Cerebral hemangioma hemorrhage is the most serious type of cerebrovascular disease and is mostly caused by high blood pressure. The vast majority of patients with hypertension have varying degrees of headaches. The degree of headache is related to the level of blood pressure. When the blood pressure suddenly rises, the headache will be severe; when the blood pressure is normal, the headache will naturally relieve. Therefore, headaches can serve as a barometer of blood pressure levels. If a hypertensive patient's headache suddenly worsens and is accompanied by a sudden increase in blood pressure, it is often a precursor to cerebral hemorrhage. According to reports, 80% to 90% of patients with cerebral hemorrhage have severe headache as the first symptom. The cause of the headache is caused by blood directly stimulating the meninges and painful structures of the brain. At the same time, cerebral hemorrhage often leads to an increase in intracranial pressure, which compresses and stretches intracranial blood vessels and nerves, which can also make headaches worse.

Headache is also a prominent symptom of subarachnoid hemorrhage. Because intracranial arteries and vascular malformations suddenly rupture, a large amount of blood flows into the subarachnoid space, directly irritating the meninges and causing severe headaches. The headache is mainly located in the occipital region and is aggravated when the head is lowered. Severe headaches are accompanied by vomiting. Reduction of headaches indicates improvement in symptoms. If the headache suddenly worsens, it is often a sign of further bleeding, and measures should be taken immediately for rescue treatment.

Not only hemorrhagic cerebrovascular diseases can cause headaches, but ischemic cerebrovascular diseases such as cerebral arteriosclerosis, cerebral thrombosis, and cerebral embolism can also cause local pain in the lesion, but it is relatively rare and the degree of pain It is mild and usually not accompanied by vomiting.

It can be seen that headache is a common symptom of cerebrovascular disease, and patients with high blood pressure and cerebral arteriosclerosis should be highly vigilant about the occurrence of cerebrovascular disease once they have severe headaches.

Normal state of consciousness depends on the normal structure and functional integrity of brain tissue. Coma is the result of severe and extensive damage to the brain and is a sign of a critical condition. Coma caused by cerebrovascular disease is common in cerebral hemorrhage and large-scale cerebral infarction. It is often caused by severe cerebral edema, increased intracranial pressure, and compression and damage of the cerebral cortex and brainstem reticular structures.

According to the degree of coma, it is usually divided into two types: shallow coma and deep coma.

(1) Light coma is behaviorally unresponsive and can only be awakened under strong stimulation. When stimulation is stopped, the patient returns to an unresponsive state. However, there was no change in the pupils, various reflexes were present, and the vital signs were stable.

(2) Deep coma is a pathological unconscious state that is unresponsive to any external stimulation. Various reflexes, such as pupillary reflex and corneal reflex, disappeared. The muscles of the limbs are relaxed, breathing is irregular, blood pressure drops, urine and feces are incontinent, and only breathing and heartbeat are available. This situation is often life-threatening, and doctors and family members should do their best to rescue.

Can a comatose patient wake up and can he be rescued? It mainly depends on the following factors:

(1) Depends on the nature of the disease. Generally speaking, the coma caused by cerebral infarction is short-lived, while the coma caused by cerebral hemorrhage lasts longer and is often life-threatening.

(2) It depends on the amount, speed and location of bleeding. If the bleeding volume is large and fast, and the blood flows into the lateral ventricles, midbrain, and pons, the coma will be severe and the prognosis will be poor; conversely, if the bleeding volume is small and slow, and it is located in the white matter of the cerebral hemisphere, the coma will be mild and the prognosis will be good.

(3) Depends on the patient’s age and physical condition. With the same disease and the same treatment method, younger people will wake up faster; older and infirm people will recover more slowly. Therefore, the latter should be treated more actively.

Coma is a sign of serious illness, but it does not mean that all coma patients will definitely die. Practice has proved that many comatose patients can still wake up after correct and timely rescue. Therefore, all efforts should be made to rescue comatose patients.

Cerebrovascular disease refers to a group of diseases in which the cerebral arteries or the cervical arteries that control the brain become diseased, causing intracranial blood circulation disorders and brain tissue damage. Clinically, the main clinical manifestations are sudden fainting, unconsciousness, or distortion of the mouth and eyes, difficulty in speaking, and hemiplegia.

Cerebrovascular disease can be divided into acute cerebrovascular disease (stroke) and chronic cerebrovascular disease according to its process. Acute cerebrovascular diseases include transient ischemic attack, cerebral thrombosis, cerebral embolism, hypertensive encephalopathy, cerebral hemorrhage and subarachnoid hemorrhage; chronic cerebrovascular diseases include cerebral arteriosclerosis, cerebrovascular disease dementia, cerebral arterial Steal syndrome, Parkinson's disease, etc.

What we usually call cerebrovascular disease generally refers to acute cerebrovascular disease, which has an acute onset and often threatens people's lives. Therefore, it is easy to attract people's attention. Chronic cerebrovascular disease has a long course and is easily ignored.

Cerebrovascular diseases can be divided into two categories according to their nature. One is ischemic cerebrovascular disease, which is more common clinically and accounts for about 70% to 80% of all cerebrovascular patients. It is due to Due to cerebral arteriosclerosis and other reasons, the cerebral artery lumen is narrowed, the blood flow is reduced or completely blocked, the blood circulation of the brain is impaired, and a series of symptoms occur due to damage to the brain tissue. The other type is hemorrhagic cerebrovascular disease, which is mostly caused by long-term hypertension, congenital cerebrovascular malformation and other factors. Because blood vessels rupture, blood overflows, compresses brain tissue, and blood circulation is blocked. Patients often show symptoms such as increased cerebral pressure and confusion. This type of patients accounts for about 20% to 30% of cerebrovascular diseases.

In addition, since the 1970s, due to the widespread use of CT and MRI, some cerebrovascular diseases in which hemorrhage and infarction coexist, namely mixed stroke, have been clinically discovered. The reports accounted for 2.67% of the number of hospitalizations for various cerebrovascular diseases during the same period. Its etiology and pathogenesis are not yet fully understood. Hypertension and arteriosclerosis are mostly believed to be important causes and are closely related to its severity.

According to domestic and foreign epidemiological surveys, cerebrovascular disease is a common disease that seriously threatens human health and life span. According to statistics from Beijing in 1994, the incidence of cerebrovascular disease ranked first. Cerebrovascular disease is one of the three major diseases causing human death in the world. According to statistics from my country in 1991, the number of stroke cases per year reached 1.5 million, making it the number one cause of death in many areas.

Cerebrovascular disease not only has a high mortality rate, but also a high disability rate. Some patients are in critical condition and suffer hemiplegia, dysphagia, aphasia or dementia after being rescued, placing a heavy burden on their families and society.

(2) The main risk factors for cerebrovascular disease: (1) hypertension, cerebral arteriosclerosis; (2) diabetes; (3) coronary heart disease; (4) family tendencies, etc.

Cerebrovascular disease has the characteristics of acute onset, rapid development, and high incidence in families, and is the focus of family first aid.

Cerebrovascular diseases are usually divided into two categories: ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease.

Ischemic cerebrovascular diseases include: (1) Transient ischemic attack, (TIA for short, also called small stroke or transient ischemic attack), the cause of which is related to cerebral arteriosclerosis , is a functional disorder caused by transient, ischemic, and focal damage to brain tissue. (2) Cerebral thrombosis is mostly caused by blood clot obstruction caused by local lesions of cerebral blood vessels caused by atherosclerosis, various arteritis, trauma and other physical factors, and blood diseases. (3) Cerebral embolism can be caused by emboli produced by various diseases entering the blood and blocking blood vessels in the brain. Clinically, heart disease is the most common cause; followed by fractures or fat entering the blood after trauma; insect eggs or bacterial infections; pneumothorax and other air entering the blood; emboli formed by phlebitis and other factors that embolize cerebral blood vessels.

Hemorrhagic cerebrovascular diseases include: (1) Cerebral hemorrhage, which refers to rupture and bleeding of blood vessels in the brain parenchyma, excluding traumatic cerebral hemorrhage. It is mostly caused by hypertension, cerebral arteriosclerosis, tumors, etc. (2) Subarachnoid hemorrhage is caused by rupture and bleeding of blood vessels on the surface and base of the brain, and blood flows directly into the subarachnoid space. Common causes include aneurysm rupture, vascular malformation, hypertension, arteriosclerosis, blood diseases, etc.

According to foreign statistics, ischemic cerebrovascular diseases are the most common, with cerebral infarction accounting for 59.2% to 85%. Except for Japan, cerebral hemorrhage is generally less than 20%. A survey of 280 new cases of complete stroke in rural areas in my country in 1984 found that subarachnoid hemorrhage accounted for 3.9%, cerebral hemorrhage accounted for 44.6%, cerebral thrombosis accounted for 46.4%, cerebral embolism accounted for 2.5%, and those who were difficult to classify accounted for 2.9%. From the above data, it can be seen that the situation in my country is different from that in foreign countries. Although the incidence of cerebral infarction is relatively common, the proportion of cerebral hemorrhage is 44.6%, which is obviously higher than that in foreign countries. The reasons for this need to be further explored.

Cerebrovascular disease can be caused by many factors. In addition to high blood pressure, heart disease, arteriosclerosis and climate abnormalities, the most common ones are also currently found to be some drugs, such as antihypertensive drugs, sedatives, and diuretics. etc., are also important factors in inducing ischemic cerebrovascular disease.

(1) Antihypertensive drugs The blood flow in brain tissue is mainly maintained by blood pressure. If strong antihypertensive drugs are used or the dosage of antihypertensive drugs is too large, the blood pressure will suddenly drop significantly. This affects the blood supply to the brain, causing slow blood flow in the brain and promoting the formation of cerebral thrombosis. You should avoid taking large doses of antihypertensive drugs before going to bed. After people fall asleep, most of the body is in a resting state, metabolism slows down, and blood pressure is relatively low. If you take a large amount of antihypertensive drugs, your blood pressure will inevitably be lowered, and the blood supply to important organs such as the heart, brain, and kidneys will be reduced, and the blood flow will be slow. Blood viscosity increases, blood stasis accumulates in the cerebral blood vessels, forming thrombus, and cerebrovascular disease occurs.

(2) Sedatives Some strong sedatives, such as chlorpromazine, chloral hydrate, magnesium sulfate, etc., can also cause blood pressure to drop sharply in a short period of time, causing ischemia and hypoxia in brain tissue. , leading to cerebral thrombosis.

(3) Hemostatic drugs. Generally, middle-aged and elderly people are often accompanied by vascular sclerosis, high blood lipids, and increased blood viscosity. If large doses of hemostatic drugs are used, such as Anluoxue, hemostatic aromatic acid, etc., they can increase the coagulability of the blood, slow the blood, and promote the formation of cerebral thrombosis.

(4) Diuretics: Diuretics used by middle-aged and elderly people, such as furosemide, hydrochlorothiazide, etc., due to large amounts of diuresis, excessive water loss, blood concentration, increased viscosity, and easy formation of Cerebral thrombosis; in the same way, excessive use of diaphoretic and antipyretic agents such as aspirin and compound aminopyrine during fever, or excessive use of diaphoretic antiperspirants such as Chinese ephedra and cassia twig, can cause excessive sweating and even water loss. Too much can lead to cerebrovascular disease.

(5) Contraceptive pills It is reported that some contraceptive pills can increase blood coagulation. The incidence of cerebrovascular disease in those taking oral contraceptive pills is 5 to 8 times higher than that in the control group. The time from taking the pill to the onset of the disease is as short as a few days and as long as 5 years. Therefore, during the process of taking contraceptive pills, blood pressure and blood pressure should be checked frequently. If abnormality is found in rheological examination, the drug should be discontinued. For those with a tendency of cerebral thrombosis, contraceptive pills should be discontinued.

(6) Antiarrhythmic drugs taken in excessive doses or at too fast an intravenous infusion rate can cause blood pressure to drop, conduction block, bradycardia, and promote cerebral thrombosis.

It can be seen that cerebrovascular disease caused by drugs cannot be ignored, and the elderly should be more cautious when using the above drugs. Generally, you should start with a small dose and gradually increase the dose. Avoid sudden drops in blood pressure, strong sedation, large amounts of diuresis, excessive sweating, and excessive use of hemostatic agents to prevent drug-induced cerebrovascular disease.

What are the advantages of MRI in diagnosing acute cerebrovascular disease compared with head CT?

(1) MRI mainly relies on hydrogen atomic nuclei imaging and can detect edema in the infarct area. It is more sensitive to changes, so it can show the infarct earlier. Generally, an MRI examination can be performed 1 to 2 hours after the onset of the disease, which will reveal the characteristics of the lesion with a strong signal. However, CT often requires 24 hours to develop, and premature examination is often negative.

(2) MRI is better than CT in showing lacunar infarction. CT can only perform cross-sectional scanning, while MRI can display lesions not only on the cross-sectional plane, but also on the sagittal and coronal planes. Therefore, CT is often unable to detect lacunar cerebral infarctions below 10 mm. MRI can display lesions less than 2 mm in diameter.

(3) CT is difficult to display posterior cranial fossa, especially brainstem lesions, and MRI is of great significance in examining cerebral infarction in the posterior cranial fossa, which just fills in the shortcomings of CT.

(4) For lesions with cerebral hemorrhage and infarction, MRI is more sensitive than CT.

(5) In the subacute stage of cerebral hemorrhage, CT shows iso- or low-density shadows, making diagnosis difficult; while MRI can show the characteristic shape of hematoma.

(6) For cerebral aneurysms and vascular malformations, MRI diagnosis is higher than CT. CT requires the injection of iodine to display, while MRI can not only clearly display the location and scope of the lesion, but also does not require the injection of drugs, which brings great convenience to those allergic to the contrast agent.

(7) CT uses X-ray imaging, which may cause certain damage to the human body. MRI uses electromagnetic fields for imaging, which does not cause adverse reactions to the human body.

In short, it can be considered that MRI is more sensitive in diagnosing ischemic cerebrovascular disease. It not only detects lesions early, but also diagnoses small infarcts, especially brainstem and cerebellar infarcts. , which cannot be replaced by CT.

However, CT is more sensitive in diagnosing hemorrhagic cerebrovascular disease, saves time and money, and is especially suitable for patients with impaired consciousness.

Cerebrovascular patients often develop bacterial or fungal infections due to reduced saliva secretion, thick saliva or facial paralysis residue that easily stays in the cheeks on the affected side, leading to complications such as oral ulcers, mumps, and upper respiratory tract infections. Therefore, you should pay attention to oral hygiene and strengthen oral care.

Nursing method: Remove oral secretions promptly, and use cold boiled water, 1% hydrogen peroxide, 0.2% nitrofurazone solution or 3% boric acid solution for oral scrubbing. At the same time, pay attention to the cleaning of the buccal mucosa on the paralyzed side to avoid oral infection caused by food residue retention.

If there is oral mucosal erosion, you can apply 1% gentian violet, or use ice boron powder or tin powder. If your lips are chapped, you can apply glycerin or anti-crack oil. If there are flakes or spots of white film on the oral mucosa and tongue, it indicates a fungal infection. You can gently wipe off the foam to reveal the moist and flushed erosion surface, and then apply nystatin glycerin or nystatin sesame oil. You can make this medicine yourself by pressing nystatin tablets into powder and mixing them with glycerin or sesame oil.

Patients with dentures should take them off every time they eat, brush them clean with a toothbrush, and put them back on after the mouth is clean to avoid catching food.

People who have difficulty swallowing and have an indwelling nasogastric tube must also pay attention to oral hygiene. Generally, their mouths should be cleaned twice a day.

Coma is a severe stage of consciousness disorder and a sign of a serious condition. It manifests as a loss of normal responses to various stimuli. Most patients are accompanied by urinary and fecal incontinence, which is the stage where various complications are most likely to occur. Therefore, active treatment and careful care are an important part of turning the patient from crisis to safety. The following points should be done in caring for cerebrovascular patients:

(1) Absolutely stay in bed and reduce moving, especially for patients with hemorrhagic cerebrovascular disease. The head should be slightly raised, and the head should be turned to the side when vomiting. position to prevent aspiration pneumonia.

(2) Comatose patients should use bed rails to prevent them from falling off the bed, cut their nails short, and remove hair clips to avoid damaging the skin. Remove dentures to prevent them from accidentally entering the trachea or being swallowed into the stomach.

(3) Closely observe changes in the condition, especially changes in consciousness, pupils, respiration, pulse, and blood pressure. For example, a patient's blood pressure rises sharply, his pulse is slow, and his breathing deepens, which are mostly early symptoms of cerebral herniation; bilateral pupils are dilated and the light response disappears, indicating a very serious condition. Nursing staff should report the condition to the doctor promptly so that rescue measures can be taken.

(4) Comatose patients should pay attention to keeping the respiratory tract open and suction sputum in time. Since cerebrovascular patients have varying degrees of cerebral hypoxia, oxygen inhalation should be given and the nasal cannula should be kept unobstructed.

(5) Take good oral care. Comatose patients often open their mouths to breathe. They can often clean their mouths with saline cotton balls, 2 to 3 times a day, and apply two layers of wet gauze to the mouth and nose. Moisten the inhaled air and use paraffin oil for those with chapped lips.

(6) The eyelids of comatose patients are often incompletely closed, and the cornea may be ulcerated due to dryness. They can be protected by regular flushing of eye drops or ?F8 ED? eye ointment, or they can be covered with sterile gauze soaked in normal saline. Eyes.

(7) In order to ensure the nutritional and water intake of comatose patients, nasogastric feeding can be given, that is, the nasal tube is inserted into the stomach. Patients with cerebral hemorrhage can be given nasogastric feeding after 2 to 3 days, and the daily fluid intake and output should be recorded to understand whether the fluid is balanced. The amount of fluid injected in the first few days should be controlled at about 2000 ml to avoid aggravating cerebral edema.

(8) Stool should be kept unobstructed. Patients with urinary retention or incontinence should have an indwelling urinary catheter, and at the same time, avoid urine soaking into the skin. People with constipation should defecate regularly, but patients with cerebral hemorrhage in the acute stage and with increased intracranial pressure should not use enemas.

(9) Pay attention to skin care, always keep the skin clean, turn over regularly and change positions, use 50% alcohol, talcum powder?F8ED? to ??rub the skin and massage the pressured parts to prevent the occurrence of bedsores.

(10) For those suffering from high fever and coma, an ice cap or ice pack should be applied to the head, or a cold towel should be used to cool down the head. Cooling can reduce the brain's basal metabolism, reduce brain oxygen consumption, and reduce intracranial pressure.

After the occurrence of cerebrovascular disease, in addition to promptly consulting a doctor for diagnosis and treatment, home care is also an important part of the treatment and cannot be ignored.

So, what should be done in home care?

(1) Family members should patiently take care of the patient in various ways and actively help the patient build confidence in overcoming the disease. Stroke patients often appear irritable or pessimistic and disappointed. Families should often enlighten the patients to make them cheerful, eliminate worries, and maintain an optimistic mood, so as to facilitate the improvement of the condition.

(2) Pay attention to your diet to ensure adequate calorie supply. Stroke patients should eat light, easily digestible and nutritious food, including more fresh vegetables, fruits and soy products. Avoid eating foods that are too salty, too sweet, spicy, greasy, etc., and you should always keep your bowels unobstructed.

(3) Change positions frequently to prevent complications such as bedsores and pneumonia. Family members should encourage or help the patient to change positions frequently to avoid pressure sores on the affected limb for too long. Generally, you can turn over every 2 to 3 hours. You should also pay attention to keeping your skin and bedding dry and clean. When the skin has mild ulceration, you can use talcum powder or apply some gentian violet lotion to treat it. If the ulcer is severe or the area becomes black, a balloon can be placed on the affected area to avoid local pressure, and you should pay attention to applying medicine to help it recover as soon as possible.

Frequent changing of positions can also help cough up phlegm and improve blood circulation in the lungs, so it can effectively prevent the occurrence of pneumonia.

(4) Strengthen language training and passively move the affected limb to promote functional recovery. When the condition is stable, family members should help the patient with language training and passive movement of the affected limb as soon as possible. You can also use the unaffected limb to help the affected limb move to prevent muscle atrophy or joint ankylosis in the paralyzed limb, so as to promote the early recovery of speech and motor functions.

(5) Observe the changes in the condition carefully. When you find that the patient's consciousness, language or function of the affected limb are getting worse, ask a doctor for treatment in time.

How to control blood pressure to prevent cerebrovascular disease?

Hypertensive diseases mostly progress slowly, and the damage to the heart, brain, kidneys and blood vessels is "step by step", and the degree of danger is Increases in proportion to the level of high blood pressure. According to the Shanghai Hypertension Institute's observation of the natural history of essential hypertension, the average course from the discovery of hypertension to cerebrovascular disease is about 15 years, but many high blood pressure levels have also been found. Although patients with high blood pressure have been ill for 20 to 30 years or longer, they will not necessarily die due to high blood pressure complicated by cerebrovascular disease. This is the result of long-term prevention and treatment. Therefore, for the vast majority of patients with hypertension, long-term treatment and control of high blood pressure must be adhered to. Occasional treatment will cause repeated fluctuations in blood pressure to increase the damage to cerebral blood vessels. Some people do not take serious treatment because they have few symptoms. For these patients, the condition changes will develop quietly, gradually escalate, and cause cardiovascular and cerebrovascular diseases. Some people abroad choose to treat patients with high blood pressure with a diastolic blood pressure greater than 105mmHg. The conditions are the same. , divided into two groups, one group received antihypertensive treatment, and the other did not take drug treatment. After 3 years of follow-up, only one person in the treatment group developed cerebrovascular disease, and 11 people in the non-treatment group developed cerebrovascular disease. It was also found that the untreated group was 4 times more likely to develop cerebrovascular disease than the treated group. Therefore, for those who have been diagnosed with hypertension, they should realize that treatment will be long-term, even lifelong. So, how to carry out long-term treatment? Treatment includes both drug and non-drug methods. Drugs mainly refer to various antihypertensive drugs. Non-drug therapies include: low-salt diet, obesity control, weight loss, stopping smoking, reducing alcohol consumption, and avoiding agitation. wait. Physical therapy (such as Qigong, Tai Chi, etc.) and integrated traditional Chinese and Western medicine treatments are all ideal methods.

Under what circumstances is antihypertensive drug treatment required? Generally, drug treatment is started when the diastolic blood pressure is above 12 0kPa (90mmHg). It should be understood that treatment of high blood pressure only achieves control but does not cure it. It is wrong to think that the disease is cured once the blood pressure measurement drops to normal. For long-term treatment, it is best to take drugs under the guidance of a doctor, and it is better to use a combination of multiple drugs in small doses. If one drug is not effective, another drug should be replaced. The treatment method can be gradually upgraded until the blood pressure is controlled to normal or close to normal. Commonly used drugs are drugs with mild effects and few side effects, such as thiazide diuretics or beta-adrenergic blockers (such as propranolol). If you want to upgrade, use diuretics plus beta-blockers, or add vasodilators. Such as nifedipine, hydralazine, etc. Some compound antihypertensive drugs, such as Compound Antihypertensive Qi, Zhenju Antihypertensive Tablets, Compound Apocynum Tablets, etc., have mild antihypertensive effects and few side effects, and are more suitable for patients with stage I or II hypertension.

When blood pressure has been basically controlled after antihypertensive treatment, a maintenance dose should be used to consolidate the efficacy, and the drug dosage and frequency of medication should be appropriately adjusted according to the blood pressure level. For example, the use of two drugs is reduced to one. Changed from 3 times a day to 2 times a day. However, do not stop treatment casually or stop eating, as this may cause blood pressure to fluctuate or even rebound, affecting cerebral blood flow. When blood pressure rises or due to stress and excitement, the weather turns cold, and the blood vessels constrict, the drug dosage can be increased appropriately. When blood pressure has normalized or the weather has turned hot and blood vessels have dilated, the dose of medication can be appropriately reduced. Some people may take medication every other day to consolidate the effect. For elderly patients with hypertension, who often have arteriosclerosis and are more sensitive to drugs, they should be more cautious when using antihypertensive drugs. The dose should not be too large, otherwise the blood pressure will drop too fast, which may cause orthostatic hypotension and affect the brain. blood flow and risk of ischemic stroke.

In order to reduce the risk of cerebrovascular disease caused by high blood pressure, long-term control of high blood pressure will bring many benefits to patients and is also an effective measure to prevent cerebrovascular disease. However, it is not easy to persist in taking medication for a long time. According to rough statistics, only about 25% of patients with high blood pressure can adhere to long-term treatment, and only about 25% of patients are treated but not completely controlled, and the treatment is unsatisfactory. Therefore, in order to effectively control high blood pressure, in addition to patient persistence, doctors must A reasonable treatment plan is also very important. In short, we should change the incorrect view that although blood pressure is high, there are no symptoms and we should give up treatment. Instead, we should face science and carry out long-term treatment.