针灸治疗几类重大脑病的临床研究进展

目的：探讨针灸治疗自闭症谱系障碍、抑郁症和老年痴呆症三大脑病的临床研究进展。方法：以回顾性临床文献研究的方式,检索中文期刊数据库（中国知网、维普、万方）及PubMed数据库近年公开发表的针灸治疗三大脑病的临床研究文献,结合疾病的病因病机和治则进行分析和整理。结果：研究者对针灸治疗三大脑病进行了广泛研究,临床研究报道很多,为这一治疗的实用性和科学性奠定了一定基础。结论：针灸治疗脑病的临床疗效确切,希望相应的针灸临床实践指南尽快出台,使以后的临床研究更趋规范化。     

社区防跌倒策略在老年原发性骨质疏松症患者中的应用评价

背景　骨质疏松症（OP）患者跌倒的风险显著高于非OP者,而62%以上的低暴力骨折均由跌倒引起,因此,加强预防跌倒工作对OP患者有重要意义。但是,目前关于院内预防跌倒的研究较多,对院外预防OP患者跌倒的研究尚少。目的　评价社区防跌倒策略在老年原发性OP患者中的作用。方法　选取2016年6-12月在陆家嘴社区卫生服务中心门诊就诊的100例老年原发性OP患者,采用随机数字表法将其分为干预组和对照组,各50例。其中对照组实施常规门诊随访,干预组在对照组基础上增加社区防跌倒策略综合干预,持续干预1年。采用OP知识问卷（OKT）评估干预前后两组患者对OP知识的了解程度,采用Berg平衡量表（BBS）评估干预前后两组患者的平衡功能,采用Motricity指数（MI-L）评估干预前后两组患者的下肢肌力,统计并对比干预1年期间两组患者跌倒发生率。结果　干预后两组患者OKT评分、BBS评分、MI-L评分均较干预前升高（P<0.05）;干预前两组患者OKT评分、BBS评分、MI-L评分比较,差异无显著性（P>0.05）;干预后干预组患者OKT评分、BBS评分、MI-L评分高于对照组（P<0.05）。干预1~3个月、干预4~6个月、干预7~9个月期间,两组患者跌倒发生率比较,差异均无统计学意义（P>0.05）;干预10~12个月期间,干预组患者跌倒发生率低于对照组（P<0.05）。结论　社区防跌倒策略综合干预模式的应用可显著改善老年原发性OP患者对OP的了解程度,并且提高患者的平衡功能和下肢肌力,可有效降低患者跌倒发生率,值得推广。     

桦褐孔菌对血管性痴呆模型大鼠的保护作用

目的：探讨桦褐孔菌对血管性痴呆（VD）大鼠行为学及组织病理形态的影响,阐明桦褐孔菌对VD大鼠的保护作用。方法：选用Wistar大鼠100只,采用反复夹闭大鼠双侧颈总动脉再灌注联合腹腔注射硝普钠降压法制备VD模型,大鼠分为正常对照组,模型组,阳性药组（吡拉西坦,0.5g·kg^-1）,低、中、高剂量（0.5、1.0和2.0g·kg^-1）桦褐孔菌组,连续灌胃给药8周后,观察大鼠行为学和组织病理学变化。结果：Morris水迷宫实验,与模型组比较,中和高剂量桦褐孔菌组大鼠在实验第2~6天,到达平台的潜伏期和游程明显缩短（P<0.05或P<0.01）,实验第7天穿越平台次数、穿越有效区次数、有效区停留时间、有效区停留距离、有效区停留时间/总时间和有效区停留距离/总路程均明显增加（P<0.05）,高剂量桦褐孔菌组大鼠平台停留时间和平台停留时间/总时间明显增加（P<0.05）。组织病理形态观察,与模型组比较,高剂量桦褐孔菌组大鼠脑组织皮质区和海马区的病理性损伤明显减轻。结论：桦褐孔菌对VD大鼠具有保护作用,能改善VD大鼠的学习记忆能力,减轻VD大鼠脑组织的病理损伤。     

股骨近端防旋髓内钉手术治疗对老年股骨粗隆间骨折患者骨代谢和骨强度的影响

目的 探讨股骨近端防旋髓内钉手术(PFNA)治疗对老年股骨粗隆间骨折患者骨代谢和骨强度的影响.方法 选择2014年1月至2015年8月医院收治的老年股骨粗隆间骨折患者50例为观察组对象,另在医院健康体检处选择50例无骨折病史的正常老年人作为对照组,对观察组患者进行PFNA治疗,测定并比较手术前后观察组患者和对照组正常老年人的骨代谢和骨强度指标.结果 手术前,观察组患者骨代谢指标中前胶原氨基末端前肽Ⅰ型(PINP)、甲状旁腺激素(PTH)、Ⅰ型胶原羧基端肽(CTX)和血清骨钙素(OC)水平均明显高于对照组(均P<0.05),而25(OH)D3明显低于对照组(P<0.05);手术后,观察组患者血清PINP水平[(86.03±27.78)mg/L]较手术前[(53.97±26.13)mg/L]明显升高(P<0.05);PTH水平[(27.67±11.54)ng/L]较手术前[(51.22±17.65)ng/L]明显下降(P<0.05),略高于对照组[(36.85±12.86)ng/L](P>0.05),25(OH)D3、CTX和OC水平与手术前比较无明显变化(均P>0.05).手术前,观察组患者股骨粗隆间区以及股骨颈区骨强度指标中横截面转动贯量(CSMI)、骨密度(BMD)和截面模量z值(Z)均比对照组低(均P<0.05),屈曲比率(BR)明显高于对照组(P<0.05);手术后,观察组患者骨强度指标与手术前相比均稍有下降,但不具有统计学意义(P>0.05).结论 老年股骨粗隆间骨折患者经PFNA治疗后骨代谢增加,骨强度无明显改变,可能由于手术中应力遮挡作用而使髓内钉周围骨有少量丢失,需要加强抗骨质疏松治疗和防护措施以预防骨折.     

Paeoniflorin Improves Regional Cerebral Blood Flow and Suppresses Inflammatory Factors in the Hippocampus of Rats with Vascular Dementia

Objective: To explore the delayed neuroprotection induced by paeoniflorin(PF), the principal component of Paeoniae radix prescribed in Chinese medicine, and its underlying mechanisms in rats subjected to vascular dementia(VD). Methods: A rat model of VD was induced by bilateral common carotid arteries occlusion(BCCAO). Low-dose or high-dose PF(20 or 40 mg/kg once per day) was administrated for 28 days after VD. The behavioral analysis of rat was measured by water morris. Regional cerebral blood volume(r CBV), regional cerebral blood flow(r CBF) and mean transit time(MTT) were measured in the bilateral hippocampus by perfusion-weighted imaging(PWI). The levels of interleukin-1β(IL-1β), interleukin-6(IL-6), and tumor necrosis factor alpha(TNF-α) were measured by commercially available enzyme-linked immunosorbent assay kits. Protein levels were evaluated by western blot analysis. m RNA levels were evaluated by real time-polymerase chain reaction. Western blotting was used to estimate p65 translocation. Results: The behavioral analysis showed that PF could decrease the escape latency time(P0.05), and increase the residence time of the original platform quadrant and the across platform frequency in water maze in VD rats(P0.05). Likewise, PF remarkably promoted the r CBV(P0.05), r CBF and decreased per minute MTT(P0.05) in hippocampus of VD rats. Furthermore, PF decreased the release of IL-1β, IL-6 and TNF-α as well as inhibited the m RNA expression of IL-1β, IL-6 and TNF-α in the hippocampus of VD rats(P0.05 or P0.01). PF also could decrease the protein expressions of inducible nitric oxide synthase and cyclooxygenase-2 in the hippocampus of VD rats(P0.05 or P0.01). In addition, PF significantly inhibited the nuclear factor κB(NF-κB) pathway in the hippocampus of VD rats. Conclusions: PF significantly attenuates cognitive impairment, improves hippocampus perfusion and inhibits inflammatory response in VD rats. In addition, the anti-inflammatory effects of PF might be due to inhibiting the NF-κB pathway. PF may be a potential clinical application in improving VD.     

Standards of care in day hospitals and day centres: a comparison of services for older people with dementia

BACKGROUND: Current policy in England emphasises the importance of caring for highly dependent older people for as long as possible at home. It is therefore crucial that day care services are effective and widely available. AIM: To compare the type and standard of care provided for older people with dementia in day centre and day hospital settings. METHODS: A cross-sectional postal survey design was employed. Representatives from three-quarters of identified specialist day care services for older people with dementia in the North West of England provided information on a range of indicators including: basic structural features; delivery of care; service content; and quality measures. RESULTS: Day hospitals tended to have more day care places and a greater number of attendees, but lower occupancy rates than day centres. Day hospitals reported higher standards of care in relation to systematic assessment and care planning, promotion of rehabilitation, carer involvement and individualised provision of care. They were also more likely to employ building design features to encourage independence and choice for people with dementia. A higher proportion of day centres provided services exclusively to older people with dementia and a greater proportion of staff in day centres had undergone specific training in caring for people with dementia. Day centres were also more likely to have effective transport arrangements in place. CONCLUSION: The standards developed for the study were sufficiently reliable to allow for an acceptable estimate of quality. Day centres and day hospitals appeared to perform two distinct, but complementary functions. These results provide key material for shaping the provision of day care for older people with dementia, especially given the absence of national standards in this area.     

Usefulness of the Rowland Universal Dementia Assessment scale in South India

BACKGROUND: The number of older people with cognitive impairment being seen in out patient settings is increasing. A brief screening test, which is culturally and educationally fair, would be very useful for clinicians for identifying dementia in these settings. OBJECTIVES: To examine the new cognitive screening test, the Rowland Universal Dementia Assessment Scale (RUDAS), and to compare it with the Mini-Mental State Examination (MMSE). METHOD: We administered MMSE and RUDAS to 116 subjects, consisting of 58 patients with mild to moderate dementia and 58 age and sex matched controls. The two screening tests were compared with regard to sensitivity and specificity. We looked at the correlation of both tests with years of formal education among the controls. RESULT: RUDAS had a similar sensitivity but better specificity than MMSE, but did have an educational bias. CONCLUSIONS: RUDAS is a useful brief screening test in clinical settings.     

Processing of emotionally toned pictures in dementia

BACKGROUND: Apathy is a common symptom in dementia and is often associated with reduced emotional reactivity. This study examined whether reduced emotional reactivity can be demonstrated in dementia patients using a picture viewing task. METHODS: The viewing time of three different types of visual stimuli was measured in 24 elderly participants, half of which suffered from dementia. The participants had to make a target response to an emotionally neutral target stimulus that was intermixed with a frequently occurring non-target or 'background' stimulus and infrequently presented emotional stimuli. All participants could control the presentation time of each stimulus, but one half of the participants were explicitly instructed to perform the task quickly. RESULTS: The main measure was a ratio score in which the viewing time for emotional stimuli was expressed relative to the viewing time for the neutral non-target stimulus. Using this measure, the instigation of a time-pressure condition proved to significantly reduce the viewing time for emotional stimuli in the healthy subjects. Irrespective of time-pressure condition, the dementia patients showed a similar short viewing time for emotional stimuli as did the healthy subjects in the time-pressure condition. However, both dementia patients and healthy controls displayed longer viewing times for unpleasant than for pleasant stimuli. CONCLUSION: These results suggest the ability of the present task to reveal the simultaneous occurrence of an overall reduced interest for novel stimuli and an intact differential emotional reactivity to stimuli with a negative versus positive valence in the dementia patients.     

纳络酮对铝中毒小鼠学习记忆障碍的改善作用

在口服氯化铝导致学习记忆障碍模型的基础上,用跳台、避暗等实验方法观察了纳络酮对铝中毒小鼠学习记忆障碍的改善作用,并测定了肝丙二醇、脑B型单胺氧化酶的变化。实验结果显示,氯化铝可导致小鼠学习记忆障碍,以及增高丙二醛和B型单胶氧化酶的作用,而纳络酮对改善铝中毒小鼠学习记忆障碍有作用,同时有清除过氧化脂质和抑制B型单胶氧化酶活性的作用。