词画匹配训练法在脑卒中运动性失语康复中的作用

目的 探讨词画匹配训练法对脑卒中运动性失语患者的语言康复和非语言交流能力的作用.方法 18例患者通过词画匹配训练法进行较系统的言语功能训练,对患者训练前后的言语能力进行评估并比较.结果 18例患者经过1个疗程(3个月)的训练,言语复述、表达及运用语言功能方面与治疗前比较康复组明显恢复且优于对照组(P<0.05).结论 词画匹配训练法对脑卒中运动性失语患者的语言康复和非语言交流能力有良好的促进作用.     

头电针配合言语训练治疗脑卒中后失语的临床研究

目的:研究头电针配合言语训练对脑卒中后失语症患者语言功能的影响。方法:采用随机数字表法将90例患者分为试验组和对照组,试验组采取语言康复训练配合头电针治疗,对照组仅采用言语训练治疗,言语训练采用Schuell刺激法对患者进行一对一的训练,对不同类型的失语症患者训练类型有所侧重。每次30min,每周5次,2周为1个疗程。针灸治疗选取头部穴位,运动性失语取运动区,感觉性失语取感觉区,完全性失语取语言三区,并且配合百会、风府、哑门等穴位。每周治疗5次,2周为1个疗程,共治疗1个疗程。语言功能评分采用《汉语失语成套测验》,就自发说话、语言理解、复述和命名四方面内容对患者治疗前后的评分进行比较。失语程度采用波士顿诊断性失语症检查法(Boston diagnostic aphasia examination,BDAE)分级标准进行评价,总疗效比较采用波士顿诊断性失语症检查法。结果:试验组患者治疗前后自发说话、言语理解、复述及命名的评分及失语程度评分的比较,差异有显著性意义(P分别为0.01、0.03、0.02、0.02、0.02,P均0.05),对照组患者治疗前后自发说话、言语理解、复述及命名的评分及失语程度评分的比较,差异有显著性意义(P分别为0.02、0.03、0.01、0.02、0.03,P均0.05),且治疗后两组患者自发说话、言语理解、复述及命名的评分及失语程度评分比较有显著性差异(P分别为0.03、0.03、0.03、0.02、0.03,P均0.05)。两组总疗效比较差异有显著性意义(P为0.03,P0.05)。结论:头电针配合言语训练能明显改善脑卒中患者自发说话、言语理解、复述及命名的评分及失语程度,疗效优于单纯言语训练。     

语言训练对脑卒中运动性失语患者语言功能的影响

目的:探讨语言训练对脑卒中运动性失语患者中语言功能的影响。方法:将44例脑卒中运动性失语患者随机分为训练组和对照组各22例,对照组给予神经内科疾病常规护理,训练组在此基础上给予语言功能训练,12 d后分别对两组采用汉语失语检查法量表(ABC)评价语言功能。结果:训练组信息量、流利性、复述、词命名、色命名、反应命名、是/否题、听辨认和执行命令9个方面在语言训练后优于对照组(P0.05,P0.01)。结论:语言训练能够促进运动性失语患者的口语表达和听理解功能的恢复,运动性失语患者应尽早进行语言训练。     

经颅直流电刺激联合常规言语康复治疗脑卒中后非流畅性失语症的疗效观察

目的:探讨经颅直流电刺激(tDCS)联合常规言语康复治疗脑卒中后非流畅性失语症的临床疗效,为tDCS在脑卒中后言语康复中的应用提供依据。方法:将36例脑卒中后恢复期失语症患者采用随机数字表法分为治疗组和对照组各18例,治疗组采用tDCS分别精准左右额下回三角部区刺激配合常规言语治疗,对照组采用tDCS假刺激配合常规语言治疗训练,2组均治疗5个星期,观察2组患者的自发言语、听理解、复述、命名成绩变化情况,并在治疗后采用西方失语成套测验(WAB)进行评价。结果:2组治疗后在自发言语、复述、命名和失语商(AQ)评分方面均比治疗前改善,差异具有统计学意义(P0.05),且治疗组优于对照组(P0.05)。结论:tDCS左侧额下回三角部区阳极刺激+右侧额下回三角部区阴极刺激,并配合常规语言治疗脑卒中后非流畅性失语症,可以提高患者的自发言语、复述、命名成绩。     

音乐疗法联合语言训练对脑卒中后非流畅性失语的 疗效研究

目的：观察音乐疗法联合常规语言治疗对脑卒中后非流畅性失语患者语言功能恢复的影响。方法： 将37例符合纳入条件的脑卒中后非流畅性失语患者随机分为观察组（19例）和对照组（18例）,2组患者均 接受常规药物治疗及肢体康复治疗,观察组在此基础上每天接受30 min音乐疗法和30 min常规语言治疗, 对照组每天接受1 h常规语言治疗,每周治疗5 d。治疗前及治疗4周后,采用西方失语成套测验（WAB）汉 化版口语部分与Goodglass-Kaplan失语症严重程度分级标准（ASRS）评定患者语言功能。结果：治疗后,2 组WAB各项评分及ASRS评级均较治疗前改善（P＜0.01）。治疗后,观察组流畅度,复述,命名及失语指数 （AQ）评分均优于对照组（P＜0.05）,但2组患者信息量、自发言语、听理解评分及ASRS评级组间差异无统 计学意义（P＞0.05）。结论：音乐疗法联合常规语言治疗能有效改善脑卒中后非流畅性失语患者的语言功 能,尤其是言语流畅度,复述及命名能力。     

旋律语调治疗改善脑卒中后Broca失语的疗效观察

目的 探讨旋律语调疗法（MIT）对脑卒中后Broca失语患者语言功能的影响。 方法 选取40例符合入组标准的脑卒中后Broca失语患者，按随机数字表法分为治疗组（20例）和对照组（20例）。治疗组进行改编的旋律语调治疗，对照组进行常规言语康复训练（包括口腔发音器官的训练、口语表达训练、文字表达训练、听理解训练等）；均采用一对一的治疗方式，治疗时间每日1次，每次30 min，每周5 d，20次为1个疗程，连续治疗3个疗程。分别于入组时（治疗前）和治疗3个疗程后（治疗后），对2组患者进行西方失语成套测验（WAB）评估，对自发言语、听理解、复述、命名四项评估。最后通过统计学分析，考察治疗组的临床疗效。 结果 干预后，对照组和治疗组的各项语言评分值及失语商（AQ值）较组内治疗前均有不同程度改善（P<0.05）；治疗组自发言语评分［（13.15±2.82）］、听理解评分［(8.42±1.61)分］、命名评分［(5.484±1.69)分］和失语商（AQ值）评分［（66.87±11.75）分］亦显著优于对照组［（10.55±3.61）、（7.92±2.19）、（4.32±1.89）分和（57.03±16.58）分］，差异均有统计学意义(P<0.05)。 结论 以有语调和节奏的训练词库的MIT训练可以更有效地改善患者的言语功能及日常生活语言沟通能力。     

低频rTMS对急性脑梗死后运动性失语的疗效观察

目的:观察低频重复经颅磁刺激(rTMS)对急性脑梗死后运动性失语的临床治疗效果。方法:将116例急性脑梗死后运动性失语患者随机分为对照组和rTMS组各58例,对照组实施常规药物治疗及语言训练,rTMS组在此基础上采用低频rTMS和语言训练同步交叉的方法来进行康复。采用西方失语症成套测验(WAB)评价失语指数(AQ)及理解、复述、命名、自发言语等成分的得分情况。采用北京医科大学第一医院的汉语失语成套测验语言功能评分百分率提高程度和语言交流障碍好转程度进行疗效评定。结果:治疗30d后,2组AQ评分及理解、复述、命名、自发言语4项评分均高于治疗前(P0.05),且rTMS组提高幅度更高于对照组(P0.05);rTMS组的总有效率明显高于对照组(P0.05)。结论:早期低频rTMS治疗对急性脑梗死后运动性失语患者具有较好的疗效。     

眼动跟踪训练联合重复经颅磁刺激治疗脑卒中后完全性失语的疗效观察

目的：研究眼动跟踪训练联合重复经颅磁刺激（rTMS）对脑卒中后完全性失语患者言语功能恢复的影响。方法：将90例脑卒中患者采用随机数字表分为眼动组、经颅磁组、联合组，每组30例。所有患者均接受语言训练，眼动组增加眼动跟踪训练，经颅磁组增加rTMS治疗，联合组采取三种方法联合治疗。语言训练时间30min，眼动跟踪训练时间为20min，经颅磁刺激时间为20min，所有治疗均一天1次，一周5次，连续治疗4周。治疗前后均采用西方失语症成套测验进行评估分析。结果：治疗4周后，3组患者的失语商（AQ）总分和自发言语、听理解、复述和命名得分较治疗前均有提高（均P＜0.05）；联合组各项评分均高于眼动组和经颅磁组（均P＜0.05），眼动组仅听理解项评分高于经颅磁组 (P＜0.05），眼动组与经颅磁组在失语商、自发言语、复述和命名等4项评分比较均差异无统计学意义。结论：眼动跟踪训练联合rTMS对脑卒中后完全性失语患者语言功能恢复具有积极影响，其治疗效果优于单独使用眼动追踪训练或者rTMS。     

头皮针配合言语训练对缺血性脑卒中运动性失语的影响

目的探讨头皮针配合言语训练治疗缺血性脑卒中运动性失语患者语言功能的疗效。方法将96例缺血性脑卒中运动性失语患者分为治疗组（头皮针配合言语训练）和对照组（单纯言语训练）。采用《中国康复研究中心标准失语症检查法（CRR-CAE）》为诊断和疗效判定依据,观察两组患者的听理解、复述、说、朗读、阅读等5项基本语言功能的影响。结果经2个疗程治疗后,两组患者的综合语言能力均有明显提高,但治疗组提高的幅度明显大于对照组（P〈0.01）,治疗组患者的基本语言能力有明显改善。结论针刺配合言语训练能明显改善失语患者的语言功能。     

低频重复经颅磁刺激联合言语训练对脑卒中失语的康复效果

目的：探讨低频重复经颅磁刺激（rTMS）联合言语训练对脑卒中运动性失语的康复效果。方法：采用 随机数字表法将脑卒中运动性失语患者106例随机分为对照组和观察组,各53例。在脑卒中常规药物治 疗的基础上,2组均进行常规言语康复训练,在此基础上观察组实施低频rTMS。于治疗前、后,采用西方失 语成套测验（WAB）量表评估患者语言功能,计算AQ指数;运用功能独立性量表（FIM）的交流亚项评估患 者的语言交流能力;采用简易精神状态评价量表（MMSE）评估患者的认知功能;根据AQ指数的变化判断 疗效。结果：治疗后,2组的WAB各项评分、AQ指数、FIM量表的理解和表达评分、MMSE评分均高于同组 治疗前（均P＜0.05）,且观察组高于对照组组（均P＜0.05）;观察组的治疗有效率为83.02%,高于对照组的 66.04%（P＜0.05）;治疗期间,2组均未出现明显不良反应。结论：低频rTMS联合言语训练能够帮助脑卒中 运动性失语患者快速重建语言功能,改善失语程度,且安全性较好。     

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.     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.