新生儿缺氧缺血性脑病血清肌酸激酶及脑型同工酶的诊断价值

目的探讨血清肌酸激酶(CK)及其脑型同工酶(CK-BB)活性检测在新生儿缺氧缺血性脑病(HIE)的临床应用价值。方法对我院2008年5月～2009年5月住院的30例HIE患儿和27例正常新生儿分别在生后24h内,第7天采集股静脉血,测定CK、CK-BB活性,并做对比分析。结果 (1)HIE组CK、CK-BB存在动态变化。(2)HIE组血清CK、CK-BB生后24h内即升高,并且随着病情加重而增高,明显高于对照组(P<0.01),生后第7天轻中度HIE组CK、CK-BB基本恢复正常,而重度组尽管明显降低,仍显著高于对照组(P<0.01)。结论 (1)HIE患儿在血清中CK、CK-BB水平与HIE严重程度密切相关,HIE程度越重其水平越高。血清CK、CK-BB是HIE患儿脑损伤的早期敏感指标,可作为HIE早期诊断及评估脑损伤严重程度的重要生化指标。(2)CK、CK-BB对估计HIE预后有一定帮助。     

血清NSE在HIE患儿中的应用探讨

新生儿缺氧缺血性脑病（hypoxic ischemic encephalopathy，HIE）是围产期缺氧所致的严重并发症，其发病率和病死率都较高，部分患儿可遗留严重的神经系统后遗症。因此寻找早期诊断HIE脑损伤程度的指标和方法，对判断病情严重程度、预后及指导临床治疗均具有重要意义。有文献报道，测定血清神经元特异性烯醇化酶（neuron specmcenolase，NSE）对缺氧缺血性脑损伤的诊断有一定意义。为此，我们应用放射免疫分析（RIA）对98例HIE患者血清NSE水平进行了检测，以探讨在HIE中的变化及临床意义。     

新生儿缺氧缺血性脑病血清肌酸激酶及其同工酶的变化及临床意义

目的探讨新生儿缺氧缺血性脑病（HIE）时血清肌酸磷酸的激酶及其同工酶的动态变化和临床意义。方法对我院2006年12月～2007年12月住院的40例HIE患儿分别于出生后24h内,第7天采股静脉血,测定血中肌酸磷酸激酶（CK）、心型同工酶（CK-MB）和脑型同工酶（CK-BB）。结果（1）HIE时血清CK、CK-BB、CK-MB存在动态变化。（2）CK、CK-BB24h内即升高并且随着病情加重而增高,3组之间差异非常显著（P〈0.05）,生后7天轻中度HIE基本恢复正常,而重度HIE尽管明显降低,仍显著增高。（3）CK-MB在轻度HIE无显著变化,中重度组24h内增高,7天中度组降至正常,而重度组第7天仍保持较高水平。结论（1）HIE患儿血清中CK、CK-BB、CK-MB水平与HIE严重程度密切相关,HIE程度越重,其水平越高。血清CK、CK-BB是HIE患儿脑损伤的早期敏感指标,可作为HIE早期诊断及评估脑损伤严重程度的重要生化指标。（2）中重度HIE早期即有心肌受损,应及早进行干预治疗。（3）CK、CK-BB、CK-MB可能对估计HIE预后有一定帮助。     

血清NSE水平对新生儿缺氧缺血性脑病患儿病情的评估价值

目的:探讨血清神经特异性烯醇化酶(NSE)对缺氧缺血性脑病(HIE)病情的评估价值.方法:检测不同严重程度病情HIE患儿血清NSE的含量.结果:HIE患儿血清NSE水平均明显高于对照组新生儿NSE水平(P<0.05),随着HIE患儿病情程度的加重,血清NSE水平也明显升高.重度HIE患儿的血清NSE水平明显高于中度HIE患儿的血清NSE水平(P<0.05),而中度HIE患儿的血清NSE水平明显高于轻度HIE患儿的血清NSE水平(P<0.05),轻度HIE患儿的血清NSE水平明显高于对照组新生儿的血清NSE水平(P<0.05).HIE患儿急性期明显高于恢复期(P<0.01),恢复期仍然高于对照组新生儿(P<0.05).结论:血清NSE水平与缺氧缺血性脑损伤呈正相关,可反映神经系统的损伤程度,可作为早期诊断HIE、评价HIE转归的客观指标.     

GPBB、CTnI、NSE在新生儿缺氧缺血性脑病中的临床意义

目的：探讨新生儿缺氧缺血性脑病（HIE）患儿血清糖原磷酸化同功酶BB（GPBB）、肌钙蛋白I（CTnI）、神经元特异性烯醇化酶（NSE）变化，为新生儿HIE的诊断、治疗及预后观察提供理论依据。方法：选择38例HIE患儿为对象（HIE组）根据病情分为轻度、中度、重度三组；同时选择32例同期出生的健康足月新生儿为正常对照组（对照组）。HIE组分别于急性期（入院后当天）及恢复期，对照组出生后（5～10）d采集静脉血检测血清GPBB、CTnI、NSE的浓度。结果：HIE组急性期血清GPBB、CTnI、NSE的浓度均高于对照组，差异具有显著性（P〈0．01）。轻度、中度、重度三组之间比较具有显著性差异（P〈0．01）。恢复期只有重度HIE患儿GPBB、CTnI、NSE的浓度仍高于对照组，差异具有显著性（P〈0．01）。而轻度、中度两组血清中GPBB、CTnI、NSE的浓度已恢复正常。结论：通过检测HIE患儿血清GPBB、CTnI、NSE的浓度有助于早期准确判断HIE患儿的心、脑损伤程度，预测HIE患儿的预后具有重要价值。     

新生儿缺氧缺血性脑病血清NSE的变化及其与脑CT值的临床研究

目的探讨窒息后新生儿缺氧缺血性脑病(HIE)早期血清神经元特异性稀醇化酶(NSE)的变化及其与脑CT值的相关性,为临床早期诊断HIE脑损伤提供参考指标,协助判断脑损伤程度,为指导临床对治疗效果的判定和预后提供依据。方法随机选取59例符合新生儿缺氧缺血性脑病诊断标准的足月新生儿作为窒息后缺氧缺血性脑病组。窒息后HIE组根据临床表现分为轻度、中度及重度。随机选择20例生后无窒息,其母无任何疾病的健康足月新生儿作为对照组。HIE组及对照组分别测定生后24h内、第7天血清NSE的含量。颅脑CT值在生后第3～5天测定。所有计量资料均采用均数±标准差表示,组间比较采用q检验(Newman-Keuls法),对有相关趋势的变量进行相关分析,以P0.05为有统计学意义。结果 24h内,对照组NSE浓度(35.15±12.10)μg/L,轻度HIE组(56.71±21.77)μg/L,中度HIE组(109.13±60.70μ)g/L,重度HIE组(141.17±26.83)μg/L,HIE组与对照组比较差异有显著性(P0.01),并且HIE各组之间差异有显著性(P0.01)。生后第7天NSE浓度下降,轻度HIE组恢复至正常,但中度、重度HIE组仍高于对照组,与轻度HIE组及对照组相比以及中度、重度之间,差异有显著性(P0.01)。对照组3-5天脑CT检查其结果值大于20Hu。轻度HIE组脑CT值小于18Hu,中度组小于15Hu,重度组小于12Hu。HIE组与对照组比较,差异有显著性(P0.01)。通过对HIE组生后24h血清NSE水平与3-5天的脑CT值进行相关性分析,发现两因素呈显著负相关(r=-0.752,P0.001)。结论 HIE患儿血清NSE在24h内即升高,HIE组与对照组之间,HIE各组之间,差异有显著性。血清NSE在生后24h可作为窒息后脑损伤的早期指标。HIE患儿24h内血清NSE浓度水平与3-5天时脑CT值呈显著负相关,提示脑损伤程度越重,血清NSE水平越高,脑CT值越低。     

ADM血浆浓度的动态变化在HIE早期诊断中的临床研究

目的：通过对足月新生儿缺氧缺血性脑病（hypoxic ischemic encephalopathy,HIE）脐血浆中肾上腺髓质素（adrenomedullin,ADM）水平变化与血清神经元特异性烯醇化酶（Nenron specific enolase,NSE）动态变化及相关性研究,评价脐血ADM在HIE中的诊断价值。方法：使用放射免疫分析（RlA）测定30例正常新生儿和110例窒息足月儿的脐血在出生后24h、3d、7d ADM、NSE的动态变化。结果：①HIE组脐血ADM浓度为168.15pg/ml,较非HIE组的106.18pg/ml和对照组的103.65pg/ml明显增高,有显著性差异（P〈0.01）。②HIE组ADM浓度变化与HIE的轻、中、重程度呈正相关,与NSE浓度变化密切相关（r=0.786,P〈0.01）。HIE组出生后24h血浆ADM浓度明显增高,经治疗后,轻、中度组,第7d基本恢复正常对照组水平,而重度组仍维持较高浓度。③不同脐血ADM浓度为截断值绘制ROC曲线,最佳截断值为117.5pg/ml。ADM〉118.0pg/ml对HIE诊断的准确度为88.9%、特异性为83.3%、敏感度为91%。结论：脐血检测ADM浓度比NSE具有早期预测、快速方便、无创、更敏感的优点。脐血ADM测定在HIE早期诊断中有重要临床意义。     

新生儿缺氧缺血性脑病血清IL-6水平与脑血流变化的研究

目的探讨缺氧缺血脑病（HIE）新生儿血清IL-6水平和脑血流变化与缺氧缺血性脑损伤程度关系。方法采用ELXLA法对41例HIE患儿和14例对照组新生儿血清IL-6水平进行检测,同时采用经颅多谱勒超声（TCD）技术观察双侧大脑中动脉（MCA）收缩峰流速（Vs）、舒张末期流速（Vd）变化、阻力指数（RI）等的变化。结果轻、中、重度HIE患儿急性期血清IL-6水平均明显高于对照组水平（P〈0.01）,重度组增高尤其明显。中、重度组Vd,Vs低于对照组,RI指数重度组高于对照组（P〈0.01）。血清IL-6水平与脑血流速度呈显著负相关（r=0.872,P〈0.01）。结论检测血清IL-6和脑血流变化对于评价新生儿缺氧缺血性脑病脑损伤的程度具有重要临床意义。     

新生儿缺氧缺血性脑病血清CK-BB水平与脑实质CT值的相关性研究

目的探讨新生儿血清肌酸激酶脑型同工酶(CK-BB)的水平与脑实质CT值对缺氧缺血性脑病(H IE)的诊断价值。方法采用比色法对49例H IE患儿和32例对照组新生儿血清CK-BB水平进行动态测定。同时采用日本东芝Aq ilion螺旋CT扫描机单纯头颅平扫,在CT诊断分度的同时测定脑实质CT值。结果生后24小时内H IE组血清CK-BB水平与对照组相比明显增高(P均<0.01),且H IE各组之间差异有显著性意义(P均<0.01);生后48及72小时重度H IE组血清CK-BB水平仍高于对照组(P<0.01),与轻、中度H IE组与对照组相比差异有非常显著性意义(P<0.01)。轻、中、重度H IE患儿脑实质CT值均明显低于对照组(均P<0.01),且H IE各组之间差异有显著性意义(P均<0.01)。相关分析发现,H IE组生后24小时内患儿血清CK-BB水平与脑实质CT值呈显著负相关(r=-0.747,P<0.01)。结论血清CK-BB水平监测可作为H IE诊断及评价脑损伤程度的早期预测指标,与脑实质CT值结合可对窒息后缺氧缺血性脑病做出早期而正确的诊断,为早期治疗提供依据。     

肌酸激酶及其同功酶在新生儿缺氧缺血性脑病的诊断价值

目的探讨血清肌酸激酶（CK）及其同功酶(CK-BB)活性检测在新生儿缺氧缺血性脑病（HIE）的临床应用价值.方法设正常新生儿对照组40例,新生儿窒息后 HIE组37例,新生儿窒息后非 HIE组36例,分别测定3组出生后 24小时内和第 7天血清CK、CK—BB活性,并作对比分析.结果 HIE组血清CK、CK-BB较正常对照组和非HIE组明显升高(p<0.01) ;经治疗第7天后 HIE 组的CK及其同工酶下降(p<0.05).其值仍高于对照组和非HIE组(p<0.01).结论血清CK及其同工酶CK-BB的活性测定可作为新生儿窒息后并HIE诊断及判定治疗效果的指标之一.     

Active and passive forearm flexor tension patterns in the continuous perceptual-motor task paradigm: The significance of motivation

The psychophysiology of skeletal muscle tension patterns during goal-directed behavior was investigated by using the continuous perceptual-motor task paradigm. Subjects were recruited to form serious-minded and playful extreme groups according to their responses to the Telic Dominance Scale (10 subjects in each group). They all performed a continuous perceptual-motor task 5 times at a ‘slow’ speed followed by a final ‘fast’ task. All performance periods lasted for 150 s. Measures of passive (tonic) and active (phasic) forearm flexor EMG activity were derived. It was concluded that serious-mindedness was significant to a tonic build-up of tension in the passive forearm flexor over the course of task performance. In contrast, the playful state was associated with high phasic response amplitudes in the active forearm flexor contingent upon changing the position of the joy-stick. Training moderated the range of state-specific EMG activation. State measures confirmed that the subjects maintained their state dominance during task performance. Error-scores and scores on felt level of arousal did not discriminate between the groups.     

Cardiovascular and electrodermal responses to simple stimuli in autistic,retarded and normal children

Phasic changes in respiratory period, electrodermal activity (EDA), the evoked cardiac response (ECR), and the vasoconstrictive pheripheral pulse amplitude response (PPAR), were examined in matched groups of autistic, retarded, and normal children, using repeated presentation of simple visual and auditory stimuli. Analysis as a function of group membership and age indicated that respiratory pause and EDA showed habituation in the retarded and normal groups, but not in the autistic group, with no age effects in any group. PPAR and ECR showed no habituation in any group, but within-group age differences, and a higher mean response level for the autistic subjects. The autistic children did not display the diminution of response level with increased age that was characteristic of both the control groups. These effects were obtained across both modalities. Results could not be attributed to between-group tonic cardiac arousal differences, and were interpreted as further indications of diminished sensitivity to reductions in stimulus novelty, as well as developmental delay, in early-onset psychosis.     

Cardiovascular and respiratory responses to electrical stimulation of the midbrain in the rat

In descending through the midbrains of rats with stimulation electrodes, we have observed some remarkable reversals of pressor and depressor autonomic effects as the electrode was moved from one locus to another. Autonomic effects of stimulating in the midbrain areas that we studied are of special interest because stimulations in some of these midbrain loci have pain-relieving effects (Hosobuchi et al., 1977, 1979; Mayer et al., 1971; Soper, 1976). Our observations of cardiac arrest are of particular concern because of the use that is being made of midbrain electrical stimulation to relieve pain in human patients.     

Brain potentials related to the beginning and to the termination of voluntary flexion and extension in man

The presence of brain potentials related to the end of a sustained isometric contraction prompted this study. Potentials related to the beginning of simple ballistic flexion of the index finger were compared with isometric contraction, potentials related to the termination of the isometric contraction, and potentials related to ballistic extension of the reposed index finger. The electroencephalograms recorded in 10 healthy volunteers from scalp positions C3+2, Cz, C3-2 were averaged time-locked to the appropriate mechanograms. Both negativity preceding and positivity following execution of movement were better expressed with simple flexion movements. The negativities preceding all four types of movements were of comparable magnitude whilst the positivities differed significantly. These findings were considered as supporting the ideas of general facilitation preceding preparation for action and specific feedback information following execution, the changes being more prominent over postcentral leads. The existence of potentials related to the termination of voluntary sustained isometric contraction implied a separate command for antagonistic muscles.     

Interactions between target and masking stimuli: perceptual and event-related potential effects

TWo separate experiments were conducted to determinge the nature of the visual event related potential (ERP) at two different cortical areas under conditions of backward visual masking and to see the effects of varied inter-stimulus-intervals (ISIs) upon both masking and the ERP. The results of the first experiment clearly demonstrated visual ERP attenuation at a target-mask ISI of 40 ms, an ISI which consistently produced masking. Both experiments showed that this effect was specific for the occipital recording site since amplitude reductions were not observed at the vertex under this condition. The mask alone condition produced the largest amplitude ERPs in both experiments. Again, this was specific for Oz. In the second experiment target-mask ISIs which did not produce backward masking (i.e., 10 ms and 100 ms) were not accompanied by ERP amplitude reductions. The results may be explained by a cortical excitatory-inhibitory model. That is, when successive stimuli are presented to the visual system, the visual cortical excitation produced by the initial stimuli is inhibited by the presentation of subsequent stimuli when temporal and spatial intervals are appropriate.     

Peripheral adrenoceptors and serotonin receptors in depression. Changes associated with response to treatment with trazodone or amitriptyline

Changes in platelet and lymphocyte adrenoceptor densities, platelet serotonin uptake and aggregatory response to serotonin were assessed in a group of moderately depressed patients before and during treatment with either trazodone or amitriptyline. Platelet serotonin receptor activity and uptake were lower before the start of treatment in all patients than in those patients responding to treatment. The densities of alpha 2- and beta-adrenoceptors tended to be higher in the patients before treatment and returned to control values after effective therapy. There were no major differences in the biochemical changes between the patients treated with trazodone or amitriptyline. When the biochemical data was correlated with the clinical history of the patients, it was found that only endogenously depressed patients, and not those with non-endogenous depression, had a significantly reduced platelet serotonin uptake rate. In addition, female depressives had a slightly lower platelet 5-HT aggregatory response than males irrespective to the type of depression.     

Clinical and physiological basis for a new method underlying rehabilitation of the damaged visual nerve function by direct electric stimulation

A new method of rehabilitation of damaged visual nerves has been tested during clinical physiological investigations in 45 patients with pathological opticochiasmal brain tumor, inflammation and trauma. The essence of the new method was in implanting the electrode into the nerve when the patient was operated on for the pathological formation and in directly stimulating the nerves for 2 or 3 postoperational weeks. Effectiveness of electrical stimulation was increased by direct recording of the electroneurogram as well as by the results of ophthalmological observations. Considerable improvement of vision was observed in 75%, and in 25% of these cases the vision was found to actually normalize. Even in cases of total blindness, vision was partially rehabilitated in 8 of 10 cases. Direct electrophysiological investigation of the visual nerve potentials enabled us to objectively estimate their functional state, predict the probability of visual rehabilitation as well as increase the efficiency of therapy. Neurophysiological mechanisms of visual rehabilitation under the influence of electrical stimulation of the visual nerves are discussed.     

Bulimia and depression

Fifty-six adult females with DSM-III bulimia were evaluated for personal and family histories of other psychopathologies. Fortythree subjects (77%) evidenced mild depression of which 13 (23%) reported moderate-severe symptoms by the Beck Depression Inventory - a finding confirmed with Hamilton Rating Scale for Depression and the SCL-90-D scale. A personal history of affective disorder was found in 52%, while 59% reported first degree relative(s) with affective disorder. Subjects with first-degree relatives with drug dependence, alcoholism, or depression had an earlier onset of bulimia than those without such relatives. Bulimia may be symptomatically or pathophysiologically related to depression.     

Responses to phenelzine and amitriptyline absence of differential predictors by multiple regression analysis

Multiple regression analyses using initial symptoms to predict outcome were carried out on data from an outpatient controlled comparison of amitriptyline, phenelzine and placebo. Separate analyses were carried out in the three treatment groups and regression equations were compared. Significant prediction was obtained only for phenelzine. On only one of three outcome measures analysed, however were there significant differences between treatment groups in regressions. Individual predictors were not easily interpretable. There was little evidence for different clinical predictors or response to phenelzine and amitriptyline in this sample.     

A review of physiological prestress adaptation: effects of duration and context

This review focuses on 3 aspects of experimental designs for prestress, physiological adaptation periods: (1) effects of duration on stabilization of various physiological parameters:(2) effect of type of activity and instruction on prestress physiological adaptation: and (3) definitions of physiological baselines. Analyses of the literature revealed that for many physiological parameters it remains unclear how much time is required for stabilization and that for the remaining variables the necessary duration of prestress adaptation varies greatly, with blood pressure potentially being the slowest variable to stabilize. Effects of type of activity are essentially unknown. Instructions which create certainly about experimental procedures in subjects tend to facilitate adaptation to the laboratory environment. Baseline definitions were remarkably variable with no less than 15 different definitions being used across the 50 studies reviewed. Suggestions for future research and recommendations for prestress experimental designs are put forward in the discussion.