早期多发性硬化和视神经脊髓炎高危综合征的临床特点

目的 探讨早期多发性硬化和视神经脊髓炎高危综合征的临床特点.方法 回顾性分析我院2012-04-2014-01收治的45例早期MS患者和33例NMO高危综合征患者的临床资料,对比分析2组一般资料、机体功能评价、影像学检查和生化检查结果,总结两种疾病的临床特点.结果 2组在括约肌症状、认知障碍、小脑症状、视力受损及运动症状方面比较差异无统计学意义(P＞0.05),在病程、脑干症状、EDSS评分及感觉症状等方面比较差异有统计学意义(P＜0.05).早期MS组患者病灶数量＞9个、Barkhof标准符合率及脑MRI多发性硬化样病灶发生率均高于NMO高位综合征组,差异有统计学意义(P＜0.05).早期MS组患者脊髓病灶发生率、脑脊液白细胞计数异常率、脑脊液蛋白异常率、脑脊液蛋白水平及脑脊液白细胞计数均低于NMO高位综合征组患者,差异有统计学意义(P＜0.05).2组在钆增强扫描病灶发生率方面比较差异无统计学意义(P＞0.05).NMO高位综合征组抗体阳性率显著高于早期MS组,差异有统计学意义(P=0.018).结论 视神经脊髓炎高危综合征和早期多发性硬化具有不同的临床特点,临床诊断中应加以利用进行甄别,避免误诊的发生.     

视神经脊髓炎与多发性硬化的临床表现和视神经脊髓炎IgG抗体阳性率的对比

目的 比较视神经脊髓炎(NMO)和多发性硬化(MS)在临床表现、辅助检查等方面的不同;比较NMO和MS等脱髓鞘疾病患者血清NMO-IgG抗体的阳性率,判断该抗体能否作为鉴别诊断的一项实验室依据.方法 对34例NMO、22例MS、24例高危综合征、5例临床孤立综合征以及35例其他神经科疾病患者进行NMO-IgG检测,并对其中NMO、MS患者的人口学、临床表现、免疫学指标、脑脊液、头颅MRI等资料进行对比.结果 NMO的起病年龄较MS大且年龄跨度更广;从年复发率和进展指数来看,NMO更为严重,预后更差;NMO长节段脊髓损害者比MS多.NMO-IgG在NMO组和高危综合征组的阳性率分别为58.8%(20/34)和45.8%(11/24),高于MS组(1/22)、临床孤立综合征组(1/5)和其他疾病组(1/35;X2=37.2,P<0.01).NMO-IgG阳性率与脊髓病变长度相关.结论 NMO和MS在临床表现、辅助检查等方面都有所不同,提示NMO与MS可能是2种不同的疾病.NMO-IgG在NMO患者中的阳性率高于MS患者,可以作为鉴别诊断的一项实验室依据.     

视神经脊髓炎与多发性硬化的临床表现和视神经脊髓炎IgG抗体阳性率的对比

目的 比较视神经脊髓炎(NMO)和多发性硬化(MS)在临床表现、辅助检查等方面的不同;比较NMO和MS等脱髓鞘疾病患者血清NMO-IgG抗体的阳性率,判断该抗体能否作为鉴别诊断的一项实验室依据.方法 对34例NMO、22例MS、24例高危综合征、5例临床孤立综合征以及35例其他神经科疾病患者进行NMO-IgG检测,并对其中NMO、MS患者的人口学、临床表现、免疫学指标、脑脊液、头颅MRI等资料进行对比.结果 NMO的起病年龄较MS大且年龄跨度更广;从年复发率和进展指数来看,NMO更为严重,预后更差;NMO长节段脊髓损害者比MS多.NMO-IgG在NMO组和高危综合征组的阳性率分别为58.8%(20/34)和45.8%(11/24),高于MS组(1/22)、临床孤立综合征组(1/5)和其他疾病组(1/35;X2=37.2,P<0.01).NMO-IgG阳性率与脊髓病变长度相关.结论 NMO和MS在临床表现、辅助检查等方面都有所不同,提示NMO与MS可能是2种不同的疾病.NMO-IgG在NMO患者中的阳性率高于MS患者,可以作为鉴别诊断的一项实验室依据.     

视神经脊髓炎与多发性硬化的临床表现和视神经脊髓炎IgG抗体阳性率的对比

目的 比较视神经脊髓炎(NMO)和多发性硬化(MS)在临床表现、辅助检查等方面的不同;比较NMO和MS等脱髓鞘疾病患者血清NMO-IgG抗体的阳性率,判断该抗体能否作为鉴别诊断的一项实验室依据.方法 对34例NMO、22例MS、24例高危综合征、5例临床孤立综合征以及35例其他神经科疾病患者进行NMO-IgG检测,并对其中NMO、MS患者的人口学、临床表现、免疫学指标、脑脊液、头颅MRI等资料进行对比.结果 NMO的起病年龄较MS大且年龄跨度更广;从年复发率和进展指数来看,NMO更为严重,预后更差;NMO长节段脊髓损害者比MS多.NMO-IgG在NMO组和高危综合征组的阳性率分别为58.8%(20/34)和45.8%(11/24),高于MS组(1/22)、临床孤立综合征组(1/5)和其他疾病组(1/35;X2=37.2,P<0.01).NMO-IgG阳性率与脊髓病变长度相关.结论 NMO和MS在临床表现、辅助检查等方面都有所不同,提示NMO与MS可能是2种不同的疾病.NMO-IgG在NMO患者中的阳性率高于MS患者,可以作为鉴别诊断的一项实验室依据.     

急性播散性脑脊髓炎、多发性硬化及视神经脊髓炎脑深部灰质病灶MRI影像比较

目的 探讨并比较急性播散性脑脊髓炎(ADEM)、多发性硬化(MS)及视神经脊髓炎(NMO)脑深部灰质病灶的MRI影像学特征. 方法 自2004年8月至2012年10月在中山大学附属第三医院神经内科住院的ADEM、MS、NMO患者共353例,筛选出其中MRI显示有脑深部灰质病灶者95例(包括ADEM 12例,MS 60例,NMO 23例),对这些病灶的大小、数量、部位等特征进行分析. 结果 3组患者丘脑、尾状核、苍白球受累的病例数比例比较差异均无统计学意义(P=0.154,P=0.438,P=0.697).ADEM组壳核受累的病例数比例明显高于MS组、NMO组,差异有统计学意义(P=0.002,P=0.013).NMO组下丘脑受累的病例数比例则明显高于ADEM组、MS组,差异有统计学意义(P=0.033,P=0.001).ADEM组丘脑的病灶直径明显大于NMO组,差异有统计学意义(P=0.027),但和MS组相比差异无统计学意义(P=0.116),而MS组和NMO组丘脑的病灶直径比较差异亦无统计学意义(P=0.209).3组尾状核、壳核、苍白球、下丘脑的病灶直径比较差异均无统计学意义(P＞0.05).3组的病灶分布对称性比较差异无统计学意义(P=0.335). 结论 丘脑受累对于ADEM和MS的鉴别诊断可能意义不大,壳核受累可能是将ADEM区别于MS和NMO的一个鉴别点,下丘脑受累是NMO的特异性表现.病灶直径大小在这三种疾病的鉴别诊断中价值不大.     

视神经脊髓炎脊髓损害的磁共振研究

目的分析视神经脊髓炎(NMO)和多发性硬化(MS)患者脊髓MRI特点,以及血清抗水通道蛋白4(AQP4)IgG抗体阳性与阴性NMO患者脊髓MRI特点。方法回顾分析贵州省中枢神经系统脱髓鞘疾病数据库中42例NMO和32例有脊髓损害的MS患者的脊髓MRI资料。结果与MS组比较,NMO患者脊髓病灶累及更长的椎体节段(P0.05),在脊髓MRI矢状位上表现为线样征和纵向延展的脊髓损害(LESCL)(P0.05)。轴位T2WI上亮斑状损害(BSLs)以及中心性、横贯性脊髓损害更常见(P0.05);在病灶部位及强化病灶上,NMO和MS组间比较差异无统计学意义。与血清抗AQP4-IgG抗体阴性NMO患者比较,阳性患者线样征、BSLs、中心性损害更常见(P0.05),在脊髓病灶部位、受累椎体节段数、LESCL、横贯性损害及强化病灶方面,抗AQP4-IgG抗体阳性组和阴性组间比较差异无统计学意义。结论除LESCL、线样征、横贯性损害和中心性损害特点外,BSLs可能是另一个有助于鉴别NMO与MS的脊髓病灶MRI特征。BSLs、线样征、中心性损害特点可能与NMO患者抗AQP4-IgG抗体的血清学状态有关。     

视神经脊髓炎患者脑脊液和血清间氯失衡的探讨

目的比较视神经脊髓炎和其他疾病脑脊液及血清的氯化物比值,探讨视神经脊髓炎可能的病理机制。方法回顾性分析75例至少进行过一次血清和脑脊液配对检查的患者,分为视神经脊髓炎(NMO)、控制组(非感染性疾病)、周围神经病、中枢神经系统感染组,重点对比氯的商数(CSF水平/血清水平,Q_(Cl)),并同时对比白蛋白、葡萄糖的商数及其脑脊液细胞数等指标。结果视神经脊髓炎患者Q_(Cl)较对照组差异有统计学意义(P0.01),与其他疾病比较差异有统计学意义(P0.05),除Q_(Cl)以外的其他指标与对照组差异无统计学意义(P0.05)。其他疾病的Q_(Cl)与对照组差异无统计学意义(P0.05)。周围神经炎症组及中枢神经系统感染组Q_(Cl)较对照组差异无统计学意义(P0.05)。中枢神经系统感染组脑脊液细胞数较对照组差异有统计学有意义(P0.05),年龄、性别、Q_(Cl)与NMO阳性有回归关系。NMO阳性与Q_(Cl)有强烈的相关性,血及脑脊液的其他指标未显示出相关性。结论氯失衡是视神经脊髓炎较为特异的表现,并可能反映了其病理机制。     

视神经脊髓炎患者血清及脑脊液中B淋巴细胞活化因子的表达水平与临床意义

目的 探讨视神经脊髓炎患者血清及脑脊液中B淋巴细胞活化因子的表达水平及其临床意义。方法 选取2011年1月-2015年1月本院收治的视神经脊髓炎(NMO)患者50例及多发性硬化(MS)患者50例,将其分别作为NMO组与MS组,另选取同期于本院进行体检的非炎性神经系统疾病患者50例作为对照组,对3组血清及脑脊液中的B淋巴细胞活化因子(BAFF)水平进行检测。结果 与对照组比较,NMO组与MS组血清中BAFF水平均无明显变化(P>0.05),而NMO组与MS组脑脊液中BAFF水平均明显升高(P<0.05); 与MS组比较,NMO组脑脊液中BAFF水平明显升高(P<0.05)。NMO组与MS组脑脊液中BAFF水平与EDSS评分呈正相关,即脑脊液中BAFF水平随EDSS评分升高而升高(r=0.887,0.885,P<0.01)。结论 视神经脊髓炎患者脑脊液中的B淋巴细胞活化因子水平较高,可能是诊断视神经脊髓炎的重要标志物,对疾病严重程度的判定具有重要的临床意义。     

视神经脊髓炎与脊髓型多发性硬化的临床研究

目的：视神经脊髓炎(NMO)又称Devic病，是视神经和脊髓同时或相继受累的急性或亚急性病变。它是一种独立的疾病实体还是MS的一种亚型，仍不清楚。本研究通过比较一些NMO和脊髓型MS的病例的临床特点，来探讨两者的关系。方法：回顾性分析20例NMO患者和40例脊髓型MS患者，对两组的人口统计学、临床表现、实验室检查(CSF和MRl、EP)及临床预后等进行比较。结果：NMO患者的神经系统表现局限于视神经和脊髓，多呈现横贯性脊髓损害(P＜0．001)，而脊髓型MS多为不完全横贯性损害(P＜0．001)。NMO组出院时EDSS评分为5．3＋/－3．1，明显高于脊髓性MS组(2．2＋/－2．3，P＜0．001)。NMO组CSF细胞计数平均值明显大于脊髓型MS组(P＜0．001)，蛋白质水平前者高于后者，但缺乏统计学意义。头MRI异常见于12．5％的NMO患者和83．3％的脊髓型MS患者(P＜0．001)。脊髓大型纵向融合病灶见于64．7％的NMO患者和21．6％的脊髓型MS患者(P＝0．005)。NMO组常累及髓内中心(P＝0．003)，而MS组则多局限于侧后索(P＝0．003)。NMO组VEP异常率达100％，明显高于MS组(38．5％，P＜0．001)。BAEP异常率脊髓型MS组高于NMO组，并提示中枢受累(P＝0．372)。NMO组可分为单相型和复发型。女性、发病年龄晚、索引事件间隔时间较长可能与NMO复发病程有关。单相型临床表现比复发型重，但长期预后较好，复发型常在3年内经过一系列复发导致严重残疾。结论：根据临床数据，NMO和脊髓型MS应被视为两个独立的疾病实体。NMO发病时年龄大，女性居多，临床表现严重，预后差。头和脊髓MRI、CSF及诱发电位的特征可以帮助区别两种疾病。但是由于MS和NMO都没有特异性的生化指标，发现这样的生化指标将大大推动这一疾病的诊断和研究。此外，应进行大量多中心、大样本的长期随访研究，来对NMO和MS的各种治疗方法进行系统评价。     

OCB、抗MBP抗体及抗MOG抗体在中枢神经系统炎性脱髓鞘疾病诊断中的意义

目的：通过观察中枢神经系统炎性脱髓鞘疾病患者寡克隆区带（OCB）、抗髓鞘碱性蛋白（MBP）抗体及抗髓鞘少突胶质细胞糖蛋白（M OG ）抗体的阳性率,为临床诊断提供一定的参考。方法入组91例中枢神经系统炎性脱髓鞘疾病患者为观察组（其中MS 30例,NMO 61例）及50例神经系统非炎性病变患者为对照组。首先分析观察组与对照组间OCB、脑脊液及血清中抗MBP抗体、抗MOG抗体阳性率的差异,再分析观察组中MS亚组及NMO亚组间上述指标阳性率的差异。结果2组比较,OCB、血清抗MBP抗体及血清抗MOG抗体阳性率比较差异有统计学意义（P＜0.05）,脑脊液抗MBP抗体及脑脊液抗MOG抗体阳性率比较差异无统计学意义（P＞0.05）。MS亚组与NMO亚组,OCB、血清抗MBP抗体阳性率比较差异有统计学意义（P＜0.05）,脑脊液抗MBP抗体、血清抗MOG抗体及脑脊液抗MOG抗体阳性率比较差异无统计学意义（P＞0.05）。结论 OCB阳性对诊断MS具有重要意义。血清抗MBP抗体及抗MOG抗体可为中枢神经系统炎性脱髓鞘疾病的诊断提供重要实验室依据,血清抗MBP抗体在MS与NMO的鉴别诊断中具有一定价值。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

广西农村壮族妇女精神分裂症患者生活质量状况调查

目的研究农村壮族妇女精神分裂症患者的生活质量及影响因素。方法前瞻性的队列研究。采用随机分层抽样法分为农村壮族妇女精神分裂症组、农村汉族妇女精神分裂症组、农村正常妇女对照组,应用“世界卫生组织生存质量测定报告”(WHOQOL-100)及PANSS量表调查其生活质量和疾病的严重程度。结果农村壮族妇女精神分裂症患者生活质量明显低于农村汉族妇女精神分裂症患者,影响其生活质量的相关因素是生活环境及精神支柱/个人信仰。结论经济贫困、环境条件、缺乏有效的医疗服务和社会保障是农村壮族妇女精神分裂症患者生活质量低的关键。因此,建立农村壮族社区精神卫生服务网络势在必行。     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

The origins of innervation of the esophagus of the dog

This study defined the origins of extrinsic efferent and afferent innervation of the normal canine esophagus. When all the layers of the wall of the 3 esophageal regions (cervical, thoracic and abdominal) were injected with horseradish peroxidase (HRP), labeled nerve cells were found in the nucleus ambiguus (NA) and parasympathetic nucleus of X (PX) of the brainstem. Most labeled cells in the NA were located in the compact column (retrofacial nucleus) while labeled cells in the PX were located in separate rostral and caudal areas. There was no somatotopic organization in either the NA or PX. Labeled sympathetic postganglionic neurons were found in the cranial cervical, middle cervical, cervicothoracic, thoracic sympathetic trunk and celiacomesenteric ganglia. The HRP injection of the esophageal wall labeled sensory cell bodies in the glossopharyngeal, proximal and distal vagal, and C2-T6 spinal ganglia. There was no discernible pattern of distribution of labeled cells in the autonomic or sensory ganglia. When the HRP injections were confined to the mucosa-submucosa layers of the thoracic esophagus, a small number of labeled cells were identified in the NA; however, no labeled cells were found in the NA when injections were confined to the mucosa-submucosa of either the cervical or abdominal esophageal regions. With these confined injections, the labeled nerve cells appeared in the rostral part of the PX. Thus, it appeared that the internal tunics of the esophagus (i.e., the mucosa and submucosa) were innervated by neurons in the rostral PX while the muscular tunic was innervated by neurons in the caudal PX and the rostral NA. After mucosa-submucosa injections, labeled sympathetic neurons appeared in the same ganglia that were identified after whole wall injections and these had a similar random distribution. These injections also labeled neurons in the glossopharyngeal, proximal vagal, and distal vagal ganglia, but unlike the whole wall injections there was no labeling in the spinal ganglia. This suggested that the labeled cells of the spinal ganglia seen after whole wall injections conveyed impulses from the tunica muscularis and serosa.