年龄对住院抑郁症患者结局的影响

年龄对住院抑郁症患者结局的影响【英】／ＴｕｍａＴＡ／／ＢｒＪＰｓｙｃｈｉａｔｒｙ，─１９９６，１６８：７６─８１以往普遍认为老年抑郁症患者预后比年轻成年患者差，但近来这种观点越来越受到冲击。本文目的就是要证实老年和年轻成年抑郁症患者之间预后是否存在差...     

伴有躯体疾病的老年抑郁症

了解老年病例躯体疾病对抑郁症的影响。比较２１例有躯体疾病的与无躯体疾病的老年抑郁症病例，两组无明显区别，但有躯体疾病的病例抑郁症状较重，躯体疾病会影响老年病例的情感症状。     

头后部着力的颅脑损伤225例临床分析

本文分析225例头后部着力的颅脑损伤,其临床特点为:(1)88％的脑挫裂伤位于对冲部位的额颞叶;(2)对冲伤的发生率随年龄增大而增高,老年者的发生率高达88％;(3)易发生迟发性血肿;(4)伤情重而复杂。救治体会为:(1)对伤势危重者,应根据受伤机理和临床表现作出判断,及时行对冲部位之额颞探查,必要时探查着力部;(2)对老年伤者应予高度重视和严密观察;(3)此类病人均应以“临床重型”看待,予以留院观察治疗,必要时连续CT扫描,以免延误诊治。     

189例老年住院精神病人分析

目的分析住院老年精神病人的年龄和病种。方法回顾性查阅住院60岁以上老年精神病人的病例资料，对其年龄和病种进行分析。结果60岁以上(含60岁)住院老年精神病人占同期住院精神病人3．12％；60岁及以上住院老年精神病人随年龄增长，比例减少；以精神分裂症(含分裂样精神病)最多，其次为情感性障碍。结论建议加强老年精神病诊断与治疗业务开拓。     

短暂脑缺血后成年和老年大鼠大脑髓鞘相关蛋白基因表达变化

目的探讨短暂脑缺血后成年和老年大鼠大脑髓鞘相关蛋白基因表达变化及其意义。方法以线栓法制作成年和老年SD大鼠短暂脑缺血模型（阻塞60min再灌注1d、7d和14d）；采用5末端标记地高辛的寡核苷酸探针荧光原位核酸分子杂交检测短暂脑缺血大鼠大脑梗死中心区、梗死周边区和梗死对侧区PLP mRNA和MyT1 mRNA照射后表达变化，并计数阳性细胞数量。结果（1）短暂脑缺血后成年和老年大鼠大脑皮质梗死中心区PLP mRNA和MyT1 mRNA阳性细胞数明显减少，两组之间比较无显著差异。（2）短暂脑缺血后早期成年和老年大鼠梗死周边区PLP mRNA和MyT1 mRNA阳性细胞数无明显变化，之后（7d和14d）逐渐增加，成年大鼠PLP mRNA和MyT1 mRNA阳性细胞数增加更明显。结论成年大鼠短暂脑缺血后急性期梗死周边区髓鞘相关蛋白基因表达强于老年大鼠，提示年龄是影响少突胶质前体细胞参与脑缺血后损伤修复的因素之一。     

离退休老人轻度认知功能损害研究

目的：探讨离退休老人轻度认知功能损害(MCI)的发生率及其影响因素。方法：采用哈金斯基缺血指数(HIS)、简易智能状态检查(中文版)(MMSE)、Reisberg总体衰退量表(GDS)、日常生活活动能力(20项版本)(ADL)等，对420名离退休老人MCI的发生情况及其影响因素进行调查，分析相互问关系。结果：离退休老人中MCI的发生率为8．6％，随年龄的增长而有升高趋势，但各年龄组之间差异无显著性。结论：离退休老人中MCI较常见，应对老年人群进行MCI的监测和干预，阻止和延缓MCI发展为痴呆，提高老年人的寿命和生活质量。     

老年慢性肾衰血透患者常见神经精神症状及相关影响因素

目的分析老年慢性肾衰血透患者常见神经精神症状及相关影响因素。方法对64例出现精神神经症状的老年慢性肾衰患者(治疗组)与无神经精神症状的慢性肾衰患者(对照组)的透析年龄、肾功能及血压水平等的关系进行比较。结果 2组患者血透失衡综合征、脑血管意外及尿毒症脑病患者的透析龄差异均有统计学意义(P0.05);治疗组尿毒症脑病患者的肾功能血肌酐水平、脑血管意外患者的血压水平均明显高于对照组(P0.05)。结论老年慢性肾衰患者出现精神神经症状与透析年龄、肾功能及血压水平等有一定关系。     

综合医院老年患者抑郁情绪的特点及护理

老年人群是值得社会关注的一个弱势群体，到1995年底，60岁以上老年人口占我国人口的比例为10．09％，老年人总数已近1．3亿，全国开始进人老年型社会。老年人随着年龄的增长、生理功能下降，常见病、多发病逐渐增多，心理变化十分复杂，往往受多种因素的影响，这种变化经常使老年人有自卑及恐惧感，甚至抑郁自杀。我们对住院有抑郁情绪的老年患者进行调查，针对其临床特点实施护理干预对策，现报告如下。     

老年血压控制不良患者平均动脉压与脑卒中的相关性研究

目的探讨老年血压控制不良患者平均动脉压与脑卒中的相关性。方法选择2 716例老年高血压控制不良的患者,对所有患者采用问卷调查的方式,由专门的医学调查人员来收集患者的信息。主要包括姓名、年龄、性别、是否有吸烟史、是否有糖尿病等。血压测定:采用汞柱式血压计进行血压的测定:测定之前休息5min,连续测定2次,取平均值。对患者的一般资料、脉压及平均动脉压与脑卒中的发病情况进行分析,找出平均动脉压与脑卒中相关性。结果患者的年龄、脉压分布基本无显著性差异;血压多分布在1、2两级;收缩压控制不良的比例最高,占据了绝大部分类型;随着年龄的增长,高血压患者脑卒中的发病率有逐渐升高趋势;男性患者的脑卒中发病率显著高于女性;糖尿病患者的脑卒中发病率显著高于非糖尿病患者(P0.05);吸烟与非吸烟患者的脑卒中发病率比较差异无统计学意义(P0.05);不同脉压范围高血压患者的脑卒中发病率差异无统计学意义(P0.05);不同平均动脉压范围高血压患者的脑卒中发病率差异有统计学意义(P0.05)。结论年龄增长、男性及糖尿病均是影响老年高血压患者脑卒中发病的危险因素,平均动脉压相比于脉压更能够反映老年血压控制不良患者的血压情况,更符合老年患者特殊的生理特点,与脑卒中具有较好的相关性,可以准确预测脑卒中的发病情况。     

桡神经深支卡压综合征12例分析

自1988年～1998年间，我们共收治桡神经深支卡压综合征12例，均给予手术探查并解除压迫，取得了满意的疗效，现给予报道。1　临床资料1．1一般资料　本组男8例，女4例，其中作业工人6例，采油工作4例，其它2例，年龄20岁～38岁，平均28岁，发病时间最长4个月，最短1个月。1．2　临床诊断　本病的临床表现主要是肘关节前外侧疼痛或麻胀痛，伸指无力，尤以拇指和食指无力为主，但无皮肤感觉障碍。病程缓慢，呈进行性，先有疼痛，后有伸指无力，对痛点封闭无效，拍片无桡骨小头骨折和脱位。1．3手术方法上臂上气囊止血带，取肘前外侧切口，切开…     

The Thickness of the Temporal Squama and Its Implication for Transcranial Sonography

BACKGROUND AND PURPOSE: The difficult transtemporal ultrasound window is a relatively frequent occurrence. The authors assessed if the thickness of the temporal bone squama as measured in the "bone window" of the head computerized tomography (CT) scan can predict the transtemporal acoustic window. METHODS: The authors retrospectively reviewed the head CTs on their bone window setting of patients in which nonimaging transcranial Dopplers (TCDs) had been performed. The thickness of the temporal squama in its thinnest portion was measured. The temporal TCD windows were graded in three classes: class 1 as good, class 2 when only a partial study is possible, and class 3 as an impossible ultrasonic window. In a case-control design, for every patient with any class 2 and 3 TCD temporal window, a patient with a class 1 window was randomly included from the same time period. RESULTS: Fifty-five temporal bones (56%) were class 1, 17 (17%) were class 2, and 27 (27%) were class 3. Bone thicknesses (in mm, mean +/- SD) were greater in those with poorer windows: class 1 = 2.67 +/- 0.70, class 2 = 4.06 +/- 0.56, and class 3 = 5.04 +/- 1.06, P < or = .0001 by Cusick's nonparametric test of trend. Temporal squama thickness of > or = 5 mm portends 86% sensitivity, 90% specificity, 70% positive predictive value, and a positive likelihood ratio of 8.6 for a class 3 transtemporal ultrasound window. CONCLUSION: Measurement of temporal bone thickness on the bone window setting of the head CT scan may be useful in identifying patients who are poor candidates for transcranial ultrasound.     

重型颅脑外伤后早期急性肾功能衰竭的临床分析

目的了解重型颅脑外伤患者早期发生急性肾功能衰竭的临床特点及防治。方法回顾性分析本院1998-01～2004—12重型颅脑外伤患者的临床资料，以重型颅脑外伤后24h是否出现急性肾功能衰竭为标准，将患者分为急性肾功能衰竭组和无急性肾功能衰竭组，对两组病例进行比较。结果182例重型颅脑外伤患者中，32例（17．6％）在颅脑损伤后24h发生急性肾功能衰竭，其中6例必须行肾脏替代治疗；重型颅脑外伤后早期发生急性肾功能衰竭者较无急性肾功能衰竭者死亡率高。结论重视重型颅脑外伤早期急性肾功能衰竭及其并发症，积极预防可改善病人预后。     

Neuroendocrine (HPA axis) and clinical correlates during fluvoxamine and amitriptyline treatment

The effect of amitriptyline on hypothalamic-pituitary-adrenocortical (HPA) axis activity was compared with that of fluvoxamine in 38 patients suffering from DMS-IV major depressive disorder. Basal plasma adrenocorticotropic hormone and cortisol levels were determined in the so-called "observation window" of an hour (08:00-09:00 h), and cortisol levels were determined again at 20:00 h. Clinical and biochemical assessments were performed before therapy (T0), at day 14 (T14), and at day 42 (T42) of the course of antidepressant treatment. At T0, neuroendocrine parameters did not differ in patients from those in controls, except for the ratio between cortisol levels at 20:00 h and the mean level of the "window" (ratio F20/F8), which was significantly higher, suggesting a dysregulation of the circadian pattern of cortisol. Although a decrease in the ratio F20/F8 was already apparent at T14 of both treatments, the repeated measures analysis of variance failed to demonstrate a significant variation with time (T0, T14, and T42) and with treatment (amitriptyline and fluvoxamine) for any hormonal measure. At T42, both treated groups showed a similar level of clinical improvement. Our results did not demonstrate any effect of antidepressant therapy on the cortisol circadian rhythm abnormality.     

Mechanisms of spatial attention revealed by hemispatial neglect.

We report performance by a patient, NG, with hemispatial neglect after nondominant stroke, in detecting briefly (200 msec) presented visual targets. NG's detection of targets (gaps in circles) was determined by the location of the target in the space in which stimuli appeared. Gaps on the neglected side of a circle at fixation were rarely detected when circles of uniform size were always presented at fixation. The same targets in the same location were detected far more often in blocks that also included targets presented on each side of the central circle, or in blocks that included larger target stimuli. In these blocks, the window of space in which stimuli appeared was larger, such that the target fell closer to the center of this "window". These results indicate that the spatial extent of attention, and of hemispatial neglect, can be modified on the the basis of expectations and task requirements.     

Endoscopic management of hydrocephalus due to neurocysticercosis

Objective

Hydrocephalus due to neurocysticercosis usually shows poor prognosis and shunt failure is a common complication. Neuroendoscopy has been suggested as treatment, but the indications remain unclear.

Methods

A cohort of patients with clinical/radiological diagnosis of hydrocephalus due to NCC, treated between January 2002 and September 2006, were the subjects of the study. We excluded patients with tumors or those in whom diagnosis was not confirmed (histology/positive ELISA in CSF). Neuroendoscopy was offered as the first line of treatment. Shunt failure rate and Karnofsky index at 12 months were assessed.

Results

Eighty-six patients (47 male) with a median age of 38 (9–79) were included in the study. Of them, 36.1% had a shunt before endoscopy and 97.7% had a Karnofsky index <80. We did not find the parasite in 18.6%, extraction was achieved in 79%, and in 87.2% an endoscopic third ventriculostomy (ETV) was performed. The median follow-up time was 43 months (1–72). Shunt failure was seen in 6.6% of patients with ETV in comparison to 27.2% in those without ETV. A hazard ratio of 0.22 (95% CI, 0.05–0.93) for shunt failure after ETV was calculated. At 12 months, 20.9% had a Karnofsky index <80.

Conclusion

Early extraction of parasite plus ETV might allow improving outcome and reducing shunt failure. Limitation of inflammatory stimulation by parasite antigens and improvement of CSF dynamics could be an explanation for these findings.     

Bedside optic nerve sheath diameter ultrasound for the evaluation of suspected pediatric ventriculoperitoneal shunt failure in the emergency department

Objective

To determine the feasibility and test characteristics of optic nerve sheath diameter (ONSD) measured by ocular ultrasound as a screening tool for ventriculoperitoneal shunt (VPS) failure.

Methods

Prospective observational study using a convenience sample of children 6 months to 18 years of age, presenting to an academic pediatric emergency department for evaluation of possible VPS failure between September 2008 and March 2009. ONSD was measured by anterior transbulbar and lateral transbulbar techniques. Mean ONSD was compared between subjects with and without shunt failure, as determined by neurosurgical decision to operate.

Results

A total of 39 encounters were completed, including 20 VPS failures. The mean ONSD was 4.5?±?0.9 and 5.0?±?0.6 mm among encounters with and without shunt failure (p?=?0.03), respectively. The mean ONSD was not statistically different when obtained by the anterior transbulbar vs. the lateral transbulbar approach (4.8?±?1.0 vs. 4.7?±?0.8 mm, p?=?0.12). ONSD ultrasound had a sensitivity of 61.1 % (95 % CI 35.7–82.7) and specificity of 22.2 % (95 % CI 6.4–47.6 %) for detecting shunt failure in this sample.

Conclusions

ONSD ultrasound does not appear to be a useful primary screening tool in emergency department evaluation of VPS failure. There was no difference between the anterior transbulbar approach and the lateral transbulbar approach. Children with VPS in our sample have larger ONSD measurements than in previously reported studies.     

24小时脑电监测与术中皮层电极在癫痫外科中的应用

目的 探讨24小时脑电与术中皮层电极(Electrocorticalgram，ECoG)在癫痫外科手术中的价值。方法 对200例顽固性癫痫病人进行术前24小时脑电监测配合术中皮层电极探查，根据结果选择手术方式。结果 随访1～8年者共160例病人，其中发作消失100例(625％)，明显减少(75％以上)32例(20．0％)，减少(50％以上)20例(12．5％)，无变化8例(5％)。总有效率为95％。结论 24小时脑电监测配合术中皮层电极探查，可以更精确痫灶定位。选择最佳手术方式，提高手术疗效，是一种既经济又实用的方法。     

Educational attainment and response to HAART during initial therapy for HIV-1 infection

OBJECTIVE: Previous research has demonstrated an association between educational attainment (EA) and negative physical and psychological outcomes. This study investigated whether EA is associated with regimen failure during initial therapy with highly active antiretroviral treatment (HAART) and whether adherence self-efficacy (ASE), a coping resource, moderates the relationship between EA and regimen failure. METHODS: A secondary analysis of AIDS Clinical Trial Group Protocol 384, an international, multicenter, randomized, partially double-blinded trial, included 799 male and 181 female antiretroviral-na?ve subjects (age, 37.0+/-9.5 years). Participants were recruited from 1998 to 1999 and followed for a median of 2.3 years across 81 centers. The dependent variable was "time to first regimen failure." Covariates include baseline HIV-1 log(10)RNA and CD4(+) counts, self-reported adherence, study site, ASE, age, sex, race, treatment assignment, and baseline use of nonantiretroviral medications. RESULTS: ASE significantly moderated the relationship between EA and regimen failure. Results showed that for every 10-unit increase in ASE, individuals with "less than high school" education had a 17% reduction in regimen failure (hazard ratio=0.83; 95% confidence interval=0.70-0.98) when compared to the reference group "college/graduate," even after adjusting for baseline factors known to contribute to regimen failure. The time to first regimen failure was shorter with decreasing EA, trending toward significance (P=.08). CONCLUSIONS: There is a social gradient in HAART effectiveness, and ASE reduces the deleterious effects of lower EA on regimen failure. We recommend designing controlled interventions to evaluate the effectiveness of programs that increase ASE prior to initiation with HAART, particularly for those with lower EA.     

Proximal intentional neglect: a case study.

Although neglect has been demonstrated in the horizontal, vertical, and radial planes of space and has been attributed to sensory-attentional, motor-intentional, and representational deficits, motor intentional neglect in the radial plane has not been previously described. A patient who had a right parietal infarct was tested with a modified cancellation task that uses a fixed window, thereby controlling attentional demands and allowing one to dissociate between intentional and representational neglect. This patient showed proximal (radial) intentional neglect (a failure to move towards or in proximal space). Unlike controls whose search times decreased with increasing window size, our patient showed no change in search time as a function of window size. This pattern of behaviour suggests that the patient's search strategy does not incorporate factors such as the relation between a fixed target space and a variably sized aperture, but rather was based on the allocation of a certain amount of resources for a fixed period of time after which, regardless of performance, the patient would stop searching.     

大鼠急性脑梗死溶栓治疗时间窗的研究

目的　研究尿激酶溶栓治疗大鼠急性脑梗死的时间窗。方法　用自体血栓法制作大鼠大脑中动脉闭塞 (MCAO)模型 ,在栓塞后 30、6 0、90、12 0、180min(A、B、C、D、E组 )经静脉注射尿激酶 (5万U/kg)溶栓 ,用神经功能缺损评分、TTC染色测梗死体积、核磁共振 (MRI)及病理学观察 ,比较不同时间点溶栓的疗效及安全性。结果　MCAO后 90min内溶栓 (A、B、C组 )能显著改善神经功能 ,缩小梗死体积 (P <0 .0 5 ) ,12 0min以后溶栓组 (D、E组 )与对照组无显著性差异 (P >0 .0 5 ) ,且并发脑出血率高 (31.3% )。结论　本研究提示大鼠脑梗死溶栓治疗最佳时间窗为栓塞后 90min内 ,溶栓治疗时间越早 ,疗效及安全性越高。