Wada试验在癫痫外科术前评估中的应用

1949年日本神经科医师Juhn Atsushi Wada博士在治疗精神分裂人格障碍患者时发现颈内动脉注射异戊巴比妥麻醉一侧大脑半球可以鉴定出患者的语言功能优势半球,之后Wada博士和Rasmussen博士在癫痫患者术前评估时也使用此方法为患者语言优势半球定侧,取得了非常好的临床效果,此后颈动脉内注射异戊巴比妥的步骤(Intracarotid Amobarbital Procedure,IAP)就常规用于难治性癫痫的术前评估以定位语言优势半球,后IAP又以其发明者Wada博士的名字为名,称为Wada试验[1].     

人类语言和记忆优势的颈内动脉异丙酚试验

目的:评估在韦达试验中异丙酚作为异戊巴比妥替代药物的有效性。方法:从123例准备进行神经外科治疗而行韦达试验作为术前评估的患者中,选择67例右利手的患者进行分析。12例进行异丙酚测试,55例进行异戊巴比妥测试。韦达试验的试验条件是在注射药物后,对于肌力达到徒手肌力试验(MMT)3级(T3/5)和5级(T5/5)的恢复时间,首次言语反应(Tverb)和手势反应(Tnon-verb)的出现时间,在两组间进行对比。在韦达试验期间,对脑电图(EEG)背景活性进行能频分析,并对3例病例多形性慢活动时间和空间分布进行比较。结果:注射异丙酚后证实全部12例患者均有语言…     

依托咪酯语言及记忆评估的Wada试验在癫痫外科运动、语言和记忆评估中的初步应用

目的 依托咪酯语言及记忆评估的Wada试验(etomidate speech and memory-Wada testing, eSAM-Wada)在我国还未见相关报道,而血管超选下eSAM-Wada试验国内外还未见报道。探讨eSAM-Wada试验的安全性及其对运动、语言和记忆功能评估的效果。 方法 本文通过回顾性分析我中心5例行eSAM-Wada试验的难治性癫痫患者,观察操作过程中患者运动、语言及记忆功能的改变和术中的不良反应。结果：5例患者均可完成整个评估流程,智商偏低的患者仍可配合完成。2例患者完成血管超选下的eSAM-Wada试验。3例左利手患者中,2例(66.7%)语言优势侧仍位于左侧半球,2例(100%)右利手患者语言优势侧均位于左侧半球。4例左侧半球病变的患者,2例(50%)记忆的优势侧仍位于左侧颞叶,1例(25%)记忆为双侧优势,1例(25%)记忆优势侧转移至右侧颞叶。2例患者进行了后续切除性手术,1例患者进行了立体定向脑电图电极引导下热凝毁损术,1例患者出现左下肢一过性无力,运动、语言及记忆功能改变均与eSAM-Wada试验预测结果相符。2例患者(40%)出现癫痫发作可能与操作流程中依托咪酯静脉推注给药速度过快有关,后给药速度改为>30秒后,患者再无癫痫发作。不良反应需要进一步观察。结论：eSAM-Wada试验是全面评估运动、语言及记忆评估较为可靠且相对安全的方法。与血管超选技术结合,可以更加有效的指导涉及功能区的颅脑外科手术治疗。由于病例数量有限,结论尚需进一步观察。     

Wada试验记忆的不对称预测颞叶切除术预后的局限性

背景:颈内动脉异戊巴比妥(W ada)试验能用于评价前颞叶切除术(A TL)前的半球记忆能力。大部分患者在拟切除侧注射异戊巴比妥后显示出较好的记忆能力[预期的不对称(EA)],但是,有一小部分患者却在对侧注射后显示出较好的记忆能力[意外的不对称(U A)]。在小样本的病例系列研究中,W     

功能性MRI可预测颞叶切除术后的记忆力

颞叶切除术是一种药物难治性颞叶癫痫(TLE)的有效治疗方法,但可能并发遗忘综合征。因此,术前评估手术的风险收益比非常必要。颈总动脉窦内异戊巴比妥试验(IAT)是目前使用最广泛的评估术前记忆优势侧的方法,但存在相对的侵袭性。过去10年,功能性MRI(fMRI)已经体现出对少数患者语言优势侧和记忆优势侧的判定结果与IAT技术一致。本研究对比了记忆编码过程中的fMRI和测试记忆优势侧的IAT结果,并且评价了记忆编码过程中的fMRI对术后记忆功能结局的预测价值。经颞叶切除术前评估的35例难治性TLE患者和30例正常志愿者,在1.5TfMRI扫描1…     

左侧颞叶的非典型语言皮层与双侧语言的关系

背景:颈动脉内异戊巴比妥注射(IA P)被广泛应用于癫痫手术前,前瞻性评估语言优势半球和记忆功能,然而,语言测定最常用的还是大脑皮质刺激的方法。目的:采用大脑皮质刺激的方法,研究具有双侧语言中枢(BL)患者的左侧颞叶语言皮质特性,同时与只有左侧语言中枢优势(LD)的患者做对照。方法:回顾每例患者的语言检测,Ⅰ组包括10例BL患者,Ⅱ组包括与之相匹配的10例LD对照者。每个刺激试验包括对命名、自动讲话、阅读、复述和理解的简单测试,采用一系列包括理解、复述和命名的错误来确定颞叶的主要语言区。结果:语言检测显示:Ⅰ组患者具有两个明…     

颅内肿瘤患者记忆损害的评价及术后随访

目的 评价各种颅内肿瘤及肿瘤切除术对患者记忆功能的影响.方法 运用4种记忆量表对58例颅内肿瘤患者进行记忆功能的评价,包括即刻记忆、延迟记忆、线索记忆、长时记忆,其中35例进行术后随访.另选18名正常人作为正常对照组.结果 凸面脑外肿瘤患者存在延迟记忆和长时记忆损害(P<0.05).而脑内肿瘤患者术前即刻记忆,延迟记忆,长时记忆均存在损害,尤其是长时记忆损害(P<0.01),较为严重;优势半球肿瘤患者各型记忆损害均较副侧半球肿瘤患者严重;脑内肿瘤患者术后较术前长时记忆能力下降(P<0.01);而鞍区肿瘤患者术前不存在记忆损害,经鼻蝶鞍区肿瘤切除术不影响患者记忆功能.结论 颅内肿瘤能够引起记忆损害.不同部位不同性质颅内肿瘤引起的记忆损害存在差异.脑内肿瘤要比脑外肿瘤严重,优势半球要比副侧半球严重,手术肿瘤切除术使长时记忆功能下降.     

Wada作为刺激类型依赖物时记忆功能的临床相关性

目的:本研究旨在探讨难治性颞叶内侧癫痫(M TLE)患者在进行W ada试验或颈内动脉给予异戊巴比妥(IAP)时,不同类型的记忆刺激能否提供不同的信息。方法:89例适合外科手术的确诊M TLE患者,在实施IAP手术之前选择性地对其左侧大脑半球语言优势区进行语言及双重编码刺激以评估其记忆能力。结果:行IAP后无论大脑半球的哪一侧损伤,左侧大脑半球的记忆能力显著高于右侧大脑半球。该现象可以被解释为,左侧大脑半球的优势是编码所有刺激信号,而右侧大脑半球的功能局限于编码语言表达的刺激信号。更为重要的是,该现象表明在损伤部位的同侧进行…     

经颅磁刺激技术在大脑语言优势半球定侧中的价值

目的 探讨重复经颅磁刺激(rTMS)对于难治性癫痫患者术前大脑半球语言功能区定位的可靠程度,预测术后发生语言功能障碍的风险性.方法 对7例难治性癫痫患者,依据国际脑电10/20电极安装系统在各患者双侧大脑半球头皮表面标记各刺激点.嘱患者行自发言语作业时,在各刺激点上给予高频、阈上强度的rTMS,同时观察rTMS对言语输出的影响.结果 7例患者均被rTMS诱导出言语中断.诱导位点在F8(F7)/T4(T3)之间的颞前区,大致位于Broca区头皮投影区附近.结合其他评估结果,最终有5例患者接受手术治疗,术后语言功能无损害;所有患者评估中未见癫痫发作.结论 高频rTMS对难治性癫痫患者语言优势半球的术前定侧评估是较为安全、可靠的,有望取代侵入性的Wada试验.     

脑损伤或颞叶内侧癫痫患者语言特异性皮层的重构

目的:在伴有左侧半球占位性损伤和颞叶内侧硬化(M TS)所致左侧颞叶癫痫的患者中,采用脑磁图(M EG)研究语言理解功能的大脑活动形式,并且评价半球内和跨半球的语言可塑性是否可以按照功能损伤类型或位置的不同而分类。方法:选取21例M TS患者和23例通过单个词语识别检查进行术前语言评估的脑损伤患者,采用共记录M EG配合结构M R I扫描确定脑磁活动灶的解剖定位,语言偏侧指数根据每侧半球脑磁活动灶数目计算,发现语言特异性活动的位置与W ernicke区相近或重叠。结果:M TS患者较脑损伤患者的不典型语言偏侧性发生率高(43%vs13%)。大多数…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.