老年人房颤发生脑梗死的临床特征及预防措施

目的研究老年房颤患者发生脑梗死的危险性、临床特点及防治措施。方法对88例发生脑梗死的老年房颤患者的病史、临床表现和治疗进行分析。结果老年房颤患者发生脑梗死多为活动时急性起病,病情很快达高峰,神经系统功能损伤严重,且神经系统功能恢复慢,后遗症重。合并有其他脑血管病易患因素的房颤患者更易发生脑梗死。结论老年房颤患者发生脑梗死的后遗症明显,应积极预防。     

高血压脑出血的前瞻性护理

高血压脑出血为常见急诊之一。由于血肿的原发损害及继发脑缺血、水肿、脑脊液循环障碍、颅内高压等变化 ,可形成脑疝或损害下丘脑。继发中枢高热、上消化道出血、代谢及电解质紊乱等 ,加上药物 (如脱水剂 )、免疫功能改变、合并感染等因素 ,可引发肺、心、肾等功能不全 ,甚至发生多器官功能不全综合征(MODS) 〔1〕。作者对我院 2 0 0 1-0 1～ 2 0 0 2 -10月收住的高血压脑出血病人 3 0例进行回顾性分析 ,旨在发现高血压脑出血并发MODS的危险性 ,在护理上提出前瞻性措施 ,预防和早期发现MODS ,降低发生率和死亡率。1　临床资料1 1　一…     

脑梗死合并代谢综合征的并发症及预后分析

目的 总结脑梗死的合并代谢综合征(metabolic syndrome,MS)患者的临床特征.方法 对593例脑梗死患者的临床资料进行相关分析.结果 脑梗死合并MS的发生率为55.99%,脑梗死合并MS与单纯脑梗死患者比较,心、肺、肾等并发症的发生率明显增高.脑梗死患者合并MS的发生率随患者脑梗死病程的延长和发病年龄的增加而呈上升趋势.结论 代谢综合征与脑梗死关系密切,发生MS后直接影响到患者的预后,而脑梗死病程越长,发病年龄越大,MS的发生率越高.     

老年人颅脑外伤并发多器官功能衰竭的临床分析

目的探讨老年颅脑外伤并发多器官功能衰竭(MOF)患者的进展和特点，分析其发病机制及防治措施方法应用同顾性调杏法分析36例MOF患者的临床特征、治疗方法及结果结果36例MOF发生于外伤后平均5d；2、3、4个以上器官衰竭者死亡率分别为52．6％、58．3％、90％；器官衰竭发生顺序依次为：肺、胃肠道、肾、心血管、代谢、血液、免疫系统结论肺部感染是老年颅脑外伤并发MOF最常见的诱因，及时采用预防保护措施可降低老年颅脑外伤患者的致残率、致死率、     

高血压脑出血的前瞻性护理

高血压脑出血为常见急诊之一。由于血肿的原发损害及继发脑缺血、水肿、脑脊液循环障碍、颅内高压等变化，可形成脑疝或损害下丘脑。继发中枢高热、上消化道出血、代谢及电解质紊乱等，加上药物(如脱水剂)、免疫功能改变、合并感染等因素，可引发肺、心、肾等功能不全，甚至发生多器官功能不全综合征(MODS)。     

急性脑血管病并发多器官功能失常综合征临床分析

目的探讨急性脑血管病并发多器官功能失常综合征(MODS)的发病因素、临床特点及转归，总结治疗经验，便于临床医师更好的认识本病。方法回顾性分析28例急性脑血管病合并MODS患者的临床资料。结果脑缺血-再灌注损伤与微循环障碍最终导致MODS，合并上消化道出血、肾功能衰竭的病因是综合性的。治疗中应早期常规进行有关器官的功能监测，积极有效地控制脑、呼吸、循环、肾脏功能衰竭。结论本病预后极差，预防脑卒中后的MODS的发生至关重要，积极有效的综合治疗是减少MODS死亡的重要环节。     

血必净注射液对急性重型颅脑损伤患者多器官功能的影响

目的研究血必净注射液对急性重型颅脑损伤患者各重要脏器功能的影响。方法将急性重型颅脑损伤患者78例随机分成治疗组和对照组各39例。观察下列指标变化:(1)血清C反应蛋白(CRP)、乳酸(LA)、内皮素(ET)水平、凝血指标;(2)肝、肾功能、动脉血气分析;(3)比较2组Cushing溃疡出血、肺部感染、脓毒血症、多器官功能障碍综合征(MODS)、电解质紊乱并发症发生情况。结果血必净注射液可以降低血清CRP、ET、LA水平,保护凝血功能;对心、肝、肺、肾、脑等重要脏器功能具有保护和改善作用;能减少脓毒血症、肺部感染、多器官功能障碍综合征的发生。结论血必净注射液能降低重型颅脑损伤患者的多器官功能障碍,提高临床救治效果。     

缺血性脑卒中患者并发MODS的影响因素、特征及对结局的影响

目的 探讨缺血性脑卒中患者并发多脏器功能障碍综合征(MODS)的影响因素、疾病特征及功能障碍器官个数对结局的影响。方法 收集本院2014～2015年收治的358例缺血性脑卒中患者的临床资料,回顾性分析患者人口学因素、疾病病情对MODS发生率的影响,分析出血性脑卒中伴发MODS患者中脏器损害情况对其病死率的影响。结果 不同年龄(χ~2=44.02,P=0.00)、合并疾病情况(χ~2=140.94,P=0.00)和具体疾病种类(χ~2=23.24,P=0.00)的脑卒中患者伴发MODS的差异显著;缺血性脑卒中患者基本病情中病灶性质(χ~2=16.35,P=0.00)、既往脑卒中史(χ~2=83.62,P=0.00)、病情发现时间(χ~2=94.13,P=0.00)的患者并发MODS的差异明显;缺血性脑卒中患者并发MODS的器官依次为肺(占51.96%)、心脏(占26.47%)、胃肠道(占12.75%)、肾脏(占3.92%);功能障碍器官个数不同的MODS患者的病死率有明显差异(χ~2=8.22,P=0.04)。结论 高龄、合并心功能障碍、病情发现较晚的脑出血复发患者更易伴发MODS,损害的脏器主要为心肺,器官损害个数较多患者的病情较为严重,病死率更高。     

脑白质疏松症对大面积脑梗死预后的影响

目的探讨脑白质疏松症对大面积脑梗死预后的影响。方法收集60例首次卒中即表现为大面积脑梗死的患者的临床资料,分为合并脑白质疏松组(LA 组,30例)和不合并脑白质疏松组(LA-组,30例)。记录2组患者神经影像学表现、患者的病死率及发病2年内卒中的再发率,并根据脑卒中患者临床神经功能缺损程度评分标准和简易智能量表对患者进行神经功能和智能状态的评估。结果合并脑白质疏松症的患者平均年龄偏大,初次梗死时梗死灶的数目较多,有更严重的神经功能缺损和智能障碍,2组之间病死率没有差别。在2年随访期间,合并脑白质疏松组的患者的再次卒中和脑出血的比例均增加。2年随访结束时,合并脑白质疏松组的患者有更严重的神经功能缺损和智能障碍。结论合并脑白质疏松的大面积脑梗死患者预后比不合并脑白质疏松的大面积脑梗死患者预后差。     

急性脑梗死诱发全身炎症反应综合征致多器官功能障碍综合征的机制探讨

目的探讨急性脑梗死（ACI）后诱发SIRS及导致多器官功能障碍综合征（MODS）的发病机制。方法收集急性脑梗死患者48例，分为三组，急性单纯脑梗死组（SACI）26例；急性脑梗死致全身炎症反应综合征组（SIRS组）22例；急性脑梗死致多器官功能障碍综合征组（MODS组）13倒；应用酶联免疫吸附法（ELISA法）分别测定不同组别患者血清中TNF-α、IL-6值，与对照组（20例同期健康体检者）比较。结果（1）48例ACI致SIRS的发生率为45．83％，ACI致MODS的发生率为27．08％，ACI致SIRS时诱发MODS的发生率为59．09％。（2）ACI致MODS时均已提前发生了SIRS。（3）SACI组、SIRS组及MODS组患者血清TNF-α、IL-6含量均明显高于正常对照组（P〈0．01）；且SIRS组明显高于SACI组（P〈0．01）；MODS组明显SIRS组（P〈0．01），呈逐渐升高的趋势。（4）MODS不同积分组血清TNF-α、IL-6含量均明显高于SIRS组（P〈0．01）；且MODS组患者，严重者（积分≥9分）血清TNF-α、IL-6含量明显高于病情较轻者（积分〈9分）（P〈0．01）。（5）MODS组死亡患者血清TNF-α、IL-6含量明显高于存活者（P〈0．01）。结论（1）急性脑梗死（ACI）可以诱发全身炎症反应综合征（SIRS），并且是脑梗死致多器官功能障碍综合征（MODS）的发病基础和前提。（2）ACI首先诱发SIRS，SIRS是致MODS的主要机制，动态监测急性脑梗死患者血清TNF-α、IL-6的变化对急性脑梗死是否导致SIRS及MODS的发生有很高的预警价值。（3）急性脑梗死患者血清TNF-α、IL-6含量可作为判断急性脑梗死致SIRS、急性脑梗死致MODS病变程度、预后及转归的指标，并对及时指导临床早期治疗有着重要意义，对SIRS向MODS过度的早期诊断有非常重要的参考价值。     

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.     

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     

《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。     

Onset of action of antipsychotics in the treatment of mania

Introduction: An important consideration in treating acute mania is the promptness with which a chosen therapy can bring symptom amelioration. This article reviews the available published data from controlled, blinded studies regarding the latency of responses to antipsychotics in patients with acute mania.

Methods: Articles for this review were obtained from a search of the Medline database (1966–1999), using the following keywords and phrases: antipsychotic, atypical, bipolar disorder, mania, neuroleptic, typical. The bibliographic sections of articles gleaned from this search were used to direct further inquiries.

Results: Although information regarding the onset of action of antipsychotics is limited, we discovered data for four typical and three atypical antipsychotics. Drugs with the fastest onsets include haloperidol, risperidone, and olanzapine, with onsets appearing in 2–6 days. Chlorpromazine and thiothixene were at the slowest end of the continuum, with onsets of 2 weeks or longer. Data regarding pimozide are mixed, with some studies showing an onset equivalent to that of the 'fast' compounds and others showing one similar to that of the 'slow' compounds.

Conclusions: Choice of therapy should consider not only efficacy and safety, but also onset speed. Atypical antipsychotics appear to offer safer, faster, and more effective therapies.     

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。     

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.     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

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。