Deep brain stimulation of the subthalamic nucleus for essential tremor

Essential tremor (ET),characterized by a postural and/or kinetic tremor and primarily manifested in the upper extremities,head,and other parts of the body,is one of the most common neurological disorders.1 The traditional target for the neurosurgical treatment of ET,the ventral intermedius nucleus (Vim) of the thalamus,has confirmed that chronic deep brain stimulation (DBS) is an effective,standard,and primary procedure for ET.However,the loss of tremor suppression due to tolerance of chronic Vim stimulation,accompanied by other adverse effects,such as paresthesias,dysarthria,dysequilibrium,hyperhidrosis,and localized pain,has necessitated changes in the stimulation target in some patients.Therefore,an alternative target for ET stimulation is required.Although targeting the subthalamic nucleus (STN) also has complications,such as dyskinesia,dysarthria,paresthesias,diplopia,mood changes,depression,and restless leg syndrome,in view of the evidence that STN could be the target for patients with tremors associated with Parkinson's disease (PD),STN was elected in two ET patients in our study with positive effects.Our research is reported to have explored the possibilities of STN-DBS in the treatment of ET.     

丘脑底核脑深部电刺激治疗特发性震颤

背景：虽然丘脑腹中间核（Vim）是治疗特发性震颤（ET）首选靶点,但是由于存在刺激耐受和其他副作用,因此需要探索新靶点。作者讨论了丘脑底核（STN）脑深部电刺激治疗ET的可能性。 方法 回顾性分析两例在北京天坛医院接受丘脑底核脑深部电刺激的ET病人的资料。病人接受立体定向手术,根据神经解剖图谱、术前MRI,术中微电极记录和测试以确定靶点。术后调节刺激参数以达到较好的控制效果和电池寿命。术后随访对治疗效果进行评价。 结果 两例患者术中记录到典型的电信号,测试震颤明显减轻。术后震颤评分（FTMTRS）分别提高66.7%和75.5%。电极植入术后没有感染、出血、感觉异常、构音困难、认知和平衡障碍以及复视等副作用。 结论 丘脑底核也可以作为特发性震颤脑深部电刺激的治疗靶点。     

特发性震颤的临床特点

目的:探讨特发性震颤(Essential Tremor,ET)的临床特点。方法:对92例ET患者的临床资料进行回顾性分析。结果:92例ET中男58例,女34例,发病年龄12岁～80岁,平均(50.2±17.3)岁,病程6个月～60a,平均(16.2±8.9)a,49例(53.3%)患者有阳性家族史,多呈常染色体显性遗传,临床主要表现为单症状的姿势性震颤,累及部位依次为手(92.4%),头(25.0%),咽喉部(21.7%),下颏(15.2%)等,16.3%患者因震颤致日常生活困难,42例饮酒患者中,85.7%显示对酒精有反应性,6.5%患者并发帕金森病(Parkinson Disease,PD),67.3%患者小剂量普萘洛尔治疗有效。结论:本组ET患者男多于女,临床表现为单症狀姿势性震颤,部分病例可伴发PD,小剂量普萘洛尔治疗大多有效。     

家族性与散发性特发性震颤患者临床特征比较

目的比较家族性与散发性特发性震颤患者临床特征是否存在差异。方法临床确诊的ET患者88例,根据有无家族史,分为家族性ET和散发性ET。比较两组在性别、起病年龄、起病部位、震颤类型、震颤演变过程、最严重部位、是否对称、加重或减缓因素等方面的异同。结果家族性ET 45例和散发性ET 43例。家族性ET患者平均起病年龄早于散发性ET患者平均起病年龄[(33.48±18.87)岁vs(42.19±18.80)岁,P<0.05];两组间震颤类型及起病部位无明显差异;家族性ET患者震颤评分高于散发性者(4.34±2.22 vs 3.37±2.00,P<0.05)。家族性ET患者饮酒后震颤减轻或缓解明显高于散发性者(11/13 vs 4/10,P<0.05)。结论与散发性ET患者比较,家族性ET发病较早,进展较快,震颤较重,饮酒后震颤减轻更多。     

SLAM family predicting the initiation potential of human acute lymphoblastic leukemia in NOD/SCID mice

Background  The SLAM family recently has been reported to show an important biological role in lymphocyte development and immunological function, and it is efficient to highly purify hematopoietic stem cells using a simple combination of SLAM family members. To elucidate the presence of this family on acute lymphoblastic leukemia (ALL), as well as its relationship with the leukemia-initiating potential, we analyzed the expression pattern of this family members on human ALL progenitor cells, combined with serial xenotransplantation assay.

Methods  Expression analysis was carried out by flow cytometry. We combined the expression pattern of human CD₁₅₀, CD₂₄₄ and CD₄₈ with serial xenotransplantation of B-ALL progenitor cells to indicate their relationship.

Results  CD₄₈ and CD₂₄₄ were expressed on most B-ALL progenitor cells, the percentage being (93.08±6.46)% and (63.37±29.31)%, respectively. Interestingly, the proportion of CD₁₅₀⁺ cells declined obviously in engrafted cases ((24.94±7.32)%) compared with non-engrafted cases ((77.54±5.93)%, P <0.01), which indicated that only blast cells with low percentage of CD₁₅₀⁺ population were able to reconstitute leukemia into primary, secondary and tertiary NOD/SCID mice.

Conclusions  SLAM family members are present on B-ALL progenitor cells and the leukemia-initiating potential of leukemic blasts is correlated negatively with the proportion of CD₁₅₀⁺ cells, the percentage of which can serve as a useful predictor for engraftment success of B-ALL to immune deficient mice.

     

体外受精失败的次级卵母细胞单精子显微注射后的效果观察

目的：探讨采用精子卵胞浆内注射（ICSI）对于常规体外受精和胚胎移植（IVF－ET）受精失败的次级卵母细胞实施补救受精的效果。方法：对在常规IVF－ET中没有得到受精卵的病例的次级卵母细胞实施ICSI,观察受精、卵裂、胚胎种植和受孕情况。结果：2000年1月～2000年12月在我院生殖中心接受常规IVF治疗的夫妇中,12例在授精后12～20 h卵子全部不受精,在取卵后24 h实施ICSI。12例患者有卵111个,对其中的69个次级卵母细胞实施ICSI, ICSI 20 h后检查,56个受精,受精率81．2％,形成胚胎50个,卵裂率89．3％,移植11个周期共38胚胎,临床妊娠1例（双胎）。胚胎着床率为5．3％。结论：在常规IVF无受精的情况下,应当立即实施ICSI以补救。但在此情况下,胚胎的着床率低下。     

武连仲教授针刺治疗特发性震颤经验

特发性震颤（EssentialTremor,ET）又称家族性震颤,是一种原因未明的具有遗传倾向运动障碍性疾病。震颤是本病的唯一临床症状。表现为姿势性或动作性震颤,常累及一只手或双手或头部,无全身或其他神经系统阳性体征。国内外尚无安全有效的治疗方法。武教授对此病有独特的看法,认为其病机在于“窍闭神妄”,独创五心穴,用于治疗特发性震颤屡见效验。     

乳腺癌内分泌治疗依从性研究

目的 了解乳腺癌内分泌治疗的依从性,分析影响内分泌治疗正确率的相关因素.方法 对2006年6月至2008年6月在江苏省肿瘤医院住院治疗的379例激素受体阳性乳腺癌患者进行规范的电话随访,记录内分泌治疗完成情况,对成功随访病例进行依从性相关因素分析.结果 85.0％（322/379）成功随访,其中4.7％（15/322）完全未接受内分泌治疗,13.4％ （43/322）院外服用一段时间后自行停药,4.3％（14/322）无规律间断服药,250例规律完成了5年的口服内分泌治疗,治疗正确率为77.6％ （250/322）.定量资料采用t检验和单因素方差分析发现,患者停药高峰主要集中在初始服药2个月内和2年内,分别占39.5％和48.8％;停药人群与患者所从事职业和受教育程度表现出相关性（初中以上及以下学历人群停药率分别为29.4％ vs 19.8％,P＜0.001）,停药原因主要为对副作用的过度担心和难以坚持长期服药.结论 内分泌治疗对激素受体阳性患者疗效肯定,已作为乳腺癌的常规治疗手段应用于临床,但由于治疗时间长、院外服药缺乏监管,使得内分泌治疗的正确率和依从性较低,很大程度降低了乳腺癌治疗疗效.如何对行内分泌治疗的患者进行科学管理,提高治疗依从性和疗效,值得医务人员探讨.     

Neuronal firing in the ventrolateral thalamus of patients with Parkinson’s disease differs from that with essential tremor

Background Although thalamotomy could dramatically improve both parkinsonian resting tremor and essential tremor （ET）, the mechanisms are obviously different. This study aimed to investigate the neuronal activities in the ventrolateral thalamus of Parkinson＇s disease （PD） and ET. Methods Thirty-six patients （PD： 20, ET： 16） were studied. Microelectrode recordings in the ventral oral posterior （Vop）and the ventral intermediate nucleus （Vim） of thalamus was performed on these patients who underwent thalamotomy.Electromyography （EMG） was recorded simultaneously on the contralateral limbs to surgery. Single unit analysis and the interspike intervals （ISIs） were measured for each neuronal type. ISI histogram and auto-correlograms were constructed to estimate the pattern of neuronal firing. Mann-Whitney test and Kruskal-Wallis （K-W） test were used to compare the mean spontaneous firing rate （MSFR） of neurons of PD and ET patients. Results Three hundred and twenty-three neurons were obtained from 20 PD trajectories, including 151 （46.7%） tremor related neuronal activity, 74 neurons （22.9%） with tonic firing, and 98 （30.4%） neurons with irregular discharge. One hundred and eighty-seven neurons were identified from 16 ET trajectories including 46 （24.6%） tremor-related neuronal activity, 77 （41.2%） neurons with tonic firing, and 64 neurons （34.2%） with irregular discharge. The analysis of MSFR of neurons with tonic firing was 26.7 （3.4-68.3） Hz （n=74） and that of neurons with irregular discharge （n=98） was 13.9 （3.0-58.1） Hz in PD; whereas MSFR of neurons with tonic firing （n=77） was 48.8 （19.0-135.5） Hz and that of neurons with irregular discharge （n=64） was 26.3 （8.7-84.7） Hz in ET. There were significant differences in the MSFR of two types of neuron for PD and ET （K-W test, both P〈0.05）. Significant differences in the MSFR of neuron were also obtained from Vop and Vim of PD and ET （16.3 Hz vs. 34.8 Hz, 28.0 Hz vs. 49.9 Hz） （K-W test, both P 〈0.05）, respectively. Conclusion In consistent with recent findings, the decreased MSFR of neurons observed in the Vop is likely to be involved in PD whereas the increased MSFR of neurons seen in the Vim may be a cause of ET.     

原发性震颤的脑细胞电生理基础及手术治疗

目的 探讨丘脑腹外侧Vim核中与震颤症状相关的神经细胞电活动撮律,总结丘脑切开术治疗原发性震颤(ET)的临床效果和安全性。方法 对42例ET患者行单侧微电极导向丘脑切开术。采用FAHN临床震颤评分法对其中11例患者手术前后进行定量评估和分析。结果 Vim核中神经细胞簇状电活动节律与肢体震颤节律一致,毁损这些与震颤症状相关的神经细胞后,所有ET患者手术对侧肢体的震颤完全消失;震颤整体改善率52％,特殊动作和功能改善率54％,功能残疾改善率77％;长期随访疗效稳定,其中40例患者术后随访已3个月以上,无复发;一过性并发症12例,无永久性并发症发生。结论 丘脑“震颤细胞”与ET患者震颤症状密切相关,毁损这些细胞能完全永久性地消除震颤症状。     

内皮素-1与心律失常

内皮素-1是作用强烈的缩血管肽,对血管舒缩、心脏的电与机械活动、心血管增殖与重塑等心血管活动有广泛影响.外源性内皮素-1对心肌有直接的致缺血与致心律失常效应,心肌缺血时内源性内皮素-1的合成与释放增加与缺血性损伤和缺血性心律失常的发生密切相关.本文试图对内皮素-1与心律失常关系的研究作一简要回顾.     

Evaluating the oncologic outcomes in 152 patients undergoing extraperitoneal laparoscopic radical prostatectomy

Background  Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in western countries, few oncologic data of the extraperitoneal procedure was published in China. The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.

Methods  From January 2005 to March 2010, a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP. The patients were staged according to the TNM (tumor, nodes, metastases) system. Median and mean postoperative follow-up were 28.1 months and 27.0 months, respectively. The patients were retrospectively analyzed for progression-free survival.

Results  One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in, and 40 cases (26.3%) as pT3. Positive lymph nodes were shown in 5 patients (3.3%). Gleason score was <7 in 49 men (32.2%), 7 in 69 men (45.4%), and >7 in 34 men (22.4%). Positive surgical margins (PSM) were observed in 15 patients (9.9%), which included 32.0% of all pT3a cases and 46.7% of all pT3b cases, respectively. The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients. The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients, respectively. Preoperative prostate-specific antigen, surgical margins, tumor stage, and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.

Conclusions  ELRP is a precise, safe and effective procedure at this particular Chinese institution. The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.

     

丘脑腹外侧核团细胞电活动与原发性震颤

目的 探讨与原发性震颤(ET)相关的丘脑腹外侧核(Vop和Vim)细胞电活动.方法 以10例ET患者和10例原发性帕金森病(PD)患者为研究对象,在实施立体定向手术的同时采集Vop/Vim细胞电活动和肢体EMG.用单细胞和峰间隔(ISI)分析不同细胞放电模式和频率.结果 发现266个神经元,包括与震颤相关的细胞放电活动(101个),紧张性放电活动(85个)和不规则放电活动(80个).在10个ET患者针道中发现131个神经元,除29.0%与震颤相关的细胞放电活动外,41.2%为紧张性放电活动,平均细胞自发放电频率(MSFR)为(55±21)Hz;29.8%为不规则放电活动,MSFR为(32±17)Hz.在PD患者10个针道中发现135个神经元,除46.7%与震颤相关的放电活动外,23.0%为紧张性放电活动,MSFR为(39±15)Hz;30.3%为不规则放电活动,MSFR为(21±8)Hz.进一步分析发现ET的紧张性和不规则放电活动的MSFR明显高于PD(t分别为2.74,2.72,均P<0.05).另外发现ET的Vop和Vim的MSFR分别为31.4 Hz和59.0 Hz,显著高于PD的Vop和Vim 16.8 Hz和34.5 Hz(t分别为4.43,4.92,均P<0.05).结论 Vim接受来自小脑的投射,Vim神经元放电频率的增加提示ET的病理生理可能与小脑的过度活跃相关.     

促醒汤保留灌肠联合西药治疗肝性脑病

目的观察促醒汤保留灌肠联合西药治疗肝性脑病的临床效果。方法病例来源于2012年1月-2016年12月在我院就诊的肝性脑病患者82例,随机分为观察组与对照组,各41例。2组均采用降低血氨生成,祛除诱因,降低血氨,保护肝脏,禁止蛋白质摄入、出现脑水肿者采用甘露醇脱水、补充人血白蛋白、血浆和支链氨基酸,抗感染等常规治疗。对照组采用西药治疗,静脉滴注醒脑静以及门冬氨酸鸟氨酸;观察组联合使用促醒汤,间隔12 h,早晚灌肠治疗。2组均治疗1周。比较2组临床治疗效果,扑翼样震颤消失时间及苏醒时间,治疗前、治疗后3 d、5 d、7 d血氨水平变化。结果观察组总有效率92.68%,高于对照组的75.61%(P0.05);观察组扑翼样震颤消失时间以及苏醒时间均明显短于对照组(P0.05);与治疗前相比较,2组治疗后3 d、5 d、7 d患者血氨水平均明显降低(P0.05),且观察组优于对照组(P0.05)。结论促醒汤保留灌肠联合西药治疗肝性脑病,可有效促进血氨排出,加快恢复苏醒,安全有效。     

家族型特发性震颤的临床分析

目的 对特发性震颤 (essential tremor, ET) 患者进行研究, 以便于更深一步认识疾病的遗传特点和疾病转归.方法 对7个家族39名特发性震颤患者的发病年龄、病程和震颤幅度、药物敏感性、并发症等相关性进行临床总结和统计分析.结果 震颤幅度和发病年龄相关系数为rs=0.542, 和病程相关系数rs=0.168;口服盐酸普萘洛尔在中青年组和老年组有效率分别为79.2%和35.7%, P=0.014;饮酒试验在中青年组和老年组有效率分别为66.7%和28.6%, P=0.042;中青年组和老年组并发症发生率分别为8.3%, 42.9%, P=0.042.结论 随着发病年龄的增长, 听力下降和认知功能下降等并发症明显增多;随着病程延长, 震颤幅度不断增加, 药物敏感性逐渐下降。提示:ET易向其它变性疾病转化, 易合并其它变性疾病, 这种变化和年龄、遗传有一定相关性, 而非传统认为的单纯良性疾病.     

利培酮对精神分裂症患者代谢指标影响的对照研究

目的 探讨利培酮对精神分裂症患者各项代谢指标的影响效应及其相关因素.方法 累积符合入组标准的入院精神分裂症患者共56例,予以利培酮治疗16周,于治疗前后测腰围、血压、血糖、血脂等指标,与36名健康者做对照,并分析患者组发生代谢综合征( Metabolic syndrome,MS)及各项代谢指标异常的危险因素.结果 患者组MS发生率为12.50％,显著高于对照组的0％(P=0.026);患者组16周末腰围、甘油三酯、高密度脂蛋白、餐后2h血糖的变化值[分别为:男(4.15±3.14)cm;女(4.41±2.86)cm,(0.26±0.51) mmol/L,(-0.09±0.19)mmol/L,( 0.49±0.84) mmol/L]均大于对照组[分别为男(0.76±1.09)cm;女(0.64±0.81)cm,(0.04±0.15) mmol/L,(-0.01±0.12)mmol/L,(0.04±0.35) mmol/L],差异有显著性(P＜0.05);Logistic回归分析显示,发生MS及腰围、甘油三酯、餐后2h血糖异常的危险因素分别为糖尿病家史( OR20.34,95％ CI1.97～ 210)及年龄(OR1.19,95％ CI1.03～ 1.38)、基线腰围(OR1.26,95％ CI1.04～1.52)及肥胖家史(OR4.27,95％ CI1.21～15.1)、基线甘油三酯(OR73.88,95％ CI3.41～16.01)及基线收缩压(OR1.16,95％ CI1.00～1.33)、基线腰围(OR1.41,95％ CI1.08～1.84)及年龄(OR1.53,95％ CI1.02 ～1.31).结论 利培酮可引发腹型肥胖、糖脂代谢紊乱乃至MS;对年龄大、有糖尿病家史以及体态较胖的患者应慎用利培酮.     

特发性震颤患者双侧丘脑磁共振波谱研究

目的:应用氢质子磁共振波谱(1H-MRS)成像方法研究特发性震颤(ET)患者双侧丘脑的代谢物变化情况.方法:对14名ET患者和8名健康成人(为对照组)的双侧丘脑进行1H-MRS检查,计算N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)的比值,并对患者采用Fahn-Tolosa-Marin震颤评定量表进行评分.结果:ET患者症状较明显肢体的相关侧丘脑较非相关侧丘脑的NAA/Cr值升高(1.63±0.25 vs 1.56±0.26),ET患者双侧丘脑感兴趣区内NAA/Cr值较对照组双侧丘脑NAA/Cr均值升高(1.63±0.25 vs 1.49±0.35),但差异均无统计学意义(P＞0.05).结论:ET患者双侧丘脑并未发现神经元损伤丢失现象,其在该病发生发展中起到的作用还有待进一步研究.     

充血性心力衰竭患者血浆内皮素改变及卡托普利疗效分析

目的 :探讨内皮素 (ET)与充血性心力衰竭 (CHF)严重程度的关系及卡托普利对其影响。方法 :采用放射免疫法测定ET浓度。6 9例CHF患者为治疗组 (CHF组 ) ,30例正常人为对照组。 6 9例CHF患者中的 12例因有禁忌症而未用卡托普利治疗为非卡托普利组 ,余 5 7例常规口服卡托普利治疗为卡托普利组 ,测入院和治疗 4周时的ET。对随访资料完整的 4 2例卡托普利组患者分别于 8周和 12周时复查ET。结果 :CHF组与对照组比较 ,ET浓度明显增高 (P <0 0 1)。CHF组治疗 4周后ET都有降低 ,但卡托普利组降低明显 (P <0 0 5 )。在 8周与 12周时卡托普利组 4 2例患者ET浓度差异无显著性。结论 :ET参与了CHF的发生发展 ,血浆ET浓度和CHF严重程度呈正相关。血管紧张素转换酶抑制剂 (ACEI)卡托普利应用可降低血浆ET浓度。     

2008-2009年喀什55岁及以上汉族人群原发性震颤患病率调查

目的 了解新疆喀什地区55岁及以上汉族人群原发性震颤(ET)的患病率及特点.方法 采用分层、分段、整群的抽样原则,2008-2009年在新疆喀什地区共调查了2834名汉族中老年人.结果 发现ET患者184例,ET患病率为6.49%,男性患病率(8.45%)高于女性(4.59%);对总人口及不同年龄组ET的患病率进行趋势卡方分析,不同年龄组中,≥75年龄组ET患病率增高较明显(15.32%);不同受教育程度ET患病率分析,文盲人群ET患病率7.26%,小学文化ET患病率7.27%,初中文化ET患病率5.81%,高中、中专文化ET患病率5.58%,大专、大学文化ET患病率9.37%,ET患者中丧偶人数所占比例(15.21%)高于总调查人数中丧偶人数比例(8.89%).结论 ET的患病率有随年龄的增加逐渐增高的趋势,不同受教育程度与ET患病率无明确影响.

Abstract：

Objective To investigate the prevalence and clinical feature of essential tremor (ET)in a community cohort of the elderly in kashkar. Methods By using a door-to-door, two-phase screening approach, some 2834 residents of Hans ethnicity were investigated form 2008 to 2009. Results In this study, 184 ET patients were found. The prevalence rate of ET was 6. 49%. The prevalence rate was increased with age and higher in men (8.45%) than in women (4. 59% ),especially in people ageds above 75years old. The prevalance rate of ET was 7.26% in illiterate people, followed by 7.27%, 5.81%, 5.58% and 9. 37% in those having received primary,junior, senior high school and college. The ratio of windowed people in ET patients was 15.21% ,higher to the ratio of windowed people in total number. Conclusions The prevalence rate of ET increased with age, but not influenced by education.     

帕金森病和原发性震颤患者运动和静息-活动节律的变化

目的　研究帕金森病 (PD)、原发性震颤 (ET)和正常老年人运动和静息 -活动昼夜节律的变化。方法　应用静息活动监测仪(Actigraphy)在自然生活环境下连续在体记录11例PD、9例ET和 10例正常对照组老年人的运动和静息-活动昼夜节律的变化。结果　PD组和ET组的静息 -活动节律日间稳定系数(IS)明显低于正常对照组 (P<0 05),昼夜节律变异性系数(Ⅳ)在 3组之间差异没有显著性 (P>0 05);PD组的日间活动水平 (M10 ) (P<0 05 )、夜间活动水平(L5) (P<0 01)和昼夜节律振幅 (AMP) (P<0 05 )均显著低于ET组和正常对照组,而上述参数在ET组与正常对照组之间相比未发现差异显著性 (P>0 05 )。结论　PD和ET静息-活动昼夜节律的稳定性较正常老人降低,但ET的活动水平和振幅与正常老年人相比没有显著变化。Actig raphy能够灵敏的评价患者的活动水平变化和运动功能紊乱的程度。