fMRI观察海洛因成瘾戒断者情绪加工中的唤醒度异常

目的 探讨海洛因成瘾戒断者情绪加工中唤醒度异常的脑机制。 方法 通过呈现不同唤醒度的情绪图片对13例海洛因成瘾戒断者(试验组)和13名健康人(对照组)进行fMRI。扫描结束后受试者对图片进行唤醒度评定。利用AFNI软件对脑功能数据进行处理,使用SPSS 13.0统计软件对行为学数据进行分析。 结果 观看情绪图片时,试验组左侧杏仁核和海马、双侧丘脑、扣带回、双侧额上回、额中回、右侧中央前回、双侧颞上回、右侧颞下回、左侧梭状回、双侧尾状核等脑区的激活低于对照组;观看高唤醒度图片时,其右侧丘脑、左侧杏仁核和海马的激活高于观看低唤醒度图片,对照组相反。 结论 海洛因成瘾者的情绪唤醒度加工机制存在损伤。     

不同频率重复经颅磁刺激对脑卒中后非流畅性失语的影响及其血氧水平依赖-功能性磁共振成像的表现

目的 探讨不同频率(10 Hz、1 Hz)重复经颅磁刺激(rTMS)刺激右侧大脑半球Broca区镜像区对脑卒中后非流畅性失语患者语言功能恢复的影响及其作用机制.方法 对2例脑卒中后非流畅性失语患者分别进行低频rTMS治疗(1 Hz)和高频rTMS治疗(10 Hz),2例患者均于治疗前和治疗2周后(治疗后)行西方失语症成套检查量表(WAB)测试及fMRI检查.结果 治疗后,2例患者的语言功能均治疗前均明显改善,病例1的AQ评分由治疗前37.2分提升至66.6分,病例2的AQ评分由36.2分提升至60.8分.治疗前,病例1词汇朗读任务主要激活脑区有左侧中央前回,左侧额中回,此外左侧的枕叶下部也有少量激活;治疗后,词汇朗读任务主要激活脑区有左侧额叶内侧面,左侧额下回,左侧额前区,左侧岛叶前部,左侧顶下小叶,左侧颞叶中下回前中部.治疗前,病例2词汇朗读任务主要激活脑区有双侧颞叶内侧面,双侧中央前回;治疗后,词汇朗读任务主要激活脑区有双侧额中回和额叶内侧面,右侧额下回,左侧额前区,双侧顶上小叶,右侧颞上、中回.结论 rTMS治疗可显著改善脑卒中后非流畅性失语患者的语言功能,左侧半球语言区病灶较小的患者可能发生同侧半球功能重组,左侧半球病灶语言区较大的患者则可能发生双侧半球功能重组.     

愉快及非愉快气体激活相应脑区的功能磁共振成像实验研究

目的 采用功能磁共振成像（fMRI）观察和研究愉快及非愉快气体激活相应脑区的情况并对嗅觉中枢及其通路进行功能定位。方法12名右利手、无嗅觉障碍健康志愿者参加实验。采用乙酸戊酯为愉快刺激气体，吡啶为非愉快气体，组块设计，1．5T MRI行EPI序列扫描，用Matlab5．3及SPM99、Talairach等软件数据后处理。结果愉快及非愉快气体刺激海马回钩，丘脑内侧背核、眶额回皮质均出现明显激活，两种气味均表现为右侧大脑半球优势激活，即右侧额叶上、中、下回、右侧眶额回、右侧海马回钩以及右侧丘脑背内侧核均较左侧半球相应脑区激活明显；与情绪相关脑区亦发现激活，即额内侧回、海马旁回、扣带回、颢上回以及右侧额叶上、中、下回。愉快气体激活大脑前区为主，非愉快气体激活大脑后区明显。结论BOLD-fMRI是研究人类嗅觉功能的有效方法。本研究进一步验证了海马回钩、丘脑内侧背核和眶额回为嗅觉中枢及其重要通路，并且右侧大脑半球为嗅觉“优势半球”；气味嗅觉还引起与情绪相关脑区的激活，并且愉快情绪主要与大脑前部区域有关，不愉快情绪主要与大脑后部区域关系密切。     

美沙酮维持治疗的海洛因成瘾者左侧执行控制网络功能特征的fMRI研究

目的探讨美沙酮维持治疗的海洛因成瘾者左侧执行控制网络功能连接的特点。材料与方法纳入21例美沙酮维持治疗的海洛因成瘾者与20例年龄、性别、教育程度相匹配的健康者,采用3.0 T磁共振设备进行静息态磁共振成像。首先,基于左侧执行控制网络感兴趣区计算全脑功能连接,分析两组间左侧执行控制网络功能连接差异,并进一步分析差异区功能连接值与海洛因吸食史和美沙酮治疗史的相关性。结果与健康组相比,美沙酮维持治疗的海洛因成瘾者的左侧背外侧前额叶与双侧背外侧前额叶功能连接增强(P<0.05,GRF校正),左侧后顶叶与左侧中央后回的功能连接增强。(P<0.05,GRF校正)。上述区域的功能连接强度值与海洛因吸食史和美沙酮治疗史无相关性(P值均>0.05)。结论美沙酮维持治疗的海洛因成瘾者左侧背外侧前额叶与双侧背外侧前额叶功能连接增强可能提示美沙酮有助于改善海洛因成瘾者的大脑执行控制功能,从而降低复吸风险;大脑左后顶叶与中央后回功能连接增强,可能是长期服用海洛因导致的对毒品线索刺激异常适应的表现。     

高频重复经颅磁刺激对健康被试者情绪词注意的影响

目的:观察左侧背外侧前额叶高频重复经颅磁刺激对健康志愿者情绪信息注意特点的影响。方法:实验于2005-10/12在北京大学精神卫生研究所完成。招募北京大学精神卫生研究所及北京大学医学部的33名健康被试者,在完成一般情况问卷、焦虑特质-状态量表、情绪词线索-靶子测验后,接受20Hz重复经颅磁刺激左侧背外侧前额叶,5min后完成情绪词线索-靶子测验情绪词注意实验采用线索提示范式,以情绪词为线索,所采用情绪词选自中国科学院心理所开发的标准化情绪词系统,包括正性情绪词、中性词、负性情绪词各20个,各种情绪词的维度都进行了匹配。靶子为直径3mm的黑色圆点或者同样大小的三角形,被试需要对靶子做出分类反应:靶子为圆形时,被试按下游戏杆右侧的1号键,靶子为三角形时,则按右侧的2号键。线索和靶子呈现在距离中央注视点(白色 )左右各2cm的2个白色方框内,方框高5.3cm,宽3cm。实验在微机上完成,被试距显示屏50cm。实验设计为3×2被试内实验设计,第1个因素为线索即情绪词极性(正性、中性、负性);第2个因素为靶子出现的空间位置是否被提示,可将空间位置分为提示位置(线索有效位置)和非提示位置(线索无效位置)线索-靶子呈现时间为300ms,线索和靶子出现在同一侧的为有效线索,否则为无效线索。比较重复经颅磁刺激前后健康被试的情绪词注意实验结果。结果:纳入正常被试33人,有2人重复经颅磁刺激后未完成情绪词注意实验,最终进入结果分析31人。①健康被试接受重复经颅磁刺激前的情绪词注意测验多因素方差分析结果:线索的有效性这一因素(线索化)对反应时影响显著[F(1,30)=11.5,P=0.001],而情绪词的极性(正性、负性、中性)对有效和无效线索位置的反应时没有影响。②与重复经颅磁刺激前比较,重复经颅磁刺激后3种极性词语的有效线索位置,对靶子的平均反应时降低(刺激前,中性:729.79±105.23;正性:737.16±104.73;负性:728.92±107.26;刺激后:中性:674.07±86.22;正性:689.88±88.47;负性:679.03±82.77)。其中,中性以及负性情绪词线索下平均反应时减少差异具有显著性(中性:t=2.309,P=0.024;负性:t=2.073,P=0.042;正性:t=1.945,P=0.056)。③在无效线索化位置,各种极性的情绪词线索条件下,重复经颅磁刺激前后平均反应时没有差异。结论:20Hz重复经颅磁刺激左侧背外侧前额叶提高了健康被试的注意定向,而对注意滞留没有影响;20Hz重复经颅磁刺激没有造成健康被试对情绪词的注意偏向。     

电针通里、悬钟穴对1例皮质下失语症患者语言功能和fMRI改变的作用

目的：通过对1例皮质下失语症患者针刺通里、悬钟前后的语言学评估，观察此穴位配伍的语言学疗效及探索语言功能的改善与皮质激活效应的关系和意义。方法：试验1：对1例皮质下失语症志愿者在针刺通里、悬钟前后用汉语标准失语症检查表进行语言学评价。试验2：分别电针左、右通里、悬钟，试验采用组块设计模式，静息阶段与刺激阶段交替；运用fMRI中的BOLD技术及SPM2软件分析方法来显示脑皮质功能区的激活情况。结果：电针左侧通里、悬钟后出现右侧颞上回、颞横回、额下回、岛叶、海马旁回、中央前后回、小脑扁桃体等部位的激活．电针右侧通里、悬钟后左侧颞上回、颞下回、海马旁回、角回、岛叶、顶上小叶、顶下小叶、中央后回等脑区出现激活：其中电针左侧的通里、悬钟后出现双侧颞叶的皮质激活效应。结论：针刺通里、悬钟可以激活脑语言功能区，从而证实针刺此组穴位可以改善失语症患者的语言功能。通过观察针刺单侧穴位后的侧别交叉激活和双侧皮质激活推测语言功能的双侧性。     

帕金森病静息状态下纹状体功能连接的fMRI研究

目的应用血氧水平依赖的功能性磁共振成像研究帕金森病(Parkinson's disease,PD)静息状态下功能连接的改变。材料与方法对35例符合PD诊断标准的患者及20名健康者行静息态脑功能性磁共振成像,选双侧纹状体(striaum,STR)为感兴趣区,采用双样本t检验分别比较左侧STR(L-STR)、右侧STR(R-STR)在两组间的脑功能连接的差异。结果 (1)以L-STR为种子点时,PD组右侧前额叶背外侧部、双侧后扣带回皮质、左侧中央前后回、顶下小叶、左侧楔前叶、左侧缘上回等脑区的正连接较正常组减弱(P0.05,Alpha Sim校正),额下回、海马旁回、左侧海马、左侧岛叶正连接增强(P0.05,Alpha Sim校正)。(2)以R-STR为种子点时,PD组右侧前额叶背外侧部、双侧后扣带回皮质等脑区正连接较正常组减弱(P0.05,Alpha Sim校正),右侧舌回、岛叶、海马旁回、双侧海马、左侧丘脑等脑区正连接增强(P0.05,Alpha Sim校正)。结论静息状态下PD患者的脑功能连接网络存在异常。     

正常人简单与复杂乘法运算的功能磁共振成像研究

目的探讨正常人完成简单与复杂乘法运算任务时的脑功能激活特征。方法 2010年6月~2012年6月,采用任务态功能磁共振成像(f MRI),观察13名正常人完成对照任务、视空间记忆、简单(一位数)乘法和复杂(二或三位数)乘法4种任务下激活的脑区。结果相较于对照任务,视空间记忆任务主要激活双侧枕叶、右侧楔前叶、右侧顶上小叶;简单乘法任务主要激活双侧枕中回、左侧顶上小叶、左侧扣带回、左侧额中回以及左侧额下回;复杂乘法任务主要激活右侧顶上小叶、右侧额下回和双侧额中回。结论复杂乘法运算的正确执行依赖于一个右侧顶-额叶网络,该网络支持计算过程空间布局信息的存储。     

左侧颞叶癫痫患者脑皮质计算功能重组的fMRI研究

目的采用任务相关功能性磁共振成像技术（fMRI）观察左侧颞叶癫痫（TLE）患者与健康人完成计算任务时脑区激活差异。 方法选取右利手、左侧TLE患者16例作为TLE组,另选取相匹配健康受试者16例作为对照组。2组受试者均进行简单加法、简单减法及退位减法计算任务,同时进行脑部fMRI检查。采用神经影像学统计参数图（SPM-5）软件进行数据处理和分析,并比较2组间脑区激活差异。 结果计算任务中,TLE组的计算正确率为76.30%,显著低于对照组的96.80%（P<0.05）;而TLE患者组的计算反应时间为（2589±213.20）ms,与对照组的（1765±134.90）ms比较,差异有统计学意义（P<0.05）。对照组激活强度高于左侧颞叶癫痫组的脑区有左侧中央旁小叶、左侧中央后回、双侧顶下小叶、左侧角回、双侧缘上回、左侧额中回、左额上回、双侧后扣带回、双侧岛叶、双侧颞上下回、右侧海马、海马旁回、双侧丘脑和小脑。左侧颞叶癫痫组激活强度高于对照组的脑区有双侧顶上小叶、双侧前扣带回和右侧额中下回。 结论左侧TLE患者计算相关的脑功能区具有半球内及半球间重组,额顶叶可在计算功能的代偿中发挥一定的作用;任务相关fMRI技术可为无创评价TLE患者计算认知功能提供重要证据。     

fMRI观察强制戒断对海洛因成瘾者渴求任务下大型脑网络的影响

目的 探讨强制戒断对海洛因成瘾者毒品线索任务下心理渴求及脑网络功能的影响。方法 对37例强制戒断的海洛因成瘾者（强制戒断组）和32名正常志愿者（对照组）先行静息态及渴求任务fMRI数据采集,并进行心理渴求量化评分。对静息态fMRI数据进行分析获取任务负相关网络（TNN）和任务正相关网络（TPN）。对任务态fMRI数据进行建模,与对照组比较,获得强制戒断组TNN和TPN中异常激活的脑区,并分析其与心理行为学的相关性。结果 强制戒断组任务线索图片呈现前后渴求评分均显著高于对照组（P均<0.01）。渴求任务下,与对照组比较,强制戒断组在TNN中右侧海马旁回显著激活,TPN中显著性增强的网络包括视觉空间网络（双侧中央前回、额下回）和感觉运动网络（左侧中央后回）。强制戒断组双侧额下回激活强度与吸食海洛因时间呈负相关（右侧：r=－0.37,P=0.02;左侧：r=－0.41,P=0.01）。结论 强制戒断的海洛因成瘾者主观渴求依然增高,多个大型脑网络异常功能尚未完全恢复,可能是导致复吸的神经病理学基础。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.