higher than those in the non-abnormal-savda syndrome type patients (26.3%, 16.0% and 25.0%, P<0.05). In addition, depression (79.9%) and HIV/AIDS-related symptoms such as fatigue (42.3%), back aches (40.7%), lack of appetite (33.9%), night sweats (31.7%) were more common among abnormal savda syndrome patients (P<0.05). Conclusion: Abnormal savda syndrome is the dominant syndrome among HIV/AIDS patients, and they present a more sever clinical manifestation.     

The clinical application of endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer

<正>Objective The aim of the present study was to assess the frequency of depression and quality of life(QoL) in lung cancer patients before and after diagnosis,and to investigate the potential related factors. Methods The subjects consisted of 115 consecutive adult patients newly diagnosed for lung cancer in Shanghai Pulmonary Hospital between April 2008 and October 2008. Depression and     

抑郁应激-认知易感性模型在中国大学生中的构建与验证

目的 在中国大学生人群中对抑郁的应激-认知易感性模型进行初步构建和实证分析.方法 647名大学生完成测验,测查量表为学生日常生活和学习应激量表(GSASHS)和流调中心用抑郁量表(CES-D),认知方式问卷(CSQ)、功能失调态度量表(DAS)、反应方式问卷(RSQ.SF)、自尊问卷(SEQ),1月后进行追踪测查.结果 认知易感因素与应激的交互作用进入回归方程,对抑郁的发作均有预测作用,增强了抑郁发作的可能(P<0.01);路径分析显示:负性认知→过分思虑→抑郁是一条重要的作用路径,过分思虑是一个关键的中介(β=-0.31,P<0.01);整合的应激-认知易感性模型有较好的拟合指数,GFI=0.95,CFI=0.94,IFI=0.94,RMSEA=0.085.结论 在中国大学生人群初步的构建和验证了一个抑郁的应激-认知易感性模型,过分思虑是一个关键的中介.

Abstract：

Objective To test the validity of the stress-cognition vulnerability-model of depression in Chinese undergraduates.Methods 647 undergraduate students finished the Chinese version of 6 scales in time one.Cognitive Style Questionnaire(CSQ),Response Styles Questionnaire(RSQ-SF),Self-Esteem Questionnaire(SEQ),Dysfunctional Attitudes Scale(DAS),General Social and Academic Hassles Scale for Students(GSASHS),Center for Epidemiologic Studies Depression Scale(CES-DA)follow-up assessment in 1 month later,the General Social and Academic Hassles Scale for Students(GSASHS)scale and Center for Epidemiologic Studies Depression Scale (CES-D)scale were completed.Then,vulnerability factors for depression symptoms were used to predict depression symptoms by Multiple Hierarchical Regression(MHR).Path analysis and structural equation model(SEM)were used to explore integrated vulnerability-stress model of depression in Chinese undergraduates.Results Vulnerability-stress interaction was entered into regression equation.The results showed that the vulnerability-stress interaction provided incremental predictive validity to depressive.Symptoms path analysis showed that negative cognition→rumination→depression was a important pathways to cause depression(β=-0.31,P<0.01).The structural equation model for integrated vulnerability-stress model of depression analysis indicated the fit index:GFI =0.95,CFI=0.94,IFI=0.94,RMSEA=0.085.Conclusion A cognition vulnerability-stress medels of depression in Chinese undergraduates was provided and to be confirmed.The rumination was a important mediated variable.     

英语园地

Depression and Suicide in Patients Treated with Isotretinoin Between 1982 and May 2000, the Food andDrug Administration (FDA) received reports of431 cases of depression, suicidal ideation, suicideattempts, or suicide in U. S. patients treated withisotretinoin (Accutane, Hoffmann-LaRoche),     

Effects of music therapy on depression and duration of hospital stay of breast cancer patients after radical mastectomy

Background  Breast cancer remains the most important cancer among women worldwide. The disease itself and treatment may have a profound impact on the patients’ psychological well being and quality of life. Depression is common in breast cancer patients and affects the therapeutic effects as well as prolongs the duration of hospital stay. However, few studies reported the effectiveness of music therapy on depression and duration of hospital stay of female patients with breast cancer after radical mastectomy.

Methods  One hundred and twenty subjects were recruited to this clinical trial and randomly allocated to two groups. The experimental group (n=60) received music therapy on the basis of routine nursing care, whereas the control group (n=60) only received the routine nursing care. The whole intervention time was from the first day after radical mastectomy to the third time of admission to hospital for chemotherapy. Data of demographic characteristics and depression were collected by using the General Questionnaire and Chinese version of Zung Self-rating Depression Scale (ZSDS) respectively. One pre-test (the day before radical mastectomy) and three post-tests (the day before discharge from hospital, the second and third admission to hospital for chemotherapy) were utilized. Duration of hospital stay was calculated from the first day after radical mastectomy to the day of discharged from hospital.

Results  The mean depression score of all subjects was 37.19±6.30. Thirty-six cases (30%) suffered from depression symptoms, with 26 (72.2%) mild depression cases, 9 (25.0%) moderate depression cases, and 1 (2.8%) severe depression case. After music therapy, depression scores of the experimental group were lower than that of the control group in the three post-tests, with significant differences (F=39.13, P <0.001; F=82.09, P <0.001). Duration of hospital stay after radical mastectomy of the experimental group ((13.62±2.04) days) was shorter than that of the control group ((15.53±2.75) days) with significant difference (t=–4.34, P <0.001).

Conclusions  Music therapy has positive effects on improving depression of female patients with breast cancer, and duration of hospital stay after radical mastectomy can be reduced. It is worthy of applying music therapy as an alternative way of nursing intervention in clinical nursing process of caring female patients with breast cancer.

     

心理干预结合言语治疗对失语患者脑卒中后抑郁的疗效研究

目的探讨心理干预结合言语治疗对失语患者卒中后抑郁的临床效果。方法入组60例住院患者,随机分为言语治疗组和言语心理组,疗程30d,治疗前后均采用西方失语成套测试(WAB)和波士顿失语严重程度分级(BDAE)进行言语功能的评估,采用卒中后失语患者抑郁问卷评分评估抑郁状态。结果治疗前两组病情差异无统计学意义,治疗后两组失语商(AQ)值均较前明显增加,言语心理组AQ值(74.50±10.52)较言语治疗组AQ值(64.13±10.77)增加更为显著(P<0.005);波士顿失语严重程度分级言语心理组疗效优于言语治疗组(P<0.005);治疗前后抑郁严重程度比较,两组均有所减轻,言语心理组疗效优于言语治疗组(P<0.005)。结论心理干预结合言语治疗能显著改善失语患者卒中后抑郁及言语功能。     

失语综合征的分类及其CT定位

报导47例卒中后失语,按失语特点分类。失语类型包括运动性(3例)、感觉性(7例)、传导性(3例)、经皮质运动性(4例)、经皮质感觉性(2例)、经皮质混合性(4例)、完全性(9例)、命名性(1例)、丘脑性(6例)和底节性(8例)。用电子计算机对CT病灶图象进行标准化处理。结果表明各型失语与病灶部位很有关。     

经颅直流电刺激配合镜像神经元疗法治疗缺血性脑卒中后运动性失语症效果观察

目的 探讨经颅直流电刺激配合镜像神经元疗法治疗缺血性脑卒中后运动性失语症的效果。方法 选取80例缺血性脑卒中后运动性失语症患者,依照随机数字表法分为对照组和试验组,每组40例。两组均给予基础治疗,对照组另给予镜像神经元疗法治疗,试验组在对照组的基础上另给予经颅直流电刺激治疗,两组均治疗20 d。治疗前后采用波士顿诊断性失语症检查(Boston Diagnostic Aphasia Examination, BDAE)、语言功能评分(Western Aphasia Battery, WAB)和神经功能缺损评分(National Institutes of Health Stroke Scale, NIHSS)对两组进行评定,比较两组患者临床疗效及不良反应发生率。结果 治疗后2组BDAE等级分布比较差异有统计学意义(P<0.05);治疗后,试验组的总有效率高于对照组(P<0.05);两组治疗后WAB评分均升高(P<0.05),且试验组更高(P<0.05),两组NIHSS评分均降低(P<0.05),且试验组更低(P<0.05);两组不良反应发生率比较,差异...     

卒中后失语患者抑郁的量表评定

目的针对卒中后失语患者的常规抑郁量表的评定难点,采用两种非语言性抑郁量表[卒中后失语抑郁量表(SADQ)和失语抑郁量表(ADRS)]对患者抑郁程度进行评定,并判断在卒中后抑郁诊断上的信度、效度,评价其是否能满足心理测量学的要求。方法对90例脑卒中后患者在病情稳定2周后,采用SADQ、ADRS同时对其进行测量,并在首次测量2周后及6周后分别复测,分析其各自的信度、效度;对于无失语的患者同时进行汉密尔顿抑郁量表测评,作为效标依据。结果两种非语言性抑郁量表信度效度均较满意,ADRS在信度上优于SADQ,SADQ在敏感度,尤其在早期对抑郁的敏感度优于ADRS。根据量表的评定结果,卒中后失语患者抑郁的比例明显高于无失语的患者。结论 ADRS、SADQ均可作为卒中后抑郁的测评量表,在卒中后失语患者的抑郁情绪的早期识别上发挥作用,研究中ADRS的信度更好,SADQ在卒中后早期较为敏感,而ADRS在卒中后的亚急性期敏感性大大提高。     

脑卒中后失语症患者功能磁共振成像研究

目的 通过多模态磁共振分析脑卒中后失语症患者语言功能区的血流量及代谢改变,阐明失语症的机制,为临床失语症的治疗、预后及康复训练提供理论依据.方法 选取2018年10月至2019年10月就诊于牡丹江医学院附属红旗医院神经内科脑梗死后失语患者,按《西方失语症成套测验》判断所有失语患者类型,共纳入35例脑梗死后失语患者,其中...     

脑卒中后抑郁状态的临床观察

目的:观察脑卒中后抑郁的发生率及相关因素。方法:对169例诊断为急性脑卒中的患者,在入院后2、4周分别进行汉密尔顿抑郁量表(HAMD)、欧洲脑卒中量表(ESS)评分和日常生活能力评定(BI指数评定)。结果:脑卒中后抑郁67例,发生率为39.6%。其中轻度抑郁41例,占59.4%,中度抑郁23例,占33.3%;重度抑郁5例,占7.2%;病灶部位与卒中后抑郁有直接关系:提示基底带区病变患者易发生PSD,PSD发生与左右侧大脑半球病变无关;其BI指数评分显著高于无抑郁状态的患者,而且抑郁程度与神经功能缺损呈正相关。结论:卒中后抑郁是脑卒中常见的并发症,脑卒中后抑郁的发生与生物学、心理和社会因素有关。应高度重视脑卒中后抑郁的发生。     

脑梗死后抑郁发生与人文因素、血管危险因素及卒中特点的相关性研究

目的 研究首次脑梗死后抑郁发生与人文因素、血管危险因素及卒中特点的相关性。 方法 采用Zung抑郁量表(SDS)对2010年1月-2014年12月于第三军医大学大坪医院就诊的304例首次脑梗死7 d内的患者在发病后第3个月进行评分,分为抑郁组125例和非抑郁组179例,分析2组患者脑梗死后抑郁的发生与人文因素、血管危险因素、卒中特点与发生抑郁的相关性。运用Logistic回归法分析首次脑梗死抑郁发生的危险因素。 结果 首次脑梗死后抑郁的发生率为41.1%。对抑郁组和非抑郁组患者在人文因素、血管危险因素及卒中特点等相关因素进行单因素分析,抑郁组患者在失眠、独居、近期负性事件、高血压、左颈内动脉系统梗死、皮质梗死、NIHSS和Bathel Index评分、语言障碍和运动障碍,与非抑郁组患者比较差异均存在统计学意义(均P<0.05)。多因素Logistic回归分析显示,失语(OR=1.82,95%CI 1.17~2.35)、失眠(OR=1.85,95%CI 1.20~2.42)、NIHSS评分(OR=2.19,95%CI 1.36~3.18)和Bathel Index评分(OR=2.27,95%CI 1.51~3.36)与脑梗死后抑郁的发生独立相关。 结论 失语、失眠、卒中严重程度是首次脑梗死抑郁发生的危险因素。      

针刺配合语言训练治疗脑卒中后失语症临床研究

目的:通过规范的临床随机对照试验,证实针刺配合语言训练治疗脑卒中后失语症的临床疗效。方法:将78位患者随机分为针刺配合语言训练组(治疗组)和假针刺配合语言训练组(对照组),共治疗4周。治疗前后均观察失语检查记录评分值及脑卒中后失语生活质量检查评分值(SAQOL-39)。结果:治疗组与对照组在治疗前后均有恢复患者语言功能的效果(P<0.05),且治疗组治疗脑卒中后失语症的临床疗效总有效率达90.24%,优于对照组(P<0.05)。结论:针刺配合语言训练能有效治疗脑卒中后失语症。     

皮质下失语症的区域脑血流研究

研究了３４例首发急性脑血管病患者的语言功能与ＣＴ、９９ｍＴｃ－ＥＣＤＳＰＥＣＴ结果。发现左皮质下单发病灶的２５例中，２１例有失语症。其中１５例的ＳＰＥＣＴ示左皮质区低灌注；且不同失语类型与ｒＣＢＦ低灌注部位有关。２例ＣＴ未发现病灶的失语症患者有左皮质区低灌注，且血流减少部位与失语症类型有关。结果提示：单独左皮质下病变可产生失语；而左皮质区血流低灌注可能是皮质下失语的一个重要原因。