应用CT灌注评估少量基底核区脑出血手术指征的临床研究

目的探讨应用CT灌注(CTP)评估基底核区少量脑出血的手术指征。方法选择少量基底核区脑出血病人236例,根据CTP监测的入院时血肿周围局部脑血流量(r CBF)分为轻度低灌注组[(r CBF≥15 ml/(100g·min)]142例和严重低灌注组[(r CBF15ml/(100g·min)]94例,两组再根据病人是否同意手术,分别分为手术组和非手术组。两手术组病人入院后予急诊微创血肿软通道引流术,两非手术组予内科保守治疗。采用Rankin分级评估病人的生存质量,并分别对比不同灌注组中手术组与非手术组间的有效率和r CBF情况。结果轻度低灌注组中,手术组与非手术组的治疗有效率,及两组入院时与入院后7 d r CBF比较均无统计学差异(P0.05)。严重低灌注组中,手术组与非手术组的治疗有效率,及手术组中入院时与入院后7 d r CBF比较均有统计学差异(P0.05),而非手术组两者差异无统计学意义(P0.05)。结论CTP是评估少量基底核区脑出血手术指征的客观指标。对少量基底核区脑出血严重低灌注的病人,手术可明显改善预后。     

内镜下微侵袭手术治疗高血压脑出血的预后影响因素

目的探讨影响内镜下微侵袭手术治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)幕上血肿病人预后的各项因素及相互关系。方法回顾性分析109例采用内镜微侵袭手术治疗HICH病人的临床资料。以GOS评分3~5分为预后良好组(n=76),1~2分为预后不良组(n=33),统计分析入院平均动脉压(mean arterial pressure,MAP)、血肿量、GCS评分、NIHSS评分等因素对预后的影响。结果预后良好组与预后不良组之间MAP、幕上血肿量、GCS评分、NIHSS评分的差异有统计学意义(P0.05)。多因素Logistic回归分析显示:MAP(OR=0.944,95%CI=0.897~0.994,P=0.030)和NIHSS评分(OR=0.857,95%CI=0.749~0.982,P=0.026)是影响预后的独立危险因素。幕上血肿量与入院NIHSS评分呈显著正相关(r=0.688,P0.001),与GCS评分存在显著负相关(r=-0.780,P0.001)。结论 MAP和NIHSS可作为独立预测微侵袭手术治疗HICH病人预后的因素。血肿量与GCS和NIHSS评分呈相关性,可反映HICH病情严重程度及神经功能损害程度。     

血管性痴呆神经心理学与事件相关电位的研究

目的 探讨血管性痴呆神经心理学与事件相关电位(P300)的变化规律及临床意义。方法 选取血管性痴呆患者30例，并以与其年龄、性别基本相似的体检健康者为对照组，用认知能力甄别检查法(OCSE)、老年性痴呆评定量表(ADAS)作神经心理学测试后，再用听觉Oddball序列研究血管性痴呆患者事件相关电位(ERPs)的P3成分。结果 血管性痴呆组CCSE、ADAS与对照组有显著差异(P＜0．05)。血管性痴呆组P3峰潜伏期(P3PL)、P3波幅(P3AMP)与对照组相比差异显著(P＜0．05)。CCSE与P3PL呈显著负相关(r＝-0．357，P＜0．05)，ADAS与P2PL呈显著正相关(r＝1．25，P＜0．05)。结论 血管性痴呆的认知功能评分与患者的巴潜伏期长短有明显相关性。     

脑胶质瘤中细胞凋亡与相关基因Fas、survivin表达的相关性及预后意义

目的　探讨脑胶质瘤中细胞凋亡与相关基因Fas、survivin表达的关系及其预后意义。方法　应用TUNEL法检测细胞凋亡 ,免疫组化SABC法检测Fas、survivin和PCNA ,实验数据用SPSS 10 0软件包进行统计。结果　Fas阳性组的AI较Fas阴性组显著增高 (P =0 0 0 1)。Fas的加权计分和AI之间呈明显线性相关 (r=0 65 8,P <0 0 0 1)。Survivin阳性组的AI较survivin阴性组显著减小 (P<0 0 1)。Survivin表达的加权计分和AI之间呈明显负线性相关 (r=-0 3 77,P <0 0 0 1)。低AI( <0 96)组与高AI(≥ 0 96)组的术后 1年生存率的差异有显著意义 (P <0 0 5 )。死亡组与存活组的AI差异无显著意义 (P =0 2 4) ,而两组的AI/PI有显著差异 (P <0 0 0 1)。多因素Logistic回归模型分析显示 ,病理、Fas、survivin、AI、AI/PI和手术与预后相关 (P <0 0 5 )。结论　细胞凋亡受多种基因的网络式调控。AI的高低与其相关基因Fas、survivin的表达有关。AI可作提示预后的指标 ,对脑胶质瘤的生物学行为及肿瘤分级有指导意义。肿瘤级别较低、Fas阳性、survivin阴性、AI<0 96%、AI/PI较大、手术全切除的患者预后较好。     

汉语语法量表及其信度和效度研究

目的 设计一套汉语语法检查量表(Chinese Agrammatism Rattery,CAB)并测试其信度和效度。方法 对46名脑部疾病患者及46例健康受试者进行了CAB测试，计算失语法指数(agrammatism quotient,AgQ)，并与汉语标准化失语检查法(aphasia battery of Chinese,ABC)对比。计算检查者问、检查者内及复测相关系数。结果 左、右大脑半球病变组及对照组CAB各亚项量表分的平均数差异极显著(F＝4．50-18．57，P＜0．05)。左大脑半球病变组各个亚项量表分平均成绩均明显低于右大脑半球病变组(q＝5．63-9．67，P＜0．05)与健康对照组(q＝7．50-9．61，P＜0．01)。量表的复测信度、检查者间信度、检查者内信度均较好(r＝0．991-0．999，P＜0．01)。CAB法的AgQ与ABC比法各指标间呈显著正相关(r＝0．928-0．979，P＜0．01)。结论 CAB具备较好的信度和效度，可以作为定量评定汉语失语症患者语法障碍的工具。     

脑室引流及脑脊液置换治疗重型脑室出血的临床分析

目的探讨重型脑室出血的有效治疗方法.方法采用单纯内科治疗(非手术组)和侧脑室引流并脑脊液置换并加内科治疗(手术组)治疗重型脑室出血.结果手术组血肿清除时间缩短,总有效率(86.7%)、治愈率(46.7%),明显高于非手术组(P＜0.01),而病死率低于非手术组(P＜0.01).结论侧脑室引流并脑脊液置换是一种治疗有效的治疗重型脑室出血的方法.     

早期脑出血后细胞凋亡与p75NTR、TrkA的相关性研究

目的 探讨p75NTR、TrkA在高血压脑出血(hypertensive intracerebral hemorrhage,HICH)早期的表达情况,初步阐明其与细胞凋亡的关系.方法 收集20例HICH病人脑出血后早期血肿周围不同部位组织标本,分为血肿表面组、半暗带组、脑皮质下区组;并在三组中将标本按出血时间(＞7h、≤7 h)、出血量(＞60 ml、≤60 ml)分组.采用免疫组化检测三组中p75NTR、TrkA的表达,TUNEL方法检测凋亡细胞率,统计分析p75NTR、TrkA及凋亡细胞的相关性.结果 TUNEL法检测结果:脑出血后越靠近血肿凋亡细胞越多(P＜0.01).HICH早期越靠近血肿表面p75NTR表达增加(P＜0.01),并与凋亡细胞率成正比(P＜0.05);TrkA在脑出血后有表达,不同部位TrkA表达无差异(P＞0.05),与细胞凋亡无明显关系(P＞0.05).血肿表面组p75NTR/TrkA比率较其余两组上升(F=4.851,P=0.011).随着出血时间延长、出血量增加,p75NTR表达增加(P＜0.05),而TrkA表达无变化(P＞0.05).结论 HICH早期病人p75NTR在TrkA低表达或者无活性环境中促进细胞凋亡,TrkA与细胞凋亡无相关,p75NTR/TrkA比率变化影响出血后细胞凋亡.     

抑郁症患者中庸思维、反应方式和情绪的关系

目的：探讨抑郁症患者中庸思维、反应方式和情绪的关系。方法运用中庸思维量表、反应方式问卷、正性负性情绪量表对300例符合ICD－10中抑郁症诊断的患者进行测评,并对三者的关系进行分析。结果沉思与负性情绪呈正相关（ r ＝0．268,P ＜0．01）,分心与正性情绪呈正相关（ r ＝0.359,P ＜0．01）,与负性情绪呈负相关（ r ＝－0．167,P ＜0．05）;中庸思维与分心呈正相关（ r ＝0.242,P ＜0．01）,与负性情绪呈负相关（ r＝－0．237,P＜0．01）。中庸思维调节沉思和负性情绪的关系。结论中庸思维程度不会改变分心对情绪的影响,中庸思维程度越低沉思对负性情绪的影响越大。     

弥散张量成像在高血压脑出血患者预后评估中的应用

目的应用弥散张量成像(DTI)观察高血压脑出血(HICH)皮质脊髓束(CST)的损伤,探讨DTI在HICH治疗、康复过程中对预后评估的应用价值。方法对20例HICH患者分别于入院7 d内及康复治疗2个月后,进行DTI检查、CST分级和肌力评级;测定血肿层面CST部分各向异性分数(FA),计算相对FA值(r FA)。结果 HICH患者入院时和发病2个月后r FA值和肌力评级均呈正相关(r=0.703,0.712,均P=0.01);入院时和发病2个月后患侧CST分级与肌力评级均呈正相关(r=0.658,0.649,均P=0.02)。发病后2个月,肌力较好组(肌力4~5级)r FA与肌力较差组(肌力0~3级)比较,差异有统计学意义,所有r FA0.8的患者运动功能都有显著改善。结论通过DTI的FA测定,可以了解HICH患者CST的损伤情况,有助于早期评估HICH患者的肌力恢复情况和预后。     

第Ⅳ脑室血肿扩张对脑出血预后的影响

目的：探讨第Ⅳ脑室血肿扩张与脑出血预后的关系。方法：应用头部CT对脑出血破 不破入第Ⅳ脑室患者,以及健康对照者分组测量第Ⅳ脑室的左右径、前后径、第Ⅳ脑室与颅骨的比值（VCR）及哥拉斯格昏迷计分法（）GCS）判断意识障碍。结果与健康对照组及出血未破入Ⅳ脑室组比较,脑出血破入Ⅳ脑室组尤其Ⅳ脑室血肿扩张组Ⅳ脑室左右径、前后径及VCR均扩大（P＜0．01）,GCS计分明显下降（P＜0．01）,死亡率明显增加（P＜0．01）。Ⅳ脑室左右径,前后径扩大与VCR呈正相关,与GCS计分呈负相关。结论：Ⅳ脑室血肿扩张是脑出血预后不良的重要标志。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -     

Summary of legislation of 1941 of interest to the Department of Mental Hygiene

Psychiatric Quarterly -     

Asymmetry of on- and off-pathways of blue-sensitive cones of the retina of macaques

Macaque retinal ganglion cells whose receptive-field center recieves input from blue-sensitive cones show an overt asymmetry of the frequency of ON-center and OFF-center varieties, an asymmetry not present in ganglion cells whose center receives input from the other two cone types. A similar asymmetry of ON/OFF responses is found in the local electrotetinogram (d-wave) mediated by signals from blue-sensitive cones. ‘Blue-ON-center’ ganglion cells have larger receptive-field centers and shorter conduction latencies than other opponent-color varieties, suggesting an appreciable degree of receptor convergence and presumably large cell bodies. Intracellular stainings of these neurons with Procion Yellow show that they correspond to diffuse stratified (Parasol) ganglion cells whose flat-topped dendritic arborization stratifies in the sclerad half of the inner plexiform layer. In view of the known characteristics of macaque bipolar cells and of the ON/OFF asymmetry, it is proposed that these ganglion cells are postsynaptic to cone-specific flat bipolars possibly mediating sign-inverting synaptic contacts. The results also indicate a reversal, for the blue-cone pathway, of the ON/OFF lamination of the inner plexiform layer that has recently been described in other species.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.