老年自发性脑出血患者血肿变化与阻塞性睡眠呼吸暂停低通气综合征的相关性

目的分析老年自发性脑出血血肿变化与阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的相关性。方法收集自发性脑出血患者156例,其中有OSAHS的自发性脑出血患者88例为试验组,无OSAHS的自发性脑出血患者68例为空白对照组。在患者入院第24h及第4天采用CT或MRI测量脑血肿体积,检测患者脑血肿的变化。结果入院第4天相对血肿体积指数(RHI),试验组为2.18±0.81,明显高于对照组的1.72±0.51(P=0.02)。另外,不同程度OSAHS患者的脑血肿体积及血肿变化的结果表明,入院第24h和第4天时,随着OSAHS严重程度的增加,脑出血患者的脑血肿程度增加(P0.05)。且重度OSAHS并发症患者的脑血肿体积增加更显著(P=0.002)。血肿变化指数与OSAHS程度呈明显正相关(r=0.687,P=0.000)。结论伴OSAHS的老年自发性脑出血患者血肿的体积变化程度高于无OSAHS者,且OSAHS严重程度与脑血肿的变化程度呈正相关。     

铁蛋白在高血压脑出血后血肿周围脑水肿中的作用及机制研究

目的探讨血清铁蛋白与高血压脑出血后血肿周围脑水肿的关系,并分析其在血肿周围脑水肿发生中的作用。方法采集2012-05—2013-11于我院住院治疗的38例高血压脑出血患者的临床资料和实验室数据,所有患者均在入院时及入院3~4d后行血清铁蛋白及头颅CT检查,计算入院时及入院3~4d后血肿体积、脑水肿总体积及经校正后的相对水肿体积,采用Spearman相关分析相对血肿周围脑水肿体积与血清铁蛋白的关系。结果与入院当天比较,入院第3~4天后血肿体积增加19%,但差异无统计学意义(P0.05);脑水肿体积增大71%,差异有统计学意义(P0.05)。血肿周围脑水肿体积与血肿体积的比值即相对水肿体积增加1.13倍。入院当天,患者血清铁蛋白水平和相对水肿大小间无明显相关性(P0.05);入院后第3~4天时相对水肿体积与血清铁蛋白呈正相关(r=0.67,P=0.006)。结论血清铁蛋白是反映高血压脑出血后血肿周围脑水肿程度的一个重要指标,其在血肿周围继发性脑水肿的发生中起重要作用。     

脑出血后水肿体积相关危险因素分析

目的探讨脑出血后周围脑水肿严重程度与相关危险因素的关系。方法前瞻性分析河南科技大学附属黄河三门峡医院2013-01—2015-12住院诊断为自发性脑出血患者共168例。收集上述病人的基本资料,包括姓名、性别、年龄、体重指数、吸烟史、出血部位、高血压史、糖尿病史、有无合并腔隙性梗死、有无合并脑白质疏松及严重程度,实验室指标包括血脂、CRP、胱抑素C。脑出血住院患者于发病当天、发病后24h、72h、7d和14d进行头部CT扫描,计算脑出血血肿体积及周围水肿体积,分析脑出血周围水肿体积的严重程度与相关危险因素的关系。结果 (1)168例入选的脑出血患者,发病当天脑出血平均体积(16.22±5.13)mL,随着发病时间延长,脑血肿体积逐渐缩小,水肿指数随时间延长逐渐增加,7d时达最高峰,14d下降明显。(2)对发病1周时水肿指数相关因素进行单因素分析结果显示:体重指数(P=0.004)、高血压史及其程度(P=0.021)、糖尿病史(P=0.039)、CRP(P=0.018)、脑白质病变(P=0.008)对脑出血1周时幕上脑出血后周围水肿指数影响差异具有统计学意义(P0.05)。结论 (1)脑出血后血肿周周围水肿严重程度随时间进展逐渐增加,7d时达最高峰,之后逐渐下降。(2)脑出血1周时周围水肿严重程度与体质量指数、高血压病史、糖尿病病史、脑白质疏松严重程度、CRP相关。     

早期强化降压治疗与高血压脑出血血肿、血肿周围水肿的关系

目的探讨早期强化降压治疗与高血压脑出血(HICH)血肿、血肿周围水肿的关系。方法将50例HICH患者随机分为强化降压组(23例)及对照组(27例)。所有患者采用常规治疗,强化降压组患者加用氨氯地平10 mg/d。入院时及入院24 h后各进行一次头颅CT检查,比较两组的血肿及血肿周围水肿体积。结果入院时强化降压组及对照组SBP、血肿体积及周围水肿体积差异均无统计学意义(均P0.05)。与对照组比较,强化降压组24 h SBP、血肿及血肿周围水肿体积显著缩小(均P0.05)。Pearson相关分析显示,SBP与血肿、血肿周围水肿体积呈正相关(r=0.291,P=0.040;r=0.312,P=0.027)。结论早期强化降压治疗可减少血肿、血肿周围水肿体积。     

无创性脑电阻抗测定在脑出血患者脑水肿监测中的应用

目的 应用无创性脑电阻抗测定探讨急性脑出血患者脑水肿的变化规律及意义.方法 分别检测200名健康志愿者和78例脑出血患者的脑电阻抗扰动系数及其动态变化,通过多媒体图像分析系统计算头颅CT上血肿和血肿周围水肿的体积,并进行相关分析.结果 ①健康志愿者左、右大脑半球扰动系数分别为(7.98±0.95)和(8.02±0.71),基本对称(P＞0.05).性别、年龄及3～6 h连续检测前后对其无明显影响(P＞0.05).②脑出血患者的总体检测阳性率为73.1%.血肿位于基底节区时阳性率最高(83.3%),病灶体积大于20 ml者阳性率(80.0%～88.9%)明显高于体积小于20 ml者(48.1%).③脑出血患者血肿侧扰动系数由低于血肿对侧至逐渐升高并超过血肿对侧,这个"交叉"时间平均为起病后(19.67±11.52)h,在该时间点后血肿周围水肿体积较前明显增大(P＜0.05),同时扰动系数亦明显升高(P＜0.01).④起病24h内的血肿侧扰动系数变化与血肿体积及血肿周围组织水肿体积无相关关系(P＞0.05);而病后3 d的血肿侧扰动系数变化与血肿周围组织水肿体积具有显著正相关关系(r=0.5977,P＜0.01).结论 脑电阻抗测定可较敏感地反映脑出血患者脑水肿的变化,扰动系数越高,则提示脑水肿越重.病灶位于基底节区时检测阳性率最高.该方法为临床上进行动态、床旁连续无创性脑水肿监测提供了新的有意义的手段.     

脑出血患者血肿周围脑组织中基质金属蛋白酶-9及其抑制剂的表达

目的 探讨基质金属蛋白酶-9(MMP-9)及其抑制剂在高血压脑出血患者血肿周围脑组织中的表达规律,及其在早期脑水肿发生中的作用.方法应用免疫组织化学方法对高血压性脑出血患者出血后24h内血肿周围脑组织中MMP-9及基质金属蛋白酶组织抑制因子-1(TIMP-1)的表达进行测定,根据患者头部CT扫描计算血肿周围水肿体积.结果高血压性脑出血患者血肿周围有明显的脑水肿发生,对照组中未发现明显的MMP-9和TIMP-1阳性表达,而在脑出血组则呈现明显表达(P<0.01),而且MMP-9的表达明显高于TIMP-1(P<0.01).结论脑出血后血肿周围脑组织中MMP-9表达显著上调,打破了生理状态下与TIMP-1的平衡,可能参与了出血后继发性脑水肿的发生.     

银杏叶提取物(GBE)治疗高血压脑出血周围水肿的临床观察

目的观察银杏叶提取物(GBE)对高血压脑出血引起的脑水肿的治疗作用。方法高血压脑出血患者68例,随机分为治疗组和对照组,对照组使用甘露醇、呋塞米常规脱水治疗,治疗组在对照组的基础上,在出血后48h起给予GBE20mL静滴,连续14d,治疗第3天、7天、14天行头颅CT检查,测量脑血肿体积、脑水肿体积并计算水肿指数。结果治疗组脑水肿体积较对照组显著减小,水肿指数显著降低,同时脑血肿无增大。结论 GBE对减轻高血压脑出血周围水肿有治疗效果,且急性期使用安全。     

自发性脑出血后脑水肿形成的影响因素研究

目的研究自发性脑出血后脑水肿形成和变化的影响因素。方法回顾性研究216例发病24h内入院的脑出血患者的临床资料和头颅CT片,测量血肿和周围水肿的大小,分析各临床资料与脑水肿的关系。结果脑血肿体积、扫描时间与水肿体积的相关系数为0．680（P〈0．01）,0．099（P=0．073）,血肿体积、扫描时间、血肿部位对水肿体积的影响及白质和灰质水肿宽度的差异有统计学意义（P〈0．01）。结论脑出血后血肿体积对水肿的体积影响最大,其次为出血时间和出血部位。     

脑出血灶周水肿相关因素的临床分析

目的 从临床角度探讨一般因素与灶周水肿的相关性.方法 对80例符合标准的脑出血患者在入院时和发病后24h、72h、7d、14d分别进行神功能评分、头颅CT扫描,测量血肿、水肿体积,设置变量,在单因素分析的基础上进行多因素回归分析、方差分析.结果 血肿大小、发病后持续的时间、出血部位、神经功能缺损程度、高血压均对脑出血后灶周水肿有不同程度的影响.入院时神经功能缺损程度、血肿大小、高血压的程度与灶周水肿呈正相关.灶周水肿在发病后缓慢增加,至72h到峰顶,此后开始缓慢下降.结论 脑出血后灶周水肿与多种因素有关,早期应根据神经功能缺损程度、有无高血压史及血压增高程度、病程长短、血肿大小及部位等因素判断灶周水肿情况,选择防治脑水肿的手段及方法,同时注意脑水肿发生的高峰时间段.     

不同降血压药物预防高血压脑出血后早期血肿扩大的研究

目的 探讨不同降血压药物对高血压脑出血后患者血肿体积及神经功能恢复的影响,为临床上脑出血后血压控制的药物选择提供参考依据. 方法 筛选出自2010年1月至2012年1月在马鞍山市十七冶医院及南京医科大学附属脑科医院神经内科住院的93例高血压脑出血患者,按随机数字表法分为尼莫地平组、乌拉地尔组及对照组.对3组患者入院时、入院后24 h、入院后72 h血肿体积以及出院时神经功能缺损程度评分进行记录. 结果 入院后24 h、72 h时,3组患者血肿体积较入院时均明显扩大,但差异无统计学意义(P＞0.05);尼莫地平组与对照组、乌拉地尔组相比扩大较小,差异有统计学意义(P=-0.026,P=0.019;P=0.016,P=0.022).不同预后等级在3组患者间分布差异有统计学意义(P＜0.05),通过平均秩次(对照组54.38,乌拉地尔组51.19,尼莫地平组35.53)判断,尼莫地平组与对照组、乌拉地尔组相比,痊愈率高、无效率低,预后明显最好. 结论 尼莫地平作为高血压脑出血后预防早期血肿扩大的药物使用时,对预防高血压性脑出血早期血肿扩大及改善神经功能预后要明显优于乌拉地尔,可作为首选药物.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Effect of high simple dose of cisplatinum and of radiation on the brain of rabbit

Abstract

In former studies of intracarotid and intravenous administration of cisplatinum, separate and combined with brain irradiation, we found no cerebral damage. In this study! gradually increasing high doses (above the therapeutic ones) of cisplatinum were administered intravenously to one series of rabbits arid increasing high amounts of irradiation (above the therapeutic amounts) were given to another series. Although the rabbits that received highest doses of irradiation developed areas of alopecia and skin ulcers on the head! the general clinical and histopathologic examination of the rabbits brains in both series was normal. The purpose of this study was to establish the effects of high doses of intravenous cisplatinum and irradiation on the rabbits brains. [Neural Res 1997; 19: 216–218]