高频重复经颅磁刺激联合吸烟相关线索诱发对香烟成瘾的影响

目的 探讨作用于左侧背外侧前额叶皮质区（DLPFC）的高频重复经颅磁刺激(H-F rTMS)联合吸烟相关线索诱发对香烟成瘾患者香烟渴求度（VAS评分）、呼出气CO浓度（COppm）和睡眠质量（PSQI评分）的影响。 方法 60例香烟成瘾患者随机分为A组（相关线索诱发rTMS组）、B组（非相关线索诱发rTMS组）和C组（rTMS组）,每组患者20例,在治疗过程中A、B组各有1例患者脱落。A组患者在H-F rTMS治疗的同时观看吸烟相关图片10 min,B组患者在H-F rTMS治疗的同时观看非吸烟相关图片10 min,C组患者仅给予H-F rTMS治疗。以上治疗均为每日1次,每周治疗5 d,连续治疗2周。3组患者均于治疗前和治疗2周后（治疗后）进行VAS评分、COppm和PSQI检测。 结果 治疗后,3组的香烟渴求度VAS评分、呼出CO浓度和PSQI评分较组内治疗前均显著下降,差异均有统计学意义（P<0.05）。A组治疗后的香烟渴求度VAS评分和呼出CO浓度分别为（24.74±15.77）分和（4.84±2.17）ppm,与B组和C组比较,差异均有统计学意义（P<0.05）。 结论 rTMS可显著改善香烟成瘾患者的香烟渴求、呼出气CO浓度和睡眠质量,其中H-F rTMS联合吸烟相关线索诱发的治疗效果最佳。     

高频重复经颅磁刺激干预精神分裂症患者吸烟有效性研究

目的研究高频重复经颅磁刺激(rTMS)减少精神分裂症患者吸烟量及尼古丁渴求的有效性。方法本研究为随机双盲安慰剂对照试验,将60名符合入组条件的受试者随机分配至rTMS刺激组及rTMS伪刺激组各30例,研究组使用rTMS治疗(10Hz刺激左侧前额叶背外侧皮质、110%运动阈值、10s/串、间歇30s、20串/d),对照组使用伪rTMS设备干预,两组均每周治疗5次,为期3周,并随访至第6周。采用受试者自我报告的方式获悉每日吸烟数量、烟草依赖自评量表评估尼古丁渴求,使用阳性阴性症状量表(PANSS)、蒙哥马利抑郁量表(MADRS)和卡尔加里精神分裂症抑郁量表(CDSS)评定患者阴性抑郁症状。结果 (1)治疗3周末及随访期可观察到rTMS刺激组吸烟量及烟草依赖自评量表评分明显降低,与伪刺激组对比具有统计学差异(P0.01)。(2)阴性、抑郁症状变化和吸烟量改变之间未发现明显关联。结论刺激左侧前额叶背外侧皮质的高频rTMS可以减少精神分裂症患者的吸烟量及尼古丁渴求。     

重复经颅磁刺激技术对抑郁症患者吸烟依赖及睡眠的效果研究

目的 探讨重复经颅磁刺激(rTMS)技术在抑郁症患者治疗中的应用效果。方法 选取2020年7月-2022年7月我院诊治的72例抑郁症患者为研究对象,按随机数字表法分为对照组和观察组,各36例。对照组给予草酸艾司西酞普兰治疗,观察组在对照组的基础上加用rTMS治疗,连续治疗4周。比较两组心理状态、吸烟依赖、睡眠质量、生活质量、不良反应。结果 两组治疗前焦虑自评量表(SAS)、抑郁自评量表(SDS)、尼古丁依赖检验量表(FTND)、吸烟渴求量表(TCQ)、匹兹堡睡眠质量指数(PSQI)与生活质量综合评定问卷(GQOLI-74)评分比较,差异无统计学意义(P>0.05);观察组治疗后SAS、SDS、FTND、TCQ、PSQI评分低于对照组,GQOLI-74评分高于对照组(P<0.05);两组不良反应比较差异无统计学意义(P>0.05)。结论 rTMS技术治疗抑郁症效果显著,能够有效缓解焦虑、抑郁情绪,减轻吸烟依赖,改善睡眠质量及生活质量。     

重复经颅磁刺激对酒依赖者的影响

目的：研究重复经颅磁刺激（rTMS）对酒依赖者心理渴求、自我效能感（SE）及复饮的影响。方法：选择2021年4月～2022年6月于我院接受治疗的酒依赖患者86例,依据随机数字表法将86例酒依赖患者分为rTMS组（n=43）、对照组（n=43）。对照组行常规支持及替代治疗,rTMS组在对照组基础上行rTMS治疗。观察2组治疗前、治疗5周后及治疗后6个月酒精依赖、心理渴求、自我效能感及复饮情况;观察2组治疗后6个月,复饮以及再住院情况。结果：治疗完成后,2组酒精依赖戒断评估表（CIWA-Ar）、酒精依赖筛查量表（MAST）、心理渴求以匹兹堡睡眠质量指数量表（PSQI）、宾夕法尼亚酒精渴求量表（PACS）评分均较治疗前降低（P＜0.05）,且rTMS组CIWA-Ar、MAST、PSQI、PACS评分均低于对照组（P＜0.05）;治疗后6个月,rTMS组CIWA-Ar、MAST、PSQI、PACS评分均低于对照组（P＜0.05）,rTMS组CIWA-Ar、MAST、PSQI、PACS评分与治疗完成后差异无统计学意义,对照组CIWA-Ar、MAST、PSQI、PACS评分均高于治疗完成后（P＜0.05）。治疗完成后,2组一般自我效能感量表（GSES）评分均较治疗前升高,且rTMS组GSES评分均高于对照组（P＜0.05）;治疗后6个月,rTMS组GSES评分高于对照组（P＜0.05）,rTMS组GSES评分与治疗完成后差异无统计学意义,对照组GSES评分低于治疗完成后（P＜0.05）。治疗期间,2组均无显著副反应发生。治疗后6个月,rTMS组复饮以及再住院率均低于对照组（P＜0.05）。结论：rTMS治疗可有助于降低酒依赖患者酒精依赖程度及对酒精的心理渴求,缓解患者生理心理上的痛苦,增强其SE,降低复饮及再住院率。     

重复经颅磁刺激联合心理干预治疗帕金森病抑郁患者的疗效观察

目的探讨重复经颅磁刺激(rTMS)联合心理干预对帕金森病抑郁(dPD)患者抑郁症状、神经功能及生活质量的改善作用。方法采用随机数字表法将120例dPD患者分为心理组、rTMS组及观察组, 每组40例。所有患者均给予常规抗帕金森病及抗抑郁药物治疗, 在此基础上心理组、rTMS组患者分别给予心理干预或高频(10 Hz)rTMS治疗(刺激部位为左侧背外侧皮质区), 观察组患者则辅以心理干预及高频rTMS治疗, 3组患者均持续治疗8周。于治疗前、治疗8周后分别采用汉密尔顿抑郁量表(HAMD-24)、新版帕金森病综合评价量表(MDS-UPDRS)及生活质量评价量表(SF-36)对3组患者抑郁症状、神经功能受损程度和生活质量进行评估。结果治疗8周后3组患者HAMD评分、MDS-UPDRS评分及SF-36评分均较治疗前明显改善(P<0.05), 并且治疗后观察组HAMD评分[(13.98±2.46)分]、MDS-UPDRS评分、SF-36评分[(82.35±5.66)分]及临床缓解率(40.0%)、反应率(90.0%)等均显著优于心理组及rTMS组水平(P<0.05)。结论心理干预联合r...     

重复经颅磁刺激联合针刺治疗脊髓损伤后神经病理性疼痛的临床研究

目的：观察重复经颅磁刺激（rTMS）联合针刺治疗脊髓损伤（SCI）后神经病理性疼痛（NP）的临床疗效。方法：按随机数字表法将99例SCI后NP患者分成对照组、针刺组和联合组,各33例。对照组进行常规基础治疗,针刺组在对照组基础上进行针刺治疗,联合组在针刺组基础上进行rTMS治疗。分别于治疗前及治疗6周后对3组患者进行视觉模拟量表（VAS）、汉密顿抑郁量表（HAMD）、汉密顿焦虑量表(HAMA)及生活质量SF-36量表评估。结果：治疗6周后,3组患者VAS、HAMD和HAMA评分较治疗前均明显降低（P＜0.05）,SF-36量表各项评分较治疗前均明显升高（P＜0.05）;针刺组VAS、HAMD和HAMA评分较对照组均有降低（P＜0.05）,SF-36量表各项评分较对照组均有升高（P＜0.05）;联合组VAS、HAMD和HAMA评分较针刺组和对照组均有降低（P＜0.05）,SF-36量表各项评分较针刺组和对照组均有升高（P＜0.05）。结论：rTMS联合针刺治疗SCI后NP患者,有助于改善患者临床疼痛现象,且在改善患者情绪和生活质量方面疗效显著。     

高频重复经颅磁刺激联合认知训练治疗卒中后执行功能障碍的疗效

目的:探讨高频重复经颅磁刺激(rTMS)联合认知训练治疗卒中后执行功能障碍的疗效。方法:选取60例脑卒中后执行功能障碍患者，随机分成对照组和观察组各30例。对照组采用认知训练，同时给予假刺激治疗，观察组采用高频(10Hz)rTMS联合认知训练治疗，共治疗6周。2组患者于治疗前后采用额叶功能评定量表(FAB)、汉诺塔测试(TOH)、连线测验A(TMT-A)评定患者执行功能，同时评估事件相关电位P300潜伏期和波幅。结果:2组患者治疗前FAB评分、TOH评分、TMT-A评分、P300潜伏期及波幅的比较差异无统计学意义。治疗6周后，2组患者的FAB评分高于治疗前(P<0.05),TOH评分及TMT-A评分低于治疗前(P<0.05),P300潜伏期较治疗前缩短(P<0.05),波幅较治疗前增高(P<0.05);治疗后，观察组FAB评分较对照组升高(P<0.05),TOH及TMT-A评分较对照组降低(P<0.05),P300潜伏期较对照组缩短(P<0.05),P300波幅较对照组升高(P<0.05)。结论:高频rTMS联合认知训练可以有效改善脑卒中...     

高频重复经颅磁刺激在脑卒中后注意障碍患者中的临床研究

目的:探究高频重复经颅磁刺激(rTMS)对脑卒中后注意障碍患者的注意功能和事件相关电位的影响。方法:将60例卒中后注意障碍患者随机分为观察组和对照组各30例。2组患者均予以药物及常规康复治疗,在上述干预基础上观察组采用高频(10Hz)rTMS刺激,对照组予以rTMS假刺激。于治疗前及治疗4周后进行蒙特利尔认知评估量表(MoCA)、符号数字模式测试(SDMT)、数字广度测试(DST)、字母删除试验、事件相关电位P300的评定。结果:治疗后2组患者MoCA、SDMT、DST、正确删除数等评分均较治疗前提高(P<0.05),P300潜伏期缩短、波幅增高(P<0.05),观察组MoCA、SDMT、DST、字母正确删除数等评分较对照组提高更明显(P<0.05),P300潜伏期、波幅较对照组变化明显(P<0.05)。结论:高频rTMS可改善脑卒中后注意障碍患者的注意功能,P300可作为反映其注意功能受损的神经电生理指标。     

高频重复经颅磁刺激对大学生网络成瘾的干预效果

目的探讨高频重复经颅磁刺激(rTMS)对大学生网络成瘾程度及其相关症状的影响。方法选取不同程度的网络成瘾大学生受试者50例, 按随机数字表法分为治疗组和对照组, 每组受试者25例。2组均进行心理行为疗法治疗, 治疗组同时接受40 d、频率10 Hz的rTMS治疗, 刺激部位为左侧DLPFC区, 对照组则接受伪rTMS刺激治疗。于治疗前、治疗4周和治疗8周后采用中文版网络成瘾诊断量表(IAT)、Barratt冲动性量表中文修订版(BIS-11)和视觉模拟评分法(VAS)分别评估2组受试者的网络成瘾程度、冲动性和主观网络渴求程度, 并进行统计学分析。结果治疗4周后, 治疗组的BIS-11注意因子评分、BIS-11总分和VAS评分分别为(20.47±4.14)分、(68.05±6.10)分和(6.67±0.65)分, 与组内治疗前和对照组治疗4周后比较, 差异均有统计学意义(P<0.05);治疗8周后, 治疗组的IAT评分、BIS-11各项评分和VAS评分与组内治疗前、组内治疗4周后以及对照组治疗8周后比较, 差异均有统计学意义(P<0.05)。结论高频rTMS刺激网络成瘾大学生...     

高频重复经颅磁刺激结合平衡训练仪治疗对脑梗死患者平衡障碍的康复疗效

目的:研究高频重复经颅磁刺激(rTMS)结合平衡训练仪治疗对脑梗死患者平衡障碍的康复疗效。方法:选取2021年4月至2023年1月在潍坊市人民医院脑科分院康复科收治的急性脑梗死患者70例,随机分为高频rTMS组和对照组各35例。2组患者均行常规康复训练和平衡训练仪治疗,高频rTMS组给予高频rTMS刺激治疗,对照组则给予假高频rTMS刺激治疗,2组患者均治疗3周,共18次。分别于治疗前后对2组患者进行Fugl-Meyer平衡量表(FMB)评分、Berg平衡量表(BBS)评分、改良Barthel指数量表(MBI)评分,并以平衡训练仪测定患者运动时倾斜角度,行组内组间比较。结果:治疗3周后2组患者FMB评分、BBS评分、MBI评分、前后倾斜角度及左右倾斜角度均较治疗前有明显改善(均P<0.05),且高频rTMS组BBS评分、MBI评分、前后倾斜角度均明显高于对照组(均P<0.05)。结论:与单独使用平衡训练仪治疗比较,高频rTMS联合平衡训练仪治疗在改善脑梗死患者平衡障碍上效果显著,更有利于患者平衡功能恢复。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.