VNS治疗癫痫的医学工程及应用技术

迷走神经刺激(VNS)治疗难治性癫痫,特别是对复杂部分性癫痫,能减少发作的频度和强度。本文从VNS的解剖基础,作用机制和实验动物模型的试验,叙述刺激的作用和效果,并介绍刺激系统各主要部件的功能和通常采用的刺激参数。     

FDA信息(一)

美国休斯顿Gydernoics有限公司研制的神经控制修复装置已经FDA批准上市。这种可置入的装置用来作为患顽固性癫痫病人的辅助治疗，就象“大脑的起搏器。”该装置的脉冲发生器置入胸部皮下；其导程一进入到较低的颈部，并围绕在迷走神经周围。神经病学家可为该装置制定释放间歇性电脉冲计划。如果病人觉得癫痫开始发作时，他们可以激发该系统，通过发生器上的一个磁铁传递释放额叶的刺激。FDA有关人士认为，迷走神经刺激器为不受控制性癫痫发作病人提供一种新型的治疗。他指出，虽然这种治疗器械大概不能帮助美国所有（大约170万）癫痫病人…     

迷走神经电刺激术的研究现状和发展

迷走神经电刺激是通过神经外科手术将线圈放置于左颈部内的迷走神经上,并且将刺激装置埋在胸前,再调整装置参数与模式,使刺激器自动刺激迷走神经而达到治疗目的。目前迷走神经刺激术已被批准应用于临床难治性癫痫和抑郁症患者,其在疼痛、记忆功能障碍、颅脑损伤、脑缺血等诸多领域都展示了巨大的价值和潜力。目前其作用机制也正在逐步理解中,刺激参数的调控也越来越精确,对于疾病的治疗效果也在逐步提高。迷走神经电刺激术的有效性和安全性具有广阔的发展前景和应用市场。本文现将迷走神经电刺激术在癫痫、心力衰竭、疼痛的临床应用及机制研究进展作一综述。     

迷走神经刺激对大鼠海马神经元和星形胶质细胞的影响

目的：研究迷走神经刺激（VNS）对海马星形胶质细胞和神经元的影响,阐明海马在迷走神经抑制癫痫中的作用. 方法：利用免疫组织化学法,观察VNS前后,海马胶原纤维酸性蛋白（GFAP）和Fos蛋白的表达变化.结果：VNS治疗后,海马Fos、GFAP和Fos/GFAP双标细胞数,明显低于癫痫组.结论：VNS可能通过抑制海马星形胶质细胞Fos蛋白表达发挥抑制癫痫作用.     

有关癫痫病因和诊断的问题

1心理因素与癫痫发作有关系吗？ 癫痫是大脑神经元突发性异常放电,导致短暂的大脑功能障碍的一种慢性疾病。癫痫的发作与很多因素有关,过度劳累、睡眠不足、刺激性的食物都可能导致癫痫的发作,而往往人们对于精神刺激与癫痫发作的关系缺乏足够的重视。可以确定地说,心理因素与癫痫发作是有关系的。     

癫痫治疗新技术：小脑刺激器

基于中枢神经系统的兴奋和抑制的电生理特性,可用慢性小脑刺激来治疗顽固性癫痫。临床试验表明,慢性小脑刺激能改善 EEG,减少体感诱发电位和 H-反射,从而减少发作次数。     

老年人脑出血后继发癫痫及其相关因素的探讨

目的探讨老年人脑出血继发癫痫的发病率、发作机制、发作类型、出血部位与发作的关系及预后.方法对47例老年人脑出血继发癫痫病人的临床资料进行分析.结果老年人脑出血后癫痫发病率9.6%.早期发作与脑水肿有关,以部分性发作为主;晚期发作与中风囊、神经元变性及胶质增生或粘连等病理刺激有关,以全身强直阵挛性发作为主,且多见于出血后2周至半年内.脑叶出血后癫痫发作,需系统规则的用药,预后良好.结论老年人脑出血继发癫痫并非少见.脑叶出血易致癫痫发作.晚期发作需系统规则的用药.     

癫痫病人的生活起居

癫痫是危害人体健康的一大顽症,如能正确应用现代癫痫治疗技术,及时进行正规系统的治疗,80％以上的病人可以治愈或控制发作。但目前我国大部分地区癫痫治疗状况很不理想,常有复发的趋势,为此在日常生活中要注意以下几个方面。 乐观情绪 实践证明,精神紧张、悲观失望等可促使癫痫发作。多     

孩子癫痫的正确举措

有些家长发现自己的孩子患了癫痫,收于卫生知识缺乏,常犯“病急乱投医”的毛病,甚至错误地求神拜佛。据河南省城乡随机抽取376例癫痫病人调查,仅35％病人得到较好的控制,多数未得到合理系统的药物治疗。 一旦癫痫诊断成立,采取何种治疗办法应由医生决定。对于每年仅有一次大发作的,或每月仅有一次小发作的病儿,发作若无增多趋势,就不必要服药,加以预防即可。临床上没有发作,但脑电图有高峰节律紊乱和双侧有同步棘波发放的病儿,应给抗癫痫冶疗。对于那些难治的病例,不要单纯追求控制发作而加用药物     

一种新型智能电刺激治疗仪的研究

目的:针对目前电刺激治疗设备可调参数少、易产生组织极化和刺激电流不稳定等问题,研发一种基于单片机控制的新型智能电刺激治疗仪。方法:硬件系统以ADμC831为核心,电路包括按键控制、液晶显示、输出电路和反馈回路等。设计了正负对称的刺激脉冲模式,采用C语言进行模块化编程。结果:实现了电刺激波形的智能化组合及参数变化与调节,输出脉冲正负对称,提供恒流刺激模式。结论:电刺激器的设计新颖,具有固定和可编程两种刺激脉冲设置模式,脉冲波形和相关参数定量可调,可适用于不同医学基础研究及临床电刺激与治疗应用。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.