脑梗死后运动性失语的局部脑功能活动强度研究

目的利用静息态功能磁共振成像(fMRI)分析脑梗死后运动性失语患者脑功能区域活动强度的变化。方法选择急性缺血性脑卒中后运动性失语患者14例作为病例组,同期健康体检者16例作为对照组,2组采用汉语失语成套测验进行言语行为学测试,计算失语指数(AQ)评分,之后行静息态fMRI检查,记录低频波动振幅(ALFF),以全脑标准化的ALFF(mALFF)用于分析,采用REST软件进行统计分析。结果与对照组比较,病例组左侧小脑半球、右侧颞上回、右侧颞中回、右侧丘脑、右侧海马旁回、右侧中央前回、左侧额中回mALFF值明显增高(P<0.05);左侧中央前回、左侧内侧颞上回、右侧颞极mALFF值明显降低(P<0.05)。病例组所有患者左侧内侧额上回的mALFF值在-0.75~0.83,AQ评分在17~64分,且mALFF值与AQ评分呈正相关(r=0.590,P=0.026)。结论静息状态下,脑梗死后运动性失语患者某些脑区异常激活,为此类患者的诊治提供了思路。     

耳穴神门压籽法对偏头痛病人大脑低频振荡振幅影响的研究

目的基于功能磁共振成像(fMRI)技术初步研究耳穴神门压籽法对偏头痛病人静息态大脑神经元活动的影响。方法应用fMRI技术分别采集9例偏头痛病人(病例组)、9名健康受试者(健康组)耳穴神门压籽法干预前后的静息态全脑功能图像,采用REST软件对数据进行统计学处理,分析病例组和健康组脑功能区低频振动振幅(ALFF)的差异。结果干预前病例组左侧额下回的ALFF值显著低于健康组;病例组左侧距状裂周围皮质、左侧辅助运动区的ALFF值显著高于健康组(P0.005)。干预后,病例组双侧额上回、左侧额中回的ALFF值显著低于健康组;病例组左侧枕下回、右侧梭状回的ALFF值显著高于健康组(P0.005)。结论偏头痛发作间期,参与疼痛调节、视觉感受相关脑区功能分别增强、减弱,支持偏头痛发病的中枢假说;刺激耳穴神门后视觉相关的脑区功能增强,为耳针治疗偏头痛的中枢机制提供数据支持。     

基于全脑静息态fMRI评价针刺对原发性失眠病人脑区功能的影响

目的探讨针刺治疗对原发性失眠病人全脑静息态功能磁共振(fMRI)测定的影响。方法选取2016年1月—2017年5月黄石市第二医院收治的32例原发性失眠病人作为观察组,另选取同期20名健康受试者作为对照组。对照组未予以任何治疗,观察组在原发性失眠对症治疗基础上予以针刺治疗,待观察组病人治疗结束后,采用BOLD-fMRI成像技术,基于RSET1.8软件,使用低频振幅(ALFF)方法观察比较两组间脑区相关参数变化情况。结果两组性别、年龄及文化程度比较差异无统计学意义(P0.05),但观察组焦虑自评量表(SAS)和抑郁自评量表(SDS)评分高于对照组(P0.05);观察组治疗前左侧楔叶、壳核、苍白球、尾状核、额上回、额中回、颞中回及双侧中央前回和双侧中央后回区的ALFF值与对照组比较,差异有统计学意义(P0.05);观察组治疗后左侧楔叶、壳核、苍白球、尾状核、额上回、额中回及双侧中央前回和双侧中央后回区的ALFF值与对照组比较,差异有统计学意义(P0.05);观察组左侧壳核、苍白球和尾状核的ALFF值与对照组比较均降低,而前者双侧中央前回和双侧中央后回区,左侧楔叶、额上回、额中回、颞中回的ALFF值均较后者升高;治疗后观察组左侧壳核、苍白球和尾状核的ALFF值均较治疗前有所升高,而左侧楔叶、额上回、额中回均较治疗前降低。结论针刺治疗可明显改善原发性失眠病人其相应脑区功能,其中ALFF的应用也具有一定的临床价值。     

基于静息态功能磁共振探究高强度间歇运动训练对脑梗死后运动障碍康复的影响

目的 评估高强度间歇运动训练(high-intensity interval training, HIIT)对改善脑梗死后运动障碍的作用,利用静息态功能磁共振成像探讨相关机制。方法 将30例脑梗死恢复期患者随机分为对照组和HIIT组。对照组实施常规康复训练,HIIT组在常规康复训练基础上进行HIIT训练。干预前后采用Fugl-Meyer(FMA)量表评估两组的肢体运动功能,并在干预结束后对受试者进行功能磁共振扫描。结果 干预6周后,两组受试者FMA评分均较前明显改善,HIIT组下肢FMA评分高于对照组(P<0.05)。与对照组相比,HIIT训练组右侧中央后回和左侧额下回的DC值增高(P<0.05,FDR校正);HIIT训练组在左侧额下回与右侧海马旁回、右侧颞极、双侧前扣带回、双侧腹内侧前额叶、胼胝体中部之间的连接明显增强(P<0.05,FDR校正)。HIIT组左侧额下回的DC值以及左、右侧腹内侧前额叶的FC值与FMA量表评分的上升均呈正相关(r=0.466,P=0.033;r=0.625,P=0.002;r=0.487,P=0.025)。结论 对脑梗死恢复期患者进行H...     

食道癌伴抑郁患者静息态脑功能的局部一致性分析

目的探讨食道癌伴抑郁患者的静息态脑功能局部一致性。方法选取25例符合食道癌诊断标准和贝克抑郁自评量表评分≥5分的抑郁患者;25例正常对照者(贝克抑郁自评量表评分5),所有入组人员均完成静息态功能磁共振(f MRI)成像扫描。采用局部一致性(Re Ho)方法处理f MRI数据,并进行两组比较。结果与对照组相比,食道癌伴抑郁患者Re Ho值增高的脑区有左顶下小叶、右顶下小叶、左海马、右楔前叶;Re Ho值降低的脑区有左扣带前回、左颞下回、右额中回、右额上回、左额上回、左脑岛。结论静息态下食道癌伴抑郁患者存在多个脑区活动异常,这可能在其病理生理机制中起到了重要作用。     

老年缺血性脑卒中认知障碍患者海马连接功能的变化及其机制

目的采用静息态血氧水平依赖功能性磁共振成像(Bold-f MRI)观察老年缺血性脑卒中认知障碍患者海马功能连接模式变化并探讨其可能机制。方法老年缺血性脑卒中认知功能障碍患者16例为研究组,健康老年人9例为对照组。采用静息态Bold-f MRI技术,选择左侧和右侧海马为兴趣区与全脑进行相关分析,获取两组脑功能连接激活图,观察两侧海马和全脑的功能连接模式。结果与对照组相比,研究组患者左侧海马与右侧扣带回,额下回、上回,枕叶、颞上回,右侧海马的连接功能均明显减弱(P<0.05);左侧海马与左侧颞中回、额内侧回、顶叶、楔前叶,右侧后扣带回的连接功能均明显增强(P<0.05)。与对照组相比,研究组患者右侧海马与右侧扣带回,左侧额中回、上回、下回,颞上回、右侧海马旁回,顶下小叶的连接功能均明显减弱(P<0.05);右侧海马与右枕叶,颞上回,距状沟,楔前叶,小脑后叶,额叶回的连接功能均明显增强(P<0.05)。结论老年缺血性脑卒中认知障碍患者海马与相关脑区间的功能连接减弱可能是引发认知功能减弱的原因之一,功能连接增强提示在此过程中同时存在相应的代偿机制。     

缺血性卒中后非流利型失语患者局部一致性变化：静息态功能性磁共振成像研究

目的 探讨缺血性卒中后非流利性失语患者静息态功能磁共振成像（functionalmagnetic resonance imaging fMRI）的脑功能特点.方法 对17例缺血性卒中后非流利性失语患者以及19名年龄、性别和受教育程度均匹配的健康对照者进行静息态fMRI检查,采用局部区域一致性（regional homogeneity,ReHo）分析方法计算静息态下脑区的ReHo情况.结果 与对照组比较,患者组左侧额上回、右侧额下回、右侧脑岛以及右侧缘上回ReHo值增高,右侧小脑半球、左侧颞上回、颞中回以及右侧颞下回脑区ReHo值降低.结论 在静息状态下,缺血性卒中后非流利性失语患者存在多个脑区ReHo异常,这种异常改变可能与其功能损伤后修复的代偿作用有关.     

静息态fMRI技术观察肝性脑病患者双侧苍白球与全脑网络连接的改变研究

目的采用静息态功能MR(fMRI)技术探讨肝性脑病(HE)患者双侧苍白球与全脑网络连接的改变。方法 2015年2月～2017年6月诊治的明显HE患者(OHE)28例,轻微型HE患者(MHE)30例和选择健康人30例,受试者接受静息态fMRI扫描,选取双侧苍白球为种子点并进行全脑功能连接,分析比较各组双侧苍白球区域的脑功能网络连接差异。结果 HE患者苍白球与全脑网络连接出现差异的位置主要集中在额叶、顶叶和颞叶(P均0.05),与健康人比,OHE患者右侧枕下回、右侧额中回、左侧眶部额上回等脑区连接减弱,而在左海马旁回、双侧尾状核、左三角部额下回连接增强;MHE患者左中央前回、左内侧额上回、双侧颞中回等脑区连接减弱;与MHE患者比,OHE患者右侧楔前叶、右侧颞中回、右梭状回、右侧角回连接减弱,而双侧尾状核和右侧颞下回连接增强(P均0.05)。结论 HE患者双侧苍白球区域与多个脑区的功能连接受损,可能与临床出现的认知功能障碍有关。     

皮质下缺血性血管性认知功能障碍的静息态功能磁共振研究

目的探讨静息态功能磁共振低频振幅(ALFF)的分析方法在皮质下缺血性血管性认知功能障碍中的价值。方法选择49例缺血性脑小血管病患者经临床痴呆量表评分后,分为血管性痴呆(VaD)组10例,非痴呆型血管性认知功能障碍(VCIND)组20例,认知功能正常为对照组19例。分别采集高分辨率结构像和静息态功能磁共振数据,通过ALFF分析方法计算并对比3组患者脑功能活动的改变。观察VaD组ALFF统计脑图与认知量表评分的相关性。结果与对照组比较,VaD组内侧前额叶、后扣带回及双侧颞叶脑区ALFF明显降低,额中回、额上回、顶下小叶脑区ALFF明显升高,VCIND组内侧前额叶ALFF明显降低,左侧顶叶及颞中回ALFF明显升高(P<0.05);与VCIND组比较,VaD组后扣带回/楔前叶、左侧小脑区ALFF明显降低,双侧额叶、颞叶及前扣带回明显升高(P<0.05);回归灰质体积后,VaD组ALFF统计脑图与多个临床量表评分存在相关性(P<0.05)。结论血管性认知功能障碍患者存在以执行功能障碍为主的多个领域的认知功能障碍,其认知功能障碍可能与额叶-皮质下环路受损有关,ALFF在血管性认知功能障碍及其早期诊断中有重要价值。     

磁共振弥散张量成像与静息态功能磁共振成像联合应用对艾滋病患者轻度认知功能下降的初步研究

目的 应用磁共振弥散张量成像(DTI)与静息态功能磁共振成像(rs-fMRI)及两种图像融合技术探讨AIDS患者轻度认知功能下降白质损害与皮层功能区损害的分布及相互关系.方法 对26例经蒙特利尔认知评估量表(MoCA量表)评估的AIDS轻度认知功能下降患者(AIDS 组)和30名健康志愿者(健康对照组),行全脑DTI和rs-fMRI检查,获得全脑各向异性分数值(FA值)降低脑区分布图和以后扣带回为种子点静息态默认模式网络脑功能连接图,并采用图像融合技术将两组图像进行融合.结果 AIDS组脑白质FA值降低脑区为左楔前叶(t=4.0499,P＜0.005)和右侧的楔前叶(t=5.1553,P＜0.005)、额上回(t=5.1517、5.1484,均P＜0.005)、额中回(t=4.1444,P＜0.005)、中央前回(t=3.7395,P＜0.005)、枕叶(t=7.2236,P＜0.005)、顶下小叶(t=4.1450,P＜0.005);静息态与后扣带回功能连接相关脑区为左侧的扣带回(t=32.78,P＜0.005)、楔前叶(t=4.51,P＜0.005)、额上回(t=14.33、4.53,均P＜0.005)、颞中回(t=10.01、5.72,P＜0.005)、颞下回(t=5.99,P＜0.005)、海马旁回(t=7.63,P＜0.005)和右侧的后扣带回(t=34.81,P＜0.005)、楔前叶(t=32.09,P＜0.005)、额上回(t=14.12,P＜0.005)、额中回(t=17.71,P＜0.005)、颞上回(t=14.59,P＜0.005)和颞中回(t=11.83,P＜0.005);与后扣带回功能连接减弱相关脑区为左侧的楔前叶(t=5.39,P＜0.01)、前扣带回(t=3.66,P＜0.01)、小脑扁桃体(t=7.51,P＜0.01)和右侧的顶上小叶(t=4.44,P＜0.01)、海马旁回(t=3.69,P＜0.01)和小脑扁桃体(t=6.15,P＜0.01).图像融合分析显示,AIDS组左侧楔前叶脑白质FA值降低脑区其皮层功能活动显著减弱;左楔前叶、右侧的楔前叶、额上回、额中回FA值减低脑区其皮层功能活动受影响不大.结论 多个脑区脑白质神经纤维失连接和相关联皮层功能活动下降及代偿共同参与了AIDS轻度认知功能下降的发病过程.     

Therapy with budesonide in patients with refractory sprue

INTRODUCTION: Refractory sprue (RS) is a rare malabsorption syndrome, which often requires long-term corticosteroid treatment. Locally acting budesonide could replace systemic corticosteroid therapy and reduce toxicity in patients with RS. Aims: To evaluate the efficacy and toxicity of budesonide in patients with RS. PATIENTS AND METHODS: Clinical and histological data from patients with RS who received budesonide were analyzed. RS was defined as villous atrophy and malabsorption in spite of a strict gluten-free diet persisting for >6 months or requiring earlier therapeutic intervention. RESULTS: We identified 9 patients (1 with autoimmune enteropathy, 4 with RS type I without and 3 with RS type II with signs of early T cell lymphoma and 1 with CD4-positive sprue-like intestinal T cell lymphoma), who received 9 mg/day of budesonide (range 6-12) for 24 months (1-60), and 7 of whom had an initial treatment with 40 mg/day of prednisolone (30-60) for 4 months (1-144). The initial body mass index was 18 (13.1-22.8) and increased similarly under prednisolone [21.5 (14.9-26.7), p < 0.05] and budesonide therapy [21 (18-27.2), p < 0.05]. The stool frequency per day also decreased similarly from 6 (2-8) to 2 (1-3) and 2 (1-5), each p < 0.05, under prednisolone and budesonide therapy, respectively. Two patients with RS type II did not respond and 7, including all 4 with RS type I, were clinically stable with budesonide therapy. Skin fragility in 1 patient was the only adverse effect of budesonide therapy. CONCLUSIONS: Budesonide may be an effective treatment option in patients with RS type I, which can stabilize the clinical condition similar to prednisolone.     

Gammagraphy with sucralfate labelled with technetium in esophagitis

In previous studies it has been reported that, after being labeled with technetium, sucralfate, an useful drug in peptic diseases, can be used to detect peptic lesions of the digestive tract. In this work we report our experience with this technique in the diagnosis of esophagitis. 25 studies (11 controls and 14 patients) were undertaken. Sucralfate scintigraphy was normal in the 11 control studies, and abnormal in 10 out of 14 patients. Scintigraphy was abnormal in peptic as well as caustic lesions.     

Mental disorders in patients with obesity in comparison with healthy probands

OBJECTIVE: Findings concerning the association of obesity and mental disorders are inconsistent. The present epidemiological study investigates adjusted 4-week, 12-month, and lifetime prevalence rates of mental disorders in obese individuals compared with physically healthy probands and overweight individuals. Correlates of the associations are examined. METHODS: Prevalence rates were calculated from two large epidemiological surveys from both the general population of Germany and inpatient centers. The surveys investigated subjects with obesity (n=910) and overweight (n=1550), as well as physically healthy probands (n=495). The prevalence rates were based on the Munich-composite international diagnostic interview, a standardized interview for the assessment of mental disorders. Correlates of mental disorders in obese individuals were assessed using self-report questionnaires and medical examinations. RESULTS: The adjusted odds ratios (OR) of obese inpatients and obese patients from the general population were significantly elevated in comparison with healthy probands for the 4-week (OR: 2.2; 2.3), 12-month (OR: 1.8; 2.7) and lifetime (OR: 1.4; 2.0) periods. Prevalence rates of overweight individuals were below those of obese individuals. Mood, anxiety and somatoform disorders were most frequent. In particular, sex, marital status and comorbid musculoskeletal diseases proved to be correlates of an increased risk for mental disorders in obese individuals. The presence of comorbid mental disorders was associated with significantly increased health care use and lower quality of life. CONCLUSIONS: There is a strong relationship between obesity and mental disorders. A future task is to improve care of mental disorders in patients with obesity.     

Polymyositis-like syndrome with rhabdomyolysis in association with brucellosis

Diffuse myositis with progression to rhabdomyolysis has been reported in association with wide range of viral infections. We report a case of polymyositis-like syndrome complicated by rhabdomyolysis secondary to brucellosis. This case report thus contributes yet another atypical presentation to a disease already infamous for its protean manifestations.     

Metabolic remission with octreotide in patients with insulinoma

Abstract. Objectives . The efficacy of octreotide was studied in a group of patients with biochemical evidence of insulinoma. Design . A phase-II study Setting . A university department of internal medicine. Subjects . Seven patients with biochemical evidence of insulinoma and without metastatic lesions. Intervention . Daily treatment with octreotide, a somatostatin analogue, mainly within the dosage of 100–300 μg day^-1. The treatment was continued in patients with biochemical evidence of response or until surgery was undertaken. Main outcome . Five patients avoided hypoglycaemic symptoms and had normalization of blood glucose values for a median of 15+ months (range 0.2–54 months). Two did not improve metabolically. The treatment was well tolerated and had no deleterious effects on blood glucose regulation. Conclusion . Octreotide seems to be a promising treatment for many of the patients with insulinoma who are not suitable for surgery.     

Changes in coagulation parameters with exercise in patients with classic hemophilia

Vigorous exercise is known to increase VIII:C and VIIIR:Ag levels transiently in normal individuals. Although exercise programs are frequently advocated in the management of hemophilia, the effects of exercise on coagulation parameters in these patients have not been well studied. Eleven hemophiliacs were exercised on a bicycle ergometer to maximum voluntary effort as evidenced by an increase in pulse, blood pressure, and plasma catecholamine (norepinephrine and epinephrine) levels. The effects of this exercise on coagulation parameters, including functional and antigenic components of the factor VIII molecule, were determined. The entire group demonstrated a decrease in mean prothrombin time (11.7 to 11.2 sec). Four mild hemophiliacs demonstrated an increase in mean VIII:C (14.5% to 17.3%), and VIII:CAg (12% to 17.8%). Changes in VIII:C and VIII:CAg were not noted in the seven severe hemophiliacs. Both severe and mild patients demonstrated significant changes in fibrinogen, factor II, and factor VII after exercise. This study indicates that submaximal exercise modifies coagulation parameters in patients with hemophilia.     

Re-challenge with Etanercept in patients with Etanercept-induced Neutropenia

TNF blockers have rarely been associated with haematological complications; however, there are scattered case reports of marked neutropenia with their use and necessitating in their withdrawal. We would like to report a series of five patients who developed neutropenia with etanercept use; however, all these patients were re-challenged with etanercept with a mean follow up of 30 months. These patients developed neutropenia within 2 months of starting etanercept. Two patients were eventually taken off etanercept; one of them needed switching to a different form of TNF blockers, and the second patient is in clinical remission with low-dose corticosteroids. All our patients continued to have mild–moderate degree of neutropenia; however, they are being monitored very closely and they are enjoying complete disease remission. It was interesting to note that none of our patients had increased infections during the re-challenge phase, even though they had grade 2 to grade 4 neutropenia. We have re-challenged these patients without any clinical complications, revealing that patients with mild to moderate neutropenia can be safely exposed to TNF blockers as long as they are monitored with regular cell count checks. Although largely noted to be clinically insignificant in our patient series, the potential of drug-induced neutropenia in causing higher rate of infections do exist. Careful clinical and hematologic monitoring is the best way to recognize this adverse event.