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肌肉相邻结构的长度变化对其痉挛形式的影响

世界核心医学期刊文摘（神经病学分册） 2005年第11期1卷 53-53页

作者： Smeulders M.J.C. Kreulen M. Hage J.J. 张殿增 Dr.department of Plastic Reconstructive and Hand Surgery Academic Medical Centre P.O. Box 22700 1100 DE Amsterdam Netherlands

Recent animal experiments have shown that up to 37%of muscle force may be transmitted to adjacent structures rather than reach the insertion of the muscle’s tendon, and that the extent of such force transmission depends on the length and relative position of these structures. We tested whether the force-length characteristics of the distally tenotomized human flexor carpi ulnaris muscle (FCU) of nine patients with cerebral palsy varied with the change of relative length of adjacent structures induced by a change of wrist position. In four patients, the FCU exerted up to 40%more active force in a flexed wrist position at short FCU length, whereas the active force was not significantly higher in the other five. In the same manner, passive force-length characteristics of the spastic FCU changed upon changes in wrist position. Variability in myofascial force transmission may partly explain the variability in success of the FCU-transfer.

关键词：被动肌力腕关节瘫痪患者部分解释屈肌收缩力肌筋膜动物实验相对位置

一项即刻与推迟应用抗癫痫药治疗早期癫痫与单次癫痫发作的随机对照试验

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世界核心医学期刊文摘（神经病学分册） 2005年第10期1卷 2-2页

作者： Marson A. Jacoby A. Johnson A. D. Chadwick 郭俊 department of Neuro logical Science University of Liverpool Walton Centre Lower Lane Liverpool L 9 7LJ United Kingdom Prof.

Background: The relative risks and benefits of starting or withholding antiep ileptic drug treatment in patients with few or infrequent seizures are unclear. We sought to compare policies of immediate versus deferred treatment in such pat ients and to assess the effects of these policies on short- term recurrence and long- term outcomes. Methods: We undertook an unmasked, multicentre, randomise d study of immediate and deferred antiepileptic drug treatment in 1847 patients with single seizures and early epilepsy. Outcomes comprised time to first, secon d, and fifth seizures; time to 2- year remission; no seizures between years 1 a nd 3 and between years 3 and 5 after randomisation; and quality of life. Analysi s was by intention to treat. Findings: 404 patients invited to join the trial di d not consent to randomisation; 722 were subsequently assigned immediate treatme nt with antiepileptic drugs and 721 were assigned deferred treatment. Immediate treatment increased time to first seizure (hazard ratio 1.4 [95% CI 1.2 to 1.7 ]), second seizure (1.3 [1.1 to 1.6]), and first tonic- clonic seizure (1.5 [1. 2 to 1.8]). It also reduced the time to achieve 2- year remission of seizures ( p=0.023). At 5- years follow- up, 76% of patients in the immediate treatment group and 77% of those in the deferred treatment group were seizure free betw een 3 and 5 years after randomisation (difference - 0.2% [95% CI - 5.8% to 5.5% ]). The two policies did not differ with respect to quality of life out comes or serious complications. Interpretation: Immediate antiepileptic drug tre atment reduces the occurrence of seizures in the next 1- 2 years, but does not affect long- term remission in individuals with single or infrequent seizures.

关键词：抗癫痫药随机对照试验阵挛发作相对风险随机研究生活质量随机分配中有

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针刺治疗慢性头痛:一项流行病学研究

世界核心医学期刊文摘(神经病学分册) 2006年第8期 22-22页

作者： Melchart D. Weidenhammer W. Streng A. K.Linde 牛亚利 centre for Complementary Medicine Research Department of Internal Medicine II Technische Universitt Mü nchen Kaiserstr. 9 80801 Munich Germany Dr.

Objective. - To investigate the characteristics and outcomes of patients undergoing acupuncture treatment for chronic headaches under conditions of routine care provided within the framework of statutory health insurance in Germany. Furthermore, we investigated correlations between different outcomes. Patients and Methods. - Patients with migraine, episodic or chronic tension- type headache (TTH), or several other forms of chronic headache (cluster, vascular, drug- induced headache; other specific headaches) treated with acupuncture (mean number of sessions 8.6 ± 3.0) were included into an observational study. Detailed questionnaires including questions on headache days and instruments measuring disability (Pain Disability Index) and quality of life (SF- 36) were completed before treatment, after treatment, and at 6 months after inclusion. Results. - A total of 2022 patients (732 with migraine, 351 with episodic and 440 with chronic TTHs, and 499 with other diagnoses)- treated by 1418 physicians were included in the main analysis. Sociodemographic and baseline characteristics differed considerably in the four diagnostic groups. Statistically highly significant and clinically relevant improvements were seen for all clinical outcome measures in all diagnostic groups. In 52.6% of patients headache frequency decreased by at least 50% compared to baseline. The comparison of headache frequency, pain intensity, and generic outcome measures showed that some of these outcomes correlate only weakly. Conclusions. - In this epidemiological study, headache patients reported clinically relevant improvements after receiving acupuncture. Randomized trials performed in parallel to this study confirm the relevant overall effect, however, the effect may largely be due to potent unspecific needling and placebo effects.

关键词：针刺治疗慢性头痛流行病学

静注rt-PA治疗急性卒中:比较其在较年轻和老年患者中的疗效

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世界核心医学期刊文摘（神经病学分册） 2005年第12期1卷 43-43页

作者： Mouradian M.S. Senthilselvan A. Jickling G. 周永 Dr.department of Medicine University of Alberta 2E3. 13 Walter C Mackenzie Health Sciences Centre Edmonton Alta. T6G 2B7 Canada

Objective: To study the short and long term differences in outcome between patients ≥80 years of age and those ≤79 years of age who received intravenous recombinant tissue plasminogen activator (iv rt-PA) for acute stroke within the first 3 hours of symptom onset. Methods: We studied consecutive patients treated with iv rt-PA for acute stroke, with prospective follow up of up to 3 years. Outcome measures included National Institutes of Health Stroke Scale (NIHSS) score, Barthel Index (BI), modified Rankin score (MRS), and stroke mortality. Patients were split into two groups: younger (≤79 years) and older (≥80 years). Results: There were 65 patients in the younger cohort and 31 patients in the older. Older patients were more likely to present with more severe baseline stroke (p = 0.04; odds ratio (OR) 3.04; 95%confidence interval (CI) 1.03 to 8.98). Stroke mortality at 90 days was 10.8%in the younger and 32.3%in the older cohort (p = 0.01). At 90 days’follow up, patients in the older cohort with more severe stroke (NIHSS score ≥11) were nearly 10 times more likely to have poor outcome compared with their younger counterparts presenting with severe stroke (p = 0.001; OR = 10.36; 95%CI 2.16 to 49.20). Baseline stroke severity and age were the only independent and equal predictors for stroke outcome. No threshold was found for age or baseline stroke severity predicting outcome. Conclusion: Older patients presenting with more severe baseline stroke are much less likely to benefit from iv rt-PA as compared with their younger counterparts.

关键词：急性卒中 rt-PA 国立卫生院老年卒中预后指标预后差界值

卫生经济学评价报告标准共识（CHEERS）声明

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英国医学杂志中文版 2013年第3期16卷 166-170页

作者： Don Husercau Michael Drumrnond Stavrps Petrpi Chris Carswell editor David Moher Dan Greeuberg Federico Argustovski Andrew H Briggs Josephine Mauskopf Elizabeth Loder 杨莉 Institute of Health Eeonomics EdmontouCanada Departnedt of Epidemiology and Community Medicne Lniuersity of OttawaOllawaCanada University for Healty Scienccs Medical Informatics and TechnologyHall in TirolAustria centre for Health Econnomics Universityof YorkYorkUK Warwick Medical School University of WarwickCoventryUK Pharmacoeconomice Adis International Auckland New Zealand clinical Epidemiology Program Ottawa t l.spital Reseamh Institute Ottawa Canada department of Itealth Systems Managemenl Faculty of Health Sciences Bcn-Gurion University of the Negev Beer-Sheva Israel Center for the Evaluation of Value and Risk in Health Tufts Medical Center Boston MAUSA Heahh Economie Evaluation and Technology Assessment Instilute for Clinirat Effectiveness and Heahh Policy (IECS) Buenos Aires Argentina Universidad de Buenos Aires Buenos AiresArgentina Institute of Health and Wellbeing University of GlasgowGlasgowScotland RTI Health Solutions Research Triangle Park NCUSA Division of Headache and Pain Brighamand Women's/Faulkner NeurologyFaulkner HospitalBoston MAUSA 北京大学公共卫生学院

卫生干预的经济学评价对报告提出特殊挑战,有必要统一和更新已有的指南并促进其以一种用户友好的方式使用。卫生经济学评价报告标准共识（CHEERS）声明是对以前的卫生经济学评价指南的继承和更新，并将其转化为与时俱进的实用报告指南，... 详细信息

卫生干预的经济学评价对报告提出特殊挑战,有必要统一和更新已有的指南并促进其以一种用户友好的方式使用。卫生经济学评价报告标准共识（CHEERS）声明是对以前的卫生经济学评价指南的继承和更新，并将其转化为与时俱进的实用报告指南，CHEERS声明的主要读者是报告经济学评价结果的研究人员和评估经济学评价结果的编辑和审稿人。对医学编辑的调查确定了需要新的报告指南，基于系统综述创建了可能的条目清单。之后进行了两轮改进的德尔菲专家咨询，这些专家来自学术界、临床医生、企业、政府和编辑。从44个候选条目中确定了24个条目及建议。这些建议包含在一个用户友好的24条目清单里。声明、清单和这个报告可在ISPOR网站的卫生经济学评价指南工作组网站上找到（www. ispor, org/TaskForces/EeonomicPub （;uidelines. asp ）我们希望CHEERS带来更好的报告，最终带来更好的卫生决策，为了便于传播和获取，CHEERS声明刊登在10种卫生经济学和医学期刊上。我们鼓励其他期刊和团体支持CHEERS。作者团队计划在5年后更新清单，卫生经济学评价是用来辅助资源分配决策的，经济学评价被定义为“依照它们的成本和效果对可供选择的行动方案进行比较分析”,所有经济学评价都评估成本，但测量和评估健康干预效果的方法可能有所不同（框图1）。经济学评价已广泛应用于卫生政策，包括干预项目（如疫苗接种、筛检和健康促进）、诊断、治疗（如药物和外科手术）、护理和康复的评估。经济学评价越来越多地用于决策，并且是国际卫生技术评估项目的一个重要组成部分^2。

关键词：卫生经济学评价报告标准卫生技术评估评价指南医学编辑报告指南专家咨询医学期刊

儿童和青少年偏头痛和紧张型头痛临床特征、分类和预后的一项长期随访研究

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世界核心医学期刊文摘(神经病学分册) 2006年第10期 15-16页

作者： Kienbacher C. Wber C. Zesch H.E. 樊慧婷 department of Neuropsychiatry of Childhood and Adolescence Whringer Gü rtel 18- 20 A- 1090 ViennaAustria Dr.

We performed a long- term follow- up examination in children and adolescents with migraine and tension- type headache (TTH) in order to investigate the evolution of clinical features and headache diagnoses, to compare International Classification of Headache Disorders (ICHD)- I and ICHD- II criteria and to identify prognostic factors. We re- examined 227 patients (52.4% female, age 17.6 ± 3.1 years) 6.6 ± 1.6 years after their first presentation to a headache centre using identical semistructured questionnaires. Of 140 patients initially diagnosed with migraine, 25.7% were headache free, 48.6% still had migraine and 25.7% had TTH at follow- up. Of 87 patients with TTH, 37.9% were headache free, 41.4% still had TTH and 20.7% had migraine. The number of subjects with definite migraine was higher in ICHD- II than in ICHD- I at baseline and at follow- up. The likelihood of a decrease in headache frequency decreased with a changing headache location at baseline (P centre because of migraine or TTH become headache- free in the longterm. Another 20- 25% shift from migraine to TTH or vice versa. ICHD- II criteria are superior to those of ICHD- I in identifying definite migraine in children and adolescents presenting to a headache centre. The prognosis is adversely affected by an initial diagnosis of migraine and by changing headache location, and it tends to be affected by an increasing time between headache onset and first presentation.

关键词：偏头痛脑病紧张型儿童临床特征预后

疑似慢性中毒性脑病患者的认知功能:控制患者配合不佳后神经心理障碍的证据

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世界核心医学期刊文摘(神经病学分册) 2006年第8期 54-55页

作者： Van Hout M.S.E. Schmand B. Wekking E.M. Deelman B.G 刘凯 department of Psychology Medical Spectrum Twente Hospital PO Box 50000 NL- 7500 KA Enschede Netherlands Dr.

Objectives: Chronic toxic encephalopathy (CTE) caused by long term occupational exposure to organic solvents is still a controversial disorder. Neuropsychological testing is the cornerstone for diagnosing the syndrome, but can be negatively influenced by motivational problems. In this nationwide study, we investigated the neuropsychological functioning and psychological symptoms of a large group of patients with suspected CTE, and ruled out alternative explanations for their complaints, including suboptimal performance due to insufficient effort. Methods: We studied participants with suspected CTE (n = 386) who were referred for further diagnosis to the Netherlands centre of Occupational Diseases in the period 1998- 2003 and who had completed the entire diagnostic protocol. Patients were excluded if there was the slightest suspicion that test performance had been negatively influenced by insufficient effort (n = 221), or if comprehensive assessment identified an alternative diagnosis (n = 80). Insufficient effort was defined by a combination of three indices. The neuropsychological test scores of the patient group (n = 85) were compared with those of a control group of building trade workers matched for sex, age, and educational level (n = 35). Results: The patient group had significantly more psychological complaints and performed significantly worse than the control group on tests of speed of information processing and memory and learning. However, only a small percentage of the patients had clearly abnormal scores for cognitive speed (9% ) or memory (8% ). Attention, verbal abilities, and constructional functions were not disturbed. Exposure duration and cognitive complaints were significantly correlated, whereas the correlation between exposure duration and neuropsychological domain scores was not significant. Conclusions: Insufficient effort was present in a substantial part of the patient group. After minimising the likelihood that insufficient effort negatively influenced neuropsychological scores, we stil

关键词：中毒性患者神经心理学测试

脊髓梗死的弥散加权MRI成像:高分辨率成像和弥散异常的时程

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世界核心医学期刊文摘（神经病学分册） 2005年第1期1卷 9-10页

作者： Küker W. Weller M. Klose U. 杜方 department of Neuroradiology University Hospital Tü bingen Hoppe-Seyler-Str. 3 72076 Tübingen Germany Dr

Infarction is a rare cause of spinal cord dysfunction. Whereas diffusion weighted (DW) MRI has been established as a highly sensitive technique for assessing acute cerebral ischemia, its role in spinal cord infarction remains to be determined. The purpose of this study is to present the signal characteristics of acute spinal cord ischemia using DW MRI within the first two days and after one week. MRI including DW imaging (DWI) was performed in three patients with acute spinal cord dysfunction 8, 12 and 30 hours after the onset of symptoms and repeated after one week in two patients. Two initial scans included EPI DWsequences in transverse and sagittal orientation. The remaining examinations were performed with an optimised high spatial resolution DWI sequence in the transverse plane. The diagnosis of spinal cord ischemia was established by imaging, clinical history and CSF analysis. T2 signal abnormality and restricted diffusion was demonstrated in all initial examinations. Transverse DW sequences had the highest sensitivity. The spinal infarctions were mainly located in the centre of the spinal cord and the grey matter. Contrast enhancement was absent. After one week, the restricted diffusion had normalised (pseudo normalisation) whereas the T2 signal changes had become more prominent. Restricted diffusion in the course of spinal cord ischemic infarction can be demonstrated using DW MRI. Whereas a diffusion abnormality can be found after few hours, it does not last for longer than one week. At this time, the establishment of the diagnosis has to rely mainly on T2 weighted images with additional post contrast T1 weighted images being useful.

关键词：弥散加权高分辨率成像信号特点水平位影像检查急性脑缺血高敏感性高空间分辨率增强扫描综合评价

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多发性硬化症欧洲标准化临床描述的确立

世界核心医学期刊文摘（神经病学分册） 2005年第6期1卷 28-28页

作者： Amato M.P. Grimaud J. Achiti I. 李锐 department of Neurological Sciences University of Florence Viale Morgagni 85 50134 Florence Italy Dr.

Objectives The EDMUS system is a clinical database specifically tailored to the description of multiple sclerosis (MS). The EVALUED(Evaluation of the EDMUS system) study is an European project with two Abstract:Objectives: 1) to assess the interexaminer reliability of the whole EDMUS system; 2) to validate the EDMUS- Grading Scale (EGS), which is a simplified version of the Kurtzke Disability Status Scale (DSS). Methods The protocol included 12 neurologists working in pairs within six European centres (Bari, Basel, Florence, London, Lyon, Wü rzburg). They assessed independently 30 MS patients in their centre, filling in the EDMUS forms. The reliability of the system was assessed on selected key items in the history of the MS onset, the clinical course and the disease course classification. The clinical examination of the patients permitted an assessment of the Kurtzke Expanded Disability Status Scale (EDSS) and the EGS. Level of agreement was measured in terms of kappa and weighted kappa indexes whenever appropriate. Results The study included 180 patients with definite or probable MS of whom 37 % were males. Age was 35.8± 9.6 years (mean± SD), disease duration 7.8 ± 5.7 years, and mean EDSS score 4.1 ± 2.2. The disease course was relapsing- remitting in 67 % , secondary progressive in 22 % , and progressive from disease onset in 11 % . For key items of the history, the inter- examiner reliability level ranged from moderate to excellent. Concerning the disability scales, perfect agreement was reached in 59 % for EDSS and 78 % for EGS. The close correlation and linear association (r = 0.94, p clinical description of MS using a common language. This standardized follow- up of MS patients is valuable especially in studies requiring a critical mass of informative patients.

关键词：多发性硬化症 EDSS 疾病病程项目评估临床病程残疾程度观察系统神经病学伍兹状态量