Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial.

BACKGROUND: We tested whether transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (DLPFC) is effective and safe in the acute treatment of major depression. METHODS: In a double-blind, multisite study, 301 medication-free patients with major depression who had not benefited from prior treatment were randomized to active (n = 155) or sham TMS (n = 146) conditions. Sessions were conducted five times per week with TMS at 10 pulses/sec, 120% of motor threshold, 3000 pulses/session, for 4-6 weeks. Primary outcome was the symptom score change as assessed at week 4 with the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included changes on the 17- and 24-item Hamilton Depression Rating Scale (HAMD) and response and remission rates with the MADRS and HAMD. RESULTS: Active TMS was significantly superior to sham TMS on the MADRS at week 4 (with a post hoc correction for inequality in symptom severity between groups at baseline), as well as on the HAMD17 and HAMD24 scales at weeks 4 and 6. Response rates were significantly higher with active TMS on all three scales at weeks 4 and 6. Remission rates were approximately twofold higher with active TMS at week 6 and significant on the MADRS and HAMD24 scales (but not the HAMD17 scale). Active TMS was well tolerated with a low dropout rate for adverse events (4.5%) that were generally mild and limited to transient scalp discomfort or pain. CONCLUSIONS: Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported. It offers clinicians a novel alternative for the treatment of this disorder.     

善宁治疗急性胰腺炎临床疗效观察

目的:观察人工合成的生长抑素类似物(善宁)治疗急性胰腺炎(AP)的临床疗效.方法:对我院1999～2008年收治的156例AP患者分为治疗组与对照组各78例,对照组采用一般常规治疗方法,治疗组在一般常规治疗的基础上加用善宁0.1 mg,缓慢静脉推注后,继以25μg/h的速度持续静脉滴注,连用7～14天.观察两组腹痛缓解时间;实验室检查:白细胞计数、血淀粉酶、血钙与血糖恢复正常时间,多器官功能障碍(MODS)发生情况,恢复进食的时间.结果:善宁治疗组比对照组明显降低血淀粉酶,减少腹痛缓解时间,降低MODS的发生.结论:善宁能有效改善AP的临床症状,减少并发症.     

Atlas钛缆固定上颈椎的解剖与临床

目的: 观察寰椎后弓和枢椎椎板的形态学特征, 以更为安全、方便地开展颈后路寰枢椎Atlas钛缆固定术。方法: 观察 100套寰椎后弓和枢椎椎板的形态学特点并进行解剖学测量, 设计引导钛缆穿绕的特殊的器械, 并应用于 17例上颈椎损伤患者的手术操作。结果:(1) 寰椎后弓较纤弱, 横截面呈扇形, 内侧面从后上方向内下方倾斜; 枢椎椎板较粗大, 上窄下宽, 内侧面基本垂直, 内侧面下缘多形成一骨嵴; (2) 寰椎后弓的引导器要求头端折弯, 枢椎椎板引导器要求头端圆钝; (3) 17例患者手术操作均安全、顺利完成, 无脊髓损伤等并发症发生。结论: 根据寰椎后弓和枢椎椎板的形态学特征, 穿绕钛缆时宜自上向下操作; 采用专用的引导器使得颈后路寰枢椎Atlas钛缆固定术的操作更为安全、方便。     

努力提高严重多发伤的基础研究和临床救治水平

目的:探讨提高严重多发伤的基础研究和临床救治水平。方法:结合我们的有关研究和参加抢救的临床救治体会,并引用国内外公开发表的相关论文及著作进行分析研究。结果:善于应用现有的先进科技手段,提高严重多发伤的基础研究和临床救治水平。降低伤残率和死亡率。结论:严重多发伤具有脏器损伤率高、出血性休克率高、感染率高、MODS发生率高、死亡率高等“五高”特点,所以其诊治的复杂性、紧迫性远远超过其他许多疾病。因此努力提高我国严重多发伤的基础研究及诊断和救治水平已是当务之急。     

股骨远端骨折治疗方案的探讨

股骨远端骨折是创伤骨科治疗领域内的一个难点。主要原因是治疗方案的混乱和远期膝关节的病损。自1998-2005年采用经皮股骨远端髓内钉(DFN)内固定、切开复位接骨板内固定的方法治疗股骨远端骨折共59例,分析如下。1临床资料经皮DFN共27例,男19例,女8例;年龄19~75岁,平均35岁。交通伤19例,老年跌伤6例,砸伤2例。按AO分型:A1型10例,A2型8例,A3型6例,C1型3例。伴有开放性损伤4例,多发骨折3例,前交叉韧带损伤1例。切开复位接骨板内固定共32例,男21例,女11例。年龄18~79岁,平均36岁。交通伤21例,老年跌伤6例,砸伤4例,炸伤1例。按AO分型:B1型…     

Auditing your acute pain service—a UK NHS model

This audit has been conducted in order to provide an evidence base that clarifies the strengths and weaknesses of acute pain management at a UK hospital. Consequently, it sets the strategic direction for service improvement. Awarding up to three stars has identified the quality of each component that constitutes the acute pain service. Six different components were audited and star ratings have been awarded as shown below:

• Pain tool (including patient and staff understanding): no stars.

• Pain team (including education and clinical support): two stars.

• Intermittent opioid analgesia (sub-cut and oral morphine): two stars.

• Epidural patient controlled analgesia (EPCA): two stars.

• Intravenous patient controlled analgesia (IVPCA): two stars.

• Single-dose intrathecal opioid analgesia: three stars.

These star ratings were pulled together in order to award the acute pain service an overall rating. Consequently, the acute pain service was awarded two stars. The findings of this audit identify that this acute pain service provides a safe way to deliver hi-tech pain relief at ward level and can be relied upon to provide good quality pain management. However, too many patients are likely to miss out on the full benefits of the service due to the weaknesses as identified. The quality of the pain relief is impeded across the hospital due to low patient expectation and poor patient education, and also due to a lack of relevant knowledge amongst nursing staff. Developments in the role of the acute pain nurse, staff training and education programs, and a reduction in the variety of pain management pumps are combining to facilitate the opportunities required to address the weaknesses and to build on the strengths of the acute pain service.     

急性病毒性心肌炎的发病机制和临床特征

急性病毒性心肌炎是由病毒侵犯引起心肌本身的病变,包括病毒感染对心肌的损害、细胞免疫以及多种细胞因子等介导的心肌损害和微血管损伤。这些变化损害心脏功能和结构,而危及生命。且近年发病呈逐年上升趋势,其发病症状隐匿突然,加重了其危害性。本文就急性病毒性心肌炎发病机制和临床特征进行总结。     

建立具有中国特色的临床医学工程体系势在必行

我们提出了一个建立具有中国特色的临床医学工程体系新理念，并且提出了一些具体建设性的意见。它涉及到政府行政管理、医学院校教育、医院科室人员配置以及传统观念的管理模式等，由于理念新、涉及面广，会有许多问题，仅供各界人士共同去探讨。     

实习期医学生心理健康状况、应对方式及压力状况的调查

目的探讨实习期医学生心理健康状况、应对方式及压力状况。方法将进入临床实习期的364名临床医学生作为研究组,而选取379名非实习期的临床医学生作为对照组,问卷评定采用症状自评量表(SCL-90)、应对方式问卷及心理身体紧张松弛测试表。结果研究组SCL-90的人际关系敏感、强迫、抑郁、焦虑、敌对因子得分显著高于对照组(t=2.25~5.17,P<0.05);与对照组相比,研究组的应对方式中解决问题因子分有显著性降低,自责、退避因子分则有显著性增高(t=-1.97~2.89,P<0.05);研究组的心理压力状况明显差于对照组,且差异具有显著性意义(χ2=56.03,P<0.05)。结论实习期的临床医学生存在不同程度的心理问题,应予以足够重视。     

增白牙膏去除牙面外源性色素临床实验

目的测试一种增白牙膏用于减少牙面外源性色素的效果. 方法 研究对象121例,年龄21～57岁.实验组60例,对照组61例,两组年龄和性别分布差异无显著性.采用双盲法两组平行设计,根据Lobene色斑指数(LSI)和性别均衡分为两组,随机分配使用实验牙膏或对照牙膏.实验组牙膏含3 %植酸钠和1.3 %焦磷酸钠,对照组牙膏不含相应成分.临床检查分别在基线、3周和6周后进行,由同一人测定LSI.问卷询问刷牙情况. 结果 基线检查、实验3周和6周后实验组LSI分别为3.00、2.16和1.47, 对照组分别为3.10、3.08和2.18.基线检查两组LSI差别无显著性意义, 实验3周和6周后两组LSI比较差异均有显著性意义. 实验组LSI在3周和6周后分别比基线时降低28 %和51 %. 结论含3 %植酸钠和1.3 %焦磷酸钠牙膏能有效减少牙面色素,效果随使用时间而增强.