不同颈内动脉虹吸部钙化与老年人群脑萎缩的患病率相关性研究

目的分析不同颈内动脉虹吸部钙化积分与老年人脑萎缩的相关性。方法选取体检的老年人200例,根据CT检查按颈内动脉虹吸部钙化积分分组,0分为A组(35例),1~199分为B组(86例),200~399分为C组(55例),400分及以上为D组(24例),比较各组脑萎缩患病情况。结果 A组、B组、C组、D组脑萎缩患病率分别为17.14%、52.33%、69.09%、83.33%,各组间比较差异具有统计学意义(P0.05),B组、C组、D组脑萎缩患病率高于A组(P0.05),C组、D组脑萎缩患病率高于B组(P0.05),D组脑萎缩患病率高于C组(P0.05);Spearman相关性分析结果显示,随着颈内动脉虹吸部钙化积分分值升高,脑萎缩患病率随之有升高趋势,两者呈正相关(P0.05)。结论随着颈内动脉虹吸部钙化积分增高,老年人群脑萎缩患病率明显增高,检测颈内动脉虹吸部钙化积分有助于预测老年人群脑萎缩患病情况。     

头颅CT所见脑萎缩与年龄关系的相关分析

目的探讨脑萎缩患病率与年龄的关系,寻找脑萎缩与发病年龄的规律,为防治脑萎缩提供临床依据。方法对我院15~92岁的4272例头颅CT进行分析,其中2727例做了脑室、脑沟和脑池的测定。按5岁一个年龄组进行分组。结果2727例中经头颅CT提示脑萎缩897例,各年龄组都可以发生脑萎缩。35~39岁以上年龄组,随年龄增加患病率逐渐增加。中青年期(15~44岁)、老年前期(45~49岁)和老年期(60~92岁)脑萎缩患病率分别为4.6%、27.3%和81.5%,3组患病率有显著差异(P<0.05),男性正常出现率明显低于女性,而脑萎缩的患病率明显高于女性(χ2=2854.1,P<0.05)。结论脑萎缩的发生与年龄有相关性,老年人脑萎缩的发病率高。45~49岁组至75~79岁组男、女间脑萎缩患病率存在差异。     

脑动脉狭窄分布特点及病因分析

目的观察脑动脉狭窄分布特点及病因情况,以期正确认识该病,提高临床诊治水平。方法选取200例脑动脉狭窄患者为研究对象,观察其狭窄部位变化情况,并选取同时期非脑动脉狭窄的180例患者作参考,总结病因变化情况。结果在分布特点上,脑动脉狭窄主要分布在颈内动脉起始部及虹吸段(占64.5%)、大脑中动脉M1段(占50.5%)、椎动脉起始(占39.5%),与其他部位分布比较差异有统计学意义(P0.05)。2组空腹血糖、糖化血红蛋白、血压、甘油三酯、胆固醇比较差异有统计学意义(P0.05),糖尿病、高血压、高血脂发生率比较差异有统计学意义(P0.05),而2组慢性胃炎、慢性阻塞性肺疾病发生率比较差异无统计学意义(P0.05)。结论脑动脉狭窄主要分布在颈内动脉起始部及虹吸段,大脑中动脉M1段,椎动脉起始,病因有糖尿病、高血压、高血脂。     

CT血管造影检测血管内膜斑块在颈内动脉支架成形术的应用

目的 评估CT血管造影(CTA)检测血管内膜斑块对颈内动脉支架成形术(CAS)效果的预测价值. 方法 选取安徽医科大学附属省立医院神经内科自2008年12月至2011年4月行支架成形术(CAS)治疗的前循环缺血性脑血管病患者49例,根据CTA检测的颈内动脉斑块CT值将患者分为钙化组(24例)、非钙化组(25例),采用Agatston法计算钙化积分并将钙化组分为轻度钙化组(4例)、中度钙化组(12例)、重度钙化组(8例).比较钙化组和非钙化组患者行CAS后的残留狭窄率并分析钙化组患者Agatston分数与CAS后残余狭窄率的相关性. 结果 49支狭窄的颈内动脉行CAS,术后47支血管残留狭窄.钙化组CAS后平均残留狭窄率高于非钙化组患者,差异有统计学意义(P=0.001).轻度、中度、重度钙化组之间CAS后平均残留狭窄率依次增高,差异均有统计学意义(P＜0.05).钙化组Agatston分数与CAS后残留狭窄率呈正相关关系(r=0.941,P=0.001). 结论 CTA诊断颈内动脉狭窄是可靠的,以Agatston钙化分数对颈内动脉钙化斑块进行评估,对CAS具有一定的指导意义.     

血清胱抑素C对老年人脑萎缩的预测价值

目的研究血清胱抑素C(CysC)与老年人脑萎缩疾病的关系,探讨血清CysC对疾病的预测价值。方法收集114例脑萎缩组与127例非脑萎缩组患者的临床、实验室及影像学资料,比较两组间各因素差异,Logistic回归分析独立危险因素。通过头部CT检查对脑萎缩组进行评估,分析血清Cys与脑萎缩严重程度的相关性。绘制血清CysC对老年人脑萎缩患病的ROC预测曲线。结果血清CysC是老年人脑萎缩的独立危险因素(P0.05,OR值0.030,95%CI 0.007~0.124)。ROC曲线下面积为0.699(95%CI 0.634~0.765),最佳诊断界值为1.09 mmol/L。血清CysC与老年人脑萎缩严重程度呈正相关(r1=0.229,P10.05;r2=0.223,P20.05)。结论血清CysC与老年人脑萎缩发生和发展存在相关性,并存在一定预测价值。     

颈内动脉合并大脑中动脉急性闭塞的支架取栓治疗

目的 总结颈内动脉合并同侧大脑中动脉急性闭塞支架取栓治疗的经验。方法 回顾性分析37例经颈内动脉合并同侧大脑中动脉闭塞支架取栓病例资料。结果 术后TICl分级2b～3级28例(75.7%),0～2a级9例(24.3%),症状性脑出血4例(10.8%),死亡5例(13.5%),术后7 d NIHSS 7～19分,平均(8.6±3.3)分,预后良好(m RS≤2分) 18例(48.6%)。结论 支架取栓治疗颈内动脉合并同侧大脑中动脉急性闭塞安全、有效。     

颈内动脉夹层与椎动脉夹层的临床表现及危险因素对比分析

目的对比分析颈内动脉夹层与椎动脉夹层的临床表现及危险因素。方法前瞻性收集2011-01—2019-10年于郑州大学第一附属医院神经内科和神经介入科连续诊治的216例头颈动脉夹层患者,根据夹层累及部位将患者分为颈内动脉夹层组和椎动脉夹层组,分析2组患者的临床表现及危险因素的差异。结果 216例患者中颈内动脉夹层组100例,椎动脉夹层组116例。颈内动脉夹层组缺血性脑卒中患者NIHSS评分较高(3.9±5.2分比1.9±2.0分,P0.001),而椎动脉夹层组患者多有头痛(67.2%比37.0%,P0.001),轻微创伤史(14.7%比8.0%,P=0.021),并易出现SAH(24.1%比3.0%,P0.001)。结论颈内动脉夹层缺血性脑卒中症状较重,椎动脉夹层更易出现头痛症状以及蛛网膜下腔出血,既往多有轻微创伤史。     

机械取栓治疗低ASPECT评分的急性前循环大血管闭塞性卒中的初步观察

目的初步观察血管内机械取栓治疗Alberta卒中项目早期CT评分(ASPECTS)<6分的急性前循环大血管闭塞性卒中的安全性和有效性。方法回顾性分析2015年7月至2020年1月北京医院神经外科采用血管内机械取栓治疗的30例ASPECTS<6分的急性前循环大血管闭塞性卒中患者的临床资料。30例患者的术前美国国立卫生研究院卒中量表(NIHSS)评分中位数(范围)为17(7~37)分,ASPECTS为(3.8±1.0)分。头颅数字减影血管造影(DSA)检查显示,大脑中动脉闭塞13例(其中M1段闭塞11例,M2段闭塞2例),颈内动脉闭塞13例,颈内动脉与大脑中动脉串联闭塞病变4例。采用改良脑梗死溶栓(mTICI)分级对术后即刻血管再通情况进行评估,以mTICI分级2b或3级作为血管成功再通标准。根据欧洲急性卒中协作研究Ⅱ中的标准对出血转化进行分类,观察Ⅱ型脑实质血肿的发生率,用以评价血管内治疗的安全性。术后90 d通过门诊或电话进行随访,定义改良Rankin量表评分0~2分为神经功能预后良好,3~6分为预后不良。结果30例患者中,24例(80.0%)血管成功再通,术后2例(6.7%)发生Ⅱ型脑实质血肿。术后90 d行临床随访,33.3%(10/30)的患者获得良好临床预后,其中成功再通组9例(9/24,37.5%),未成功再通组1例(1/6);10例患者(10/30,33.3%)死亡,其中成功再通组7例(7/24,29.2%),未成功再通组3例(3/6)。基线ASPECTS 3~5分的患者中,获得良好神经功能预后者占37.0%(10/27),病死率为25.9%(7/27);基线ASPECTS 0~2分的患者中,获得良好神经功能预后者占比为0/3,病死比例为3/3。结论初步观察发现,对于基线ASPECTS 3~5分的急性前循环大血管闭塞性卒中患者,行血管内机械取栓治疗仍可能是安全有效的;但基线ASPECTS 0~2分的患者行血管内机械取栓治疗预后仍差。     

动脉粥样硬化所致单侧颈内动脉闭塞卒中类型分析

目的 研究动脉粥样硬化所致单侧颈内动脉闭塞卒中类型.方法 2006-10～2008-10收治的急性前循环脑梗死患者,行颈动脉超声、经颅多普勒超声(TCD)和磁共振血管成像(MRA),部分行数字减影全脑血管造影(DSA)检查,发现48例单侧颈内动脉闭塞患者为动脉粥样硬化所致, 颈内动脉颈段闭塞28例,脑段闭塞20例.根据MRI分析单侧颈内动脉闭塞卒中类型.结果 显著皮质下梗死20例(41.7%),边缘带梗死13例(27.1%),区域梗死8例(16.7%),弥散小梗死灶7例(14.5%).结论 动脉粥样硬化所致单侧颈内动脉闭塞卒中类型多为显著皮质下梗死和边缘带梗死.颈内动脉颈段闭塞组中边缘带梗死、区域梗死的发生率较颈内动脉脑段闭塞组高(42.8%vs 5.0%,28.6%vs 0),脑段闭塞组皮质下梗死的发生率较颈段闭塞组高(80.0%vs 14.3%).     

Glasgow昏迷量表在高血压性脑出血急救策略选择中的作用

目的探讨入院时Glasgow昏迷量表(GCS)评分对高血压性脑出血患者急救策略的影响。方法共286例高血压性脑出血患者中186例接受手术治疗,包括GCS评分5~8分94例、9~11分71例和12~14分21例,分别予血肿清除术联合去骨瓣减压术(63例,22.03%)、单纯血肿清除术(21例,7.34%)和血肿钻孔引流术或脑室外引流术(102例,35.66%);100例接受保守治疗,包括GCS评分5~8分25例、9~11分27例、12~14分25例和15分23例。随访3~6个月,采用Glasgow预后分级(GOS)评价疗效。结果 GCS评分5~8分组失访6例(5.04%),GOS分级1级14例(11.76%)、2级21例(17.65%)、3级39例(32.77%)、4级22例(18.49%)、5级17例(14.29%);GCS评分9~11分组失访2例(2.04%),GOS分级1级6例(6.12%)、2级2例(2.04%)、3级6例(6.12%)、4级48例(48.98%)、5级34例(34.69%);GCS评分12~14组GOS分级4级15例(32.61%)、5级31例(67.39%);GCS评分15分组GOS分级4级1例(4.35%)、5级22例(95.65%),组间差异具有统计学意义(χ~2=142.966,P=0.000)。结论高血压性脑出血患者入院时GCS评分与其预后呈正相关,GCS评分越高、GOS分级越高。     

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。     

《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。     

Impact of our understanding of the genetic aetiology of epilepsy

A genetic contribution to aetiology is estimated to be present in up to 40% of patients with epilepsy. It is useful to categorise genetic epilepsies according to the mechanisms of inheritance into Mendelian disorders, non-mendelian or ‘complex’ disorders, and chromosomal disorders. Over 200 Mendelian diseases include epilepsy as part of the phenotype, and the genes for a number of these have been identified recently. These include autosomal recessive progressive myoclonic epilepsies such as Unverricht-Lundborg disease, Lafora disease and the neuronal ceroid lipofuscinoses, and three autosomal dominant idiopathic epilepsies. The last named have been shown to arise from mutations in ion channel genes. Autosomal dominant nocturnal frontal lobe epilepsy is caused by mutations in CHRNA4, benign familial neonatal convulsions by mutations in KCNQ2 and KCNQ3, and generalised epilepsy with febrile seizures plus by mutations in SCN1B. ‘Complex’, familial epilepsies are more difficult to analyse, but evidence has been obtained for loci predisposing to juvenile myoclonic epilepsy on chromosome 6p and 15q. Lastly, the genes underlying several spike-wave epilepsies in mice have been cloned, and three of these encode sub-units of voltage-gated calcium channels. Received: 29 September 1999/Accepted: 7 December 1999     

他汀类药物的使用和颅内动脉瘤破裂相关性分析

目的 探讨他汀类药物对颅内动脉瘤破裂的影响。方法 2010年3月至2014年3月收治颅内囊状动脉瘤67例,其中破裂者32例,未破裂者35例。采用多变量Logistic回归评估他汀类药物的使用和颅内动脉瘤破裂的关系。结果 破裂组术前使用他汀类药物4例（12.5%,4/32）,未破裂组16例（45.7%,16/35）。破裂组服用他汀类药物的百分比显著低于未破裂组（P<0.01）。纠正潜在的混杂干扰后（or值: 0.30,95%可信空间:0.12~="" 0.64）显示,颅内动脉瘤破裂与他汀类药物的使用呈显著负相关,也与高血清总胆固醇浓度有关。结论 本结果提示他汀类药物对颅内动脉瘤破裂有一定的预防效果。