感觉神经动作电位波幅在糖尿病神经病中的诊断价值

目的 探讨感觉神经动作电位(SNAP)波幅及其比值在糖尿病神经病中的诊断价值.方法 病例组为91例2型糖尿病患者,根据多伦多临床评分系统(TCSS)分为亚组一(无神经症状体征者51例)、二(轻度神经病变者30例)、三(重度神经病变者10例);对照组为年龄、性别相匹配的健康对照39名.记录正中、桡浅、腓肠神经的SNAP,测量其传导速度(Vm、Vr、Vs)及波幅(Am、Ar、As),并计算腓肠.桡浅神经波幅比值(SRAR)、正中-桡浅神经波幅比值(MRAR).结果 ①与对照组比较,亚组三传导速度(m/s,Vm:46.2±7.3,Vr:45.8±6.9,Vs:30.3±9.5)减慢和波幅(μV,Am:15.4±10.5,Ar:16.6 ±9.8,As:5.9±6.3)减低(P均<0.05);亚组二Vs(46.2±4.7)减慢(P=0.002);亚组一Am(34.5±10.2)、As(13.8±5.6)和亚组二Am(33.0±14.6)、As(10.7±5.5)均减低(P均<0.05),亚组二As更低(Z=-3.22,P=0.001);亚组一仅SRAR(0.432±0.112)减小,亚组二MRAR(1.008±0.225)及SRAR(0.330±0.102)均减小(P均<0.05),亚组二SRAR更小(t=-3.86,P=0.003).②异常率:亚组一Am最高(26.0%),亚组二As最高(41.4%),A8与SRAR联合其异常率(68.9%)显著高于As(x2=9.212,P=0.003).③TCSS评分与V8(r=-0.583)、Am(r=-0.406)、As(r=-0.620)及SRAR(r=-0.527)负相关(P均<0.05);SRAR(r=-0.435)及MRAR(r=-0.319)均与病程呈负相关(P均<0.05).结论 轻度或早期糖尿病神经病,SNAP波幅较传导速度灵敏度更高;感觉传导各参数主要受病程的影响,SRAR与神经损害程度相关.     

神经干细胞及其在中枢神经系统疾病中的应用

神经干细胞 (neuralstemcell,NSC)的发现和分离成功 ,脑组织具有自我修复的潜能 ,这对“神经组织损伤不能再生”的传统观念提出了挑战。NSC就是神经系统自我修复的细胞学基础 ,NSC的生物学特性 ,分离和增殖、分化及其调控 ,已成为神经组织移植治疗中枢神经系统疾病和神经损伤修复的研究焦点 ,动物实验研究为神经干细胞移植的临床应用提供了基础。一、神经干细胞、祖细胞和神经前体细胞的概念1 992年Reynolds等[1] 从胚胎鼠脑的纹状体区 ,首次分离出能在体外持续增殖且具有向神经元及星形胶质细胞分化潜能的细胞群 ,这些细胞群具有干细胞…     

神经桥接与导管套接修复猫动眼神经形态学观察

目的探求导管修复颅内段动眼神经的可行性.方法 20只健康家猫随机分为2组.将右侧动眼神经于脑池段切断后,分组采用自体神经桥接和导管套接的方法修复.术后14周末光镜、电镜观察神经纤维的连续性、再生纤维数目和直径.结果神经修复14周后,神经桥接组67%、导管套接组75%的动物其动眼神经功能均有一定程度的恢复.形态学显示两组均取得较好的神经再生效果,两组间再生纤维直径差异无显著性(P>0.05),但导管套接组再生神经纤维数目较多,差异有显著性(P<0.05).结论导管套接法可作为颅内段动眼神经损伤后的一种修复方法,其疗效近似或稍优于神经桥接法.     

不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效比较

目的分析不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效,并探讨手术效果影响因素。方法选取2011-01—2017-12平顶山市第五人民医院骨科收治的行神经移位修复术治疗臂丛神经根性撕脱伤患者94例作为研究对象,分别行健侧颈7神经移位术(32例)、肋间神经移位术(30例)及膈神经移位术(32例),收集患者基本资料,并对患者术后患肢肘关节功能及肌力恢复情况进行评估。结果3组患者肘关节恢复达到良以上分别为膈神经组21例(65.6%),肋间神经组20例(66.7%),C7神经组23例(71.9%),3组患者术后肘关节功能恢复情况比较,差异无统计学意义(P>0.05)。术后膈神经组、肋间神经组,C7神经组肌力≥Ⅲ级的例数分别为25例(78.1%)、22例(73.3%)、25例(78.1%),3组患者术后患肢肌力恢复情况无显著性差异(P>0.05)。3组术后肘关节功能恢复的影响因素存在差异。(1)膈神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P<0.05);(2)肋间神经组术后肘关节功能恢复情况与功能锻炼时间、损伤部位和神经移植长度等因素有关(P均<0.05);(3)C7神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度等因素有关(P<0.05)。与3组患者术后肘关节功能恢复情况均有关的影响因素为神经移植长度。3组患者术后肌力恢复的影响因素存在差异。(1)膈神经组肌力恢复情况与患者年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P均<0.01);(2)肋间神经组肌力恢复情况与年龄、功能锻炼时间和神经移植长度等因素有关(P均<0.01);(3)颈7神经组肌力恢复情况与年龄、功能锻炼时间及损伤-手术时间等因素有关(P均<0.01)。结论3种供体神经移植修复臂丛神经根性撕脱伤效果相当,但术后效果的影响因素不尽相同,因此根据患者具体情况选择最优的治疗方式,有利于提高手术有效率。     

从神经心理学到功能神经影像学

神经心理学是从整体的系统方法论来研究观察人类认知过程，其一观察正常人，其二研究神经精神疾病模型的缺损症状或兴奋刺激症状。而人脑内在过程的研究则需要用功能神经影像学。显然功能神经影像学系统的活体功能解剖学观察给我们提供了利器，尤其是fMRI（能磁共振）和ERP（事件相关电位）的应用。     

神经干细胞特性及其在神经疾病治疗中的应用

神经干细胞是具有增殖、分化潜能且能增殖自身的细胞。神经干细胞分离、培养、鉴定及应用是神经科学研究的前沿领域 ,为探讨神经细胞发生、迁移、分化和治疗多种神经系统疾病提供了全新的思路。长期以来 ,人们一直认为 ,成年哺乳动物脑内不存在神经干细胞 ,神经细胞不具备更新能力 ,一旦受损乃至死亡 ,再生是不可能的 ,因为成熟神经细胞是不能分裂的 ,这种观念使人们对神经系统发生和神经疾病治疗的认识受到了很大局限。近 10年来 ,神经生物学的重要进展之一是发现神经干细胞的存在及特征 ,特别是成体脑内神经干细胞的分离和鉴定具有划时代…     

儿童晚期尺神经、桡神经损伤手术疗效分析

目的 :报告并评价儿童晚期尺神经、桡神经损伤的手术治疗效果。方法 :报道 12岁以下儿童尺神经、桡神经损伤 18例 2 6条 (尺神经 17条 ,桡神经 9条 )。手术时间为神经损伤后的 1～ 7 6年。采用神经外膜对端缝合术 11条 ,神经松解减压术 12条 ,自体神经移植术 3条。结果 :全部病例随访 1～ 16年 (平均 3 8年 ) ,优良率 65 4%。结论 :对儿童晚期尺神经、桡神经损伤 ,应积极手术修复且效果满意。     

幻听的病理机制分析

本文综述近期对幻听的研究：包括现象学、神经心理学、神经影像学、神经生化学等方面的改变。     

Mental illness in England,in Scotland and in Scots living in England

Summary Beginning from the observation that Scots living in England have much higher rates of mental hospital admission than do the English, several hypotheses are proposed to account for this. Much of the excess in rates of mental illness is accounted for by those diagnosed as having alcohol-related disorders and behaviour and personality problems. The results of an examination of offical statistics in the two countries enabled some explanations to be offered. It was found that rates of admissions to mental hospitals are higher in Scotland than in England but not as high as those found among Scots migrants who have a much higher rate of readmission to hospitals than either of the other groups. In fact, if first admissions only are considered the rates of admission in Scotland are not only higher than rates for English natives but also higher than for Scottish migrants. It seems that Scots living in England are somewhat less likely to become mental patients than Scots in Scotland but that once they do achieve this status they are very much more likely to be readmitted on subsequent occasions. It was concluded that there might be two fairly distinct groups of migrants from Scotland to England who have different backgrounds, different reasons for migrating and different psychological characteristics. On the one hand there are stable, economically motivated migrants who move south for definite employment related reasons and who show few psychological symptoms. While on the other hand there is a group of migrants who perhaps have psychological problems and who move more in hope than expectation without definite prospects and who account for the high rates of mental hospital admission found in Scottish migrants.     

Prostacyclin release in the coronary circulation during sustained stimulation in in vitro and in in vivo experimental systems

Prostacyclin release from rat isolated perfused hearts and from dog coronary circulation was studied by measuring immunoreactive 6-keto-PGF1 alpha (6-keto-PGF1a) in heart perfusate and in plasma obtained from the great cardiac vein respectively. Continuous infusion of arachidonic acid at constant concentration in isolated perfused hearts induced an increased prostacyclin release. This release showed a rapid peak within 10 min and a subsequent decrease. Low-flow ischemia induced an increased perfusate concentration of 6-keto-PGF1a but, considering the decreased flow, prostacyclin release was actually reduced. During the whole period of ischemia (60 min) prostacyclin release was constant. In open-chest anesthetized dogs 6-keto-PGF1a concentration in the great cardiac vein was increased after ligation of the left anterior descending coronary artery. A prolonged period of coronary occlusion (4.5 hours) resulted in a progressive rise of prostacyclin release. 6-keto-PGF1a determinations in the femoral vein and in the aorta did not show relevant variations during the observation period.     

癫痫与抑郁关系的研究进展

抑郁是癫痫患者中常见的精神障碍,严重地影响了患者的生活质量。传统的观点认为癫痫患者因为存在着诸多社会学问题易出现抑郁倾向,癫痫和抑郁是单向的联系,但大量的研究已经证明癫痫和抑郁之间存在双向的联系,一种异常状态的存在可能易转化为另一种异常状态的发展。癫痫和抑郁存在着共同的发病机制。本文主要就癫痫和抑郁的双向联系以及抗抑郁药物在癫痫患者中的应用进行阐述。     

Neuroimaging in epilepsy in tropics

Epilepsy is a major public health problem in many tropical countries. Also, some of the tropical diseases are major contributors to the higher prevalence of epilepsy in these countries. The etiologic factors responsible for epilepsy in these countries are quite different from those in the developed world. This article discusses the etiologic factors and neuroimaging of epilepsy in light of the conditions in these tropical countries.