发作性偏头痛慢性转化的影响因素

目的探讨发作性偏头痛慢性转化的影响因素。方法收集126例发作性偏头痛(EM)和50例慢性偏头痛(CM)患者的临床资料,并进行比较。采用Logistic多元回归方法分析偏头痛慢性转化的独立危险因素。结果 EM组超重、女性比率,年龄及体重指数(BMI)显著低于CM组(均P0.01),受教育年限显著高于CM组(P0.05)。两组间起病年龄、初发持续时间、初发疼痛程度及有先兆的比率差异无统计学意义(均P0.05)。EM组初发频率、病程、急性期止痛药物过度使用比率以及焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数评分均显著低于CM组(P0.05~0.01)。BMI(OR=1.159,95%CI:1.004~1.338)、SAS(OR=3.100,95%CI:1.360~7.069)、SDS(OR=3.390,95%CI:1.117~10.287)及急性期止痛药物过度使用(OR=2.714,95%CI:1.022~7.204)是EM慢性转化的独立危险因素(均P0.05)。结论伴有抑郁/焦虑、止痛药物过度使用和超重是EM慢性转化的独立危险因素。     

甲氧氯普胺治疗偏头痛疗效的Meta分析

目的探讨甲氧氯普胺治疗偏头痛的疗效。方法检索1970年01月～2011年06月MED-LINE、EMbase、ScienceDirect、Cochrane临床对照试验资料库(CCTR),以及国内的维普、CBM、CNKI数据库中关于甲氧氯普胺治疗偏头痛的随机对照研究的文献,按纳入、排除标准选择文献,并采用RevMan4.2软件进行Meta分析。结果共纳入16项随机对照研究,其中甲氧氯普胺治疗者985例,安慰剂对照者267例,其他药物治疗者816例。Meta分析显示,甲氧氯普胺治疗偏头痛的缓解率明显高于安慰剂治疗(OR=3.02,95%CI:2.12～4.30,P<0.001);但与其他药物治疗的相比差异无统计学意义(OR=1.14,95%CI:0.72～1.82,P=0.57);单用甲氧氯普胺治疗偏头痛的缓解率与使用其他药物治疗相比差异无统计学意义(OR=0.93,95%CI:0.34～2.53,P=0.89)。甲氧氯普胺治疗偏头痛的不良反应发生率明显低于其他药物治疗(OR=0.58,95%CI:0.44～0.77,P<0.001)。结论采用甲氧氯普胺治疗偏头痛的疗效确切,且不良反应相对较少,可作为治疗偏头痛的备选药物。     

脑白质疏松与卒中复发相关性的meta分析

目的系统评价脑白质疏松在卒中复发风险预测中的价值。方法计算机检索Pub Med、Web of science、Embase及维普、中国生物医学文献数据库、中国知网等数据库截止2019年3月15日收录的关于脑白质疏松及卒中复发关系的文献。提取资料进行质量评价并进行meta分析,利用Begg’s漏斗图和Egger’s检验评估发表偏倚。结果最终纳入33篇文献,共34444例。meta分析显示,当结局指标为任何类型复发性卒中时,中重度组与轻度或无组比较(RR=1. 71,95%CI:1. 44～2. 04),I~2=55. 69%;有脑白质疏松组与无脑白质疏松组比较(RR=1. 79,95%CI:1. 43～2. 25),I~2=56. 26%;连续性分析组(RR=1. 81,95%CI:1. 47～2. 23),I~2=34. 63%。当结局指标为缺血性卒中时,中重度组与轻度或无脑白质疏松组比较(RR=1. 82,95%CI:1. 36～2. 42),I~2=48. 43%;有脑白质疏松组与无脑白质疏松组比较(RR=2. 13,95%CI:1. 37～3. 32),I~2=70. 64%;连续性分析组(RR=2. 01,95%CI:1. 13～3. 58),I~2=69. 78%。亚组分析结果显示脑白质疏松对于远期复发性卒中的预测价值更高。通过Begg’s漏斗图和Egger’s检验,仅当结局指标为任何类型复发性卒中时,中重度组与轻度或无脑白质疏松组比较有显著性发表偏倚,经剪补法校正后仍提示相关性。结论脑白质疏松对于复发性卒中具有预测价值。     

他汀类药物治疗多发性硬化的荟萃分析

目的对他汀类降脂药应用于多发性硬化(MS)患者所获得的疗效及不良反应进行系统评价。方法通过计算机检索PubMed、Cochran Library、Ovid、EMBASE、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库,语种限制为中文和英文,时间均从数据库建库至2014-12,收集有关他汀类药物应用于MS患者治疗效果的随机对照实验研究,应用Cochran协作网推荐的"风险评估工具"对文献质量评估后应用Revman5.1软件对所提取文献资料进行荟萃分析。结果共纳入6个研究合计包含557例复发缓解型MS(RRMS)患者,在应用β干扰素基础上联合应用他汀类药物治疗与单独应用同种β干扰素对照。荟萃分析结果显示,β干扰素联合他汀类药物组在降低患者的年复发率(WMD=-0.17,95%CI:-0.59~0.26,P=0.44)、出现病情复发或进展的患者数目(RR=1.24,95%CI=0.93~1.65,P=0.14;RR=1.31,95%CI:0.73~2.36,P=0.36)、EDSS评分(WMD=-0.21,95%CI:-0.45~0.02,P=0.08),以及MRI新发T2病灶的患者人数(RR=1.41,95%CI:0.82~1.75,P=0.10)、新增T2或增强病灶数目(WMD=0.83,95%CI:-0.3~1.96,P=0.15;WMD=-0.25,95%CI:-0.65~0.14,P=0.21)等与同种β干扰素对照组比较差异均无统计学意义。在安全性方面,两组肌痛的发生率(RR=1.09,95%CI:0.48~2.50,P=0.17),疲劳的发生率(RR=1.06,95%CI:0.51~2.20,P=0.87)以及总的不良反应事件发生率(RR=1.08,95%CI:0.99~1.18,P=0.07)差异均无统计学意义。结论β干扰素联合他汀类药物治疗MS的疗效和安全性与单用同种β干扰素治疗无统计学差异。     

卒中后抑郁障碍与血管性危险因素的相关性

目的 探讨卒中后抑郁障碍与血管性危险因素的相关性.方法 选择在卒中专病门诊连续就诊的资料完整的卒中初诊患者1055例,按有无抑郁障碍分为抑郁组和非抑郁组(对照组)两组.收集并比较两组患者的血管性危险因素.结果 1055例患者中,291例(27.6%)有抑郁障碍.抑郁障碍者的高血压史、心脏病史、高脂血症史、既往卒中史、高血压家族史和心脏病家族史的比例显著高于无抑郁障碍者(P均<0.05),而吸烟史、饮酒史、糖尿病史及卒中家族史无显著统计学差异.抑郁障碍者的血管危险因素个数明显多于无抑郁障碍组(P<0.01).多因素Logistic回归分析显示高血压史(RR 1.615,95%CI 1.135～2.298, P=0.008)、高脂血症史(RR 2.085,95%CI 1.490～2.918, P<0.01)、既往卒中史(RR 1.443,95%CI 1.034～2.014, P=0.031)和心脏病家族史(RR 1.844,95%CI 1.228～2.769, P=0.003)是卒中后抑郁的独立相关因素.结论卒中专病门诊患者的卒中后抑郁障碍患病率高.多种血管性危险因素和其数目是卒中后抑郁障碍的独立危险因素.     

A型肉毒毒素预防性治疗偏头痛有效性及安全性的随机对照试验的meta分析

目的评价A型肉毒毒素预防性治疗偏头痛的有效性和安全性。方法计算机检索PubMed、Embase、Cochrane Library、SinoMed (CBM)、中国知网、万方等数据库中相关随机对照试验(RCT),采用Review manager 5. 3软件对数据进行meta分析。结果共纳入12项RCT,纳入4131例患者。meta分析结果显示,与安慰剂组比较,A型肉毒毒素组在平均每月偏头痛发作频率减少方面无明显差异(MD=-0. 1,95%CI:0. 41-0. 21,P=0. 53)。按偏头痛类型进行亚组分析后结果显示,A型肉毒毒素组在亚组慢性偏头痛组平均每月偏头痛发作频率减少方面优于安慰剂组(MD=-0. 43,95%CI:-0. 70～-0. 17,P=0. 001);而在亚组发作性偏头痛组,A型肉毒毒素组和安慰剂组在每月平均偏头痛发作频率减少方面无明显差异(MD=0. 08,95%CI:-0. 16～0. 33; P=0. 51)。与安慰剂组相比,A型肉毒毒素组平均每月偏头痛天数减少、平均每月急性头痛用药日数减少、生活质量量表评分改善情况等方面均优于安慰剂组(P 0. 05);总不良事件发生率均高于安慰剂组(OR=1. 38,95%CI:1. 20～1. 58; P 0. 00 001),但无严重不良反应发生。结论 A型肉毒毒素能有效地减少慢性偏头痛每月偏头痛发作频率、偏头痛天数和急性头痛用药的时间及改善生活质量,但对发作性偏头痛效果不明显,不良反应可耐受。     

偏头痛慢性转化的临床危险因素分析

目的比较慢性偏头痛(CM)与发作性偏头痛(EM)的病史特征、临床特点等,探究偏头痛慢性转化的危险因素,为其防治提供依据和策略。方法共纳入在中南大学湘雅医院神经内科就诊的CM患者72例及EM患者109例进行回顾性分析。采集患者基本信息,先进行单因素分析,筛选有统计学意义的指标进行相关分析和非条件性多因素logistic回归分析。结果单因素分析发现两组的BMI(P=0.000)、病程(P=0.000)、基线头痛发作频率(P=0.000)、基线头痛持续时间(P=0.037)、匹兹堡睡眠质量指数量表(PSQI,P=0.000)、焦虑自评量表(SAS,P=0.000)及抑郁自评量表(SDS,P=0.001)差异有统计学意义。logistic回归分析显示BMI(OR=1.468,95%CI:1.148～1.876)、病程(OR=1.102,95%CI:1.022～1.188)、基线头痛发作频率(OR=1.461,95%CI:1.247～1.711)、睡眠质量(OR=1.494,95%CI:1.198～1.864)、焦虑状态(OR=1.201,95%CI:1.048～1.376)是偏头痛慢性转化的危险因素。结论控制体重、减少头痛发作频率、缩短病程、改善心境状态与睡眠质量,有可能延缓偏头痛的慢性进展。     

伽玛刀治疗三叉神经痛显效、复发时间及安全性的生存分析

目的探讨影响伽玛刀治疗三叉神经痛患者预后及安全性的相关因素。方法收集行伽玛刀治疗三叉神经痛患者92例,随访并观察术后疼痛缓解显效、复发时间及不良反应,分析影响预后的因素。结果病程、靶点脑桥缘距离、手术史是影响三叉神经痛伽玛刀术后显效时间的独立风险因素(RR=0.505,95%CI 0.297~0.859,P=0.012;RR=0.556,95%CI 0.333~0.929,P=0.025;RR=5.127,95%CI 1.746~15.052,P=0.003)。手术史、病程与伽玛刀治疗三叉神经痛的复发时间相关(χ~2=5.628,p=0.018;χ~2=3.863,p=0.049)。COX生存分析显示手术史、病程不是影响三叉神经痛伽玛刀术后复发时间的独立风险因素(p=0.089;p=0.458)。靶点脑桥缘距离8mm组较≥8mm组的不良反应率高(χ~2=3.993,p=0.046)。结论病程3年、靶点脑桥缘距离较短、无手术史是影响患者术后显效时间的积极因素。靶点脑桥缘距离较短可能导致不良反应相对增多。     

偏头痛发作间期疼痛刺激的脑磁图研究

目的探讨偏头痛患者在发作间期大脑对疼痛电刺激的反应特点。方法收集30例发作间期的无先兆偏头痛患者(偏头痛组)和30名年龄、性别相匹配的健康对照者(对照组),利用脑磁图描记术记录正中神经疼痛电刺激下诱导的脑电磁信号。比较偏头痛组与对照组之间在痛觉处理上的差异。结果与对照组相比,偏头痛组疼痛电刺激疼痛阈值显著降低(P0.05),疼痛电刺激产生的体感诱发磁场M20潜伏期明显延长(P0.01)。偏头痛组疼痛诱发Gamma振荡平均能量较对照组显著增强(P0.01),且Gamma震荡能量值与视觉模拟评分法(VAS)、偏头痛残疾程度评估量表(MIDAS)评分均呈正相关(VAS左手:r=0.45,P0.05;VAS右手:r=0.46,P0.05;MIDAS左手:r=0.47,P0.01;MIDAS右手:r=0.59,P0.01)。结论偏头痛患者发作间期存在疼痛感觉异常,且痛觉刺激相关的皮质兴奋性增高。     

替罗非班治疗急性缺血性卒中安全性及有效性的Meta分析

目的系统评价临床应用替罗非班治疗急性缺血性卒中(Acute Ischemic Stroke,AIS)的疗效及安全性。方法对3个英文数据库Pub Med、EMBASE、Cochrane Library进行计算机检索,全面收集替罗非班治疗AIS的相关临床研究,检索时间为各库建库至2019年8月31日。对纳入的文献进行数据提取与质量评价,并采用软件Rev Man 5.3进行统计分析。结果最终纳入12篇文献,共2137例患者,其中试验组921例患者,对照组1216例患者。Meta分析结果显示:替罗非班可明显降低AIS患者2～7 d的NHISS评分[均数差(MD)=-1.53,95%CI-2.98～-0.09,P=0.04],显著改善90 d的良好预后(mRS≤2)[相对危险度(RR)=1.17,95%CI 1.05～1.30,P=0.003],但未提高24 h的血管再通率(RR=1.01,95%CI 0.95～1.06,P=0.84)。同时,替罗非班可显著降低90d死亡率(RR=0.79,95%CI 0.65～0.97,P=0.02),且未增加颅内出血率(颅内出血转化:RR=0.89,95%CI 0.77～1.03,P=0.11;症状性颅内出血:RR=0.93,95%CI 0.70～1.25,P=0.64)。结论替罗非班应用于AIS的治疗是安全的,能明显改善患者早期神经功能缺损症状及90 d良好预后,降低90 d死亡风险,但未改善24 h内的血管再通情况。     

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.     

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.     

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.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

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。