Establishment of a novel rat model for deep tissue injury deterioration

Deep tissue injuries (DTIs) can become significant problems because of their rapid deterioration into deep pressure ulcers. Presently, no animal model of DTI deterioration has been developed. By concentrating pressure and shear stress in deep tissues while minimising pressure and shear stress in the overlying skin, we produced an effective rat model of DTI deterioration. Two‐dimensional finite element method (FEM) simulated the distribution of pressure and shear stress under several pressure‐loading conditions. FEM showed that concentrated shear stress in deep tissue with minimum shear stress in the overlying skin could be created by using a prominence and a cushion, respectively. On the basis of the results of FEM analysis, we selected suitable conditions for testing the rat DTI deterioration model. The compressed area was macroscopically observed until day 13, and histopathologic analysis via haematoxylin and eosin (H&E) staining was performed on days 3, 7 and 13. H&E staining showed that the distribution of tissue damage was similar to the predicted FEM results. Deep ulceration and tissue damage extending from deep tissues to the overlying skin and surrounding tissues were observed in the DTI deterioration model, which are similar to the clinical manifestations of DTI deterioration. In conclusion, a representative DTI deterioration model was established by concentrating high shear stress in deep tissues while minimising shear stress in the overlying skin. This model will allow a better understanding of the mechanisms behind DTI deterioration and the development of preventative strategies.     

Injury patterns in patients who “talk and die”

Despite advances in the quality of and access to cerebral imaging, patients with mild head injuries still deteriorate and die in neurotrauma units. The term “talk and die” was first used by Reilly et al. to describe a subset of patients with head injuries who died following what was initially thought to be only a mild traumatic brain injury. A retrospective review of a database from a major Australian trauma center was performed to identify 25 patients who met the “talk and die” criteria between January 2000 and December 2009. The medical records of these patients and their imaging studies were analyzed to identify potentially preventable factors and injury patterns in this group of patients. The factors analyzed included age, modality of injury, therapeutic narcotic usage, seizures, and hyponatremia. Two groups of patients are described herein based on intracranial pathology, with statistically significant differences in age, mechanism, and coagulopathy identified.     

弱视治疗后视力回退因素分析

目的：从临床角度探讨弱视治疗后视力回退的因素。方法：对临床确诊并基本治愈的44例（77只眼）弱视患者,随访1－4年,平均2年。根据弱视的类型,治疗前弱视程度,治疗开始时年龄和巩固治疗时间进行分析。结果：44例（77只眼）中31只眼发生视力回退,回退率为40．2％。其中斜视弱视型60％发生回退,屈光参差型33％发生回退,屈光不正型12％发生回退;轻度弱视者13．3％,中度弱视者53．6％,重度弱视者83．3％发生视力回退;巩固治疗半年者38％、1年者34．8％发生回退。结论：弱视程度越重和斜视型弱视在弱视治疗成功后易发生回退,弱视治疗开始时年龄和巩固治疗时间与回退无明显关联。     

Assessing clinically relevant cognitive decline: preliminary data on a new method

Abstract. Physiological age-related cognitive decline, practice effect and regression to the mean may interfere with the interpretation of psychometric changes between subsequent neuropsychological evaluations. The standardized regression- based (SRB) change score allows investigators to define clinically relevant cognitive change on an individual basis controlling for these confounding factors. We performed a preliminary study to test its applicability and usefulness in the neuropsychological diagnosis of dementia. We derived a regression equation for the tests of a widely used Italian battery for global cognitive assessment, the Mental Deterioration Battery, in a sample of 20 normal elderly and we tested the potential clinical application of the SRB methodology in two cases of questionable dementia.     

Exponentially decaying inventory with partial back‐ordering

Most of the research in decaying inventory models considers either complete back‐ordering or complete lost sale. The analysis on partial back‐ordering has received relatively little attention. In this study, a partial back‐ordered inventory model for an item which deteriorates exponentially is developed. It is demonstrated that models with complete back‐ordering and complete lost sales are special cases of the general model. Also, a lower bound on the back‐ordered ratio is obtained to ensure convexity of the total cost function. A numerical example to illustrate the theory is provided. Copyright © 1999 John Wiley & Sons, Ltd.     

Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study

Schizophrenic patients often experience visual hallucinations (VHs) and auditory hallucinations (AHs); however, brain aberrations associated with combined VH and AH in schizophrenic patients remains poorly documented. Changes to the brain and cognition during the first episode of untreated schizophrenic patients (FUSCH) with both VHs and AHs (FUSCHVA) were evaluated. One-hundred and fifty-seven patients were enrolled that had FUSCH (1) with VHs but not AHs (FUSCHV), and (2) with AHs but not VHs (FUSCHA), plus FUSCHVA and healthy controls (n = 30). Gray matter volume (GMV) and MATRICS Consensus Cognitive Battery (MCCB) was measured to reflect impairments to the brain and cognition, respectively. FUSCHVA patients had the severest cognitive impairment for all components of the MCCB, followed by FUSCHV and FUSCHA patients. Compared to healthy patients, FUSCHVA patients had reduced GMV in the occipital, parietal, frontal, and temporal cortex, and increased GMV in the hippocampus and striatum. Compared to FUSCHV patients, FUSCHVA patients had reduced GMV in the occipital cortex and postcentral gyrus, and increased GMV in the posterio-parietal lobe. Compared to patients with FUSCHA, the GMV in patients with FUSCHVV was reduced in the occipital cortex and posterio parietal lobe. In conclusion, visual and auditory hallucinations appear to deteriorate reciprocally in FUSCHVA patients, accompanied with sever cognitive impairments. Compared to AHs, VHs might be accompanied with severe GMV impairment in the brain, especially in the primary visual cortex and higher perception integration cortex (posterio parietal lobe) in patients with FUSCH.     

系统性疾病致陈旧脑梗死症状复发的临床特点及诊治分析

目的分析系统性疾病导致陈旧性神经功能缺损症状的恶化或再发的原因，提高诊断水平。方法回顾性分析2例因贫血导致陈旧脑梗死症状复发的临床资料。结果2例患者均表现为偏侧肢体乏力，同既往脑梗死症状相同，CT提示陈旧性脑软化灶；结合患者存在贫血，给予输血治疗后患者肢体无力症状快速缓解。结论系统性疾病可导致陈旧性神经功能缺损症状的恶化或再发，积极纠正系统性疾病，有时可迅速缓解患者的症状，改善预后。我们应该重视系统性疾病对脑血管病患者的影响，避免误诊。     

成人共同性斜视术后双眼融合功能训练对术后眼位及三级视功能的影响

目的：探讨融合功能训练对斜视术后患者双眼眼位及三级视功能的影响。方法：对56例成人共同性斜视术后患者,随机分为治疗组和对照组进行观察,治疗组30例应用融合功能训练软件进行融合功能训练,观察术后7、30、180、365 d的斜视度、融合功能、立体视并比较分析。结果：治疗组与对照组在术后365 d比较,治疗组眼位回退率为3％,明显低于对照组的23％（P＜0．05）;治疗组眼位矫正率为20％,明显高于对照组的4％（P＜0．05）;治疗组融合功能恢复率达53％,高于对照组的15％（P＜0．05）;立体视觉功能恢复率达46％,明显高于对照组的11％（P＜0．05）,差异有统计学意义。结论：对斜视术后的患者进行融合功能训练能矫正眼位,减少眼位回退率,提高融合功能和立体视觉的恢复。     

多种中枢性药物合用致帕金森综合征及其恶化的临床分析

目的本研究主要就患者在使用各类中枢性药物进行治疗后出现帕金森综合征的相关情况展开分析讨论。方法对我院所收治的24例帕金森综合征患者的临床用药情况进行回顾性分析。结果采用中枢性药物来进行治疗时,多种药物联用可能导致患者出现帕金森综合征,通过停药或采取相应的措施可以使患者的病情得以缓解。结论通过对相关资料以及患者的临床表现进行分析发现,多种中枢性药物联用、使用5-羟色胺再摄取抑制剂(SSRI)后出现不良反应等情况与患者出现帕金森综合征及其恶化之间存在密切联系。