多发性硬化早期患者疲劳认知功能障碍及抑郁和焦虑对生活质量的影响

目的探讨多发性硬化(multiple sclerosis,MS)早期患者疲劳、认知功能障碍、抑郁和焦虑对生活质量的影响。方法临床纳入MS患者45例(研究组),同时纳入30例健康者作对照(对照组)。分别采用修订疲劳影响量表、简易精神状态检查量表、Rey听觉词语学测验、简化Rey复杂图形、符号-数字模式测验(symbol digit modalities test,SDMT)、Stroop测验、画钟试验、汉密尔顿焦虑量表、汉密尔顿抑郁量表及多发性硬化生活质量量表进行临床测评。结果研究组躯体功能、躯体致角色受限、情绪致角色受限、疼痛、情绪状况、精力、健康认识、社会功能、认知功能、健康压力、健康变化评分均明显低于对照组,差异有统计学意义(P0.05);研究组较对照组短延迟记忆与长延迟记忆的成绩降低;SDMT测验成绩下降,Stroop测验反应时间长,差异均有统计学意义(P0.05)。另外,研究组疲劳得分较高(P0.05)。疲劳与生活质量中的躯体功能、躯体问题导致角色受限、情绪问题导致的角色受限、情绪状况、精力、健康认识、认知功能、健康压力、总体生活质量相关(P0.05)。结论 MS患者早期生活质量即明显降低。虽然早期即出现记忆功能、执行功能/信息处理速度损害及焦虑、抑郁、疲劳症状,但仅疲劳对生活质量造成影响。     

快速眼动睡眠期行为障碍患者运动和认知功能障碍及脑功能连接研究

目的探讨快速眼动睡眠期行为障碍(RBD)患者运动和认知功能障碍以及黑质与各脑区的功能连接。方法共14例快速眼动睡眠期行为障碍患者和8例性别、年龄、受教育程度相匹配的正常对照者,采用统一帕金森病评价量表第三部分(UPDRSⅢ)和Hoehn-Yahr分期评价运动功能,数字排序测验之注意力部分、符号数字模式测验(SDMT)、Stroop色词测验、连线测验(TMT)、Rey-Osterrieth复杂图形测验(ROCFT)、画钟测验、Boston命名测验和听觉词语学习测验(AVLT)评价认知功能,静息态f MRI观察左侧和右侧黑质与各脑区的功能连接。结果两组受试者UPDRSⅢ评分和Hoehn-Yahr分期差异无统计学意义(均P0.05);RBD组患者SDMT评分(P=0.001)、ROCFT量表之临摹部分评分(P=0.013)和AVLT量表之第2次瞬时回忆部分评分(P=0.032)低于正常对照组,TMT-B测试部分评分高于正常对照组(P=0.005)。与正常对照组相比,RBD组患者右侧黑质与左侧中央前回(P0.005)和右侧角回(P0.005)的功能连接下降。结论快速眼动睡眠期行为障碍患者认知功能障碍早于运动障碍,且黑质与运动功能区和认知功能区均存在异常功能连接,为快速眼动睡眠期行为障碍患者的行为学改变提供脑功能连接异常的客观证据。     

多发性硬化患者的认知功能损害

目的研究多发性硬化(multiplesclerosis,MS)患者认知功能损害的形式、特点及相关影响因素,了解认知功能损害对患者生活功能的影响。方法将66例MS患者分为脊髓型和脑/脑脊髓型两组,另外选择健康对照30名,采用神经心理学测验的方法系统评价记忆、语言、信息处理速度、执行功能及整体认知功能,并进行生活功能评定,所有MS患者同时接受头颅及脊髓磁共振成像(MRI)检查。结果神经心理学测试发现,与健康对照组相比,脑/脑脊髓型MS组瞬时记忆和长延迟记忆受损明显(P<0.05),执行功能损害显著(P<0.01),信息处理速度下降(P<0.01)。单纯脊髓型也存在认知功能损害,以执行功能损害及信息处理速度下降为主(P<0.05)。记忆、执行功能等认知功能测验成绩与头颅MRI所见病变相关(r=-0.319～-0.543,P<0.05)。认知功能测验成绩与病程长短、复发次数无明显相关。执行性画钟作业(CLOX)及Stroop测验反应错误数与扩展功能障碍状态量表(EDSS)有相关性(r=-0.325及0.372,P<0.05)。操作性日常生活能力(IADL)及MS生活影响量表(MSIS29)得分与记忆、执行功能等认知测验成绩呈负相关(r=-0.325～-0.537,P<0.05)。结论MS的认知功能损害以记忆、信息处理速度、执行功能为主,整体认知功能及语言功能相对保存。认知功能损害影响患者的生活功能,与病程长短、复发次数无明显相关。     

注意缺陷多动障碍儿童的执行功能研究

目的：研究注意缺陷多动障碍患儿的执行功能。方法选择60例注意缺陷多动障碍患儿为观察组，另选择健康志愿者60例为对照组，2组研究对象均接受Stroop色词测验及威斯康星卡片分类测验（WCST ）。记录并比较2组Stroop效应测试及威斯康星卡片分类测验结果。Stroop效应测试指标包括完成卡片A耗时、完成卡片B耗时、完成卡片C耗时及干扰效应。威斯康星卡片分类测验指标包括总测验次数、正确反应数、持续错误数、非持续错误数及分类数。结果2组儿童完成卡片A、B耗时比较差异无统计学意义（ P＞0.05）。观察组儿童完成卡片C耗时（54.76±11.65）s ，显著长于对照组，其干扰效应为（28.76±6.75）s ，显著长于对照组，差异均有统计学意义（P＜0.05）。观察组完成分类数、概念化水平均显著低于对照组，差异均有统计学意义（P＜0.05）。但观察组错误应答数、持续性错误数及持续性应答数均显著高于对照组，差异有统计学意义（P＜0.05）。结论注意缺陷多动障碍患儿存在执行功能障碍。     

首发精神分裂症病人治疗前后认知功能改变及其与精神症状的相关研究

目的探讨利培酮治疗对未服药首发精神分裂症患者认知功能的影响,以及认知功能与症状变化的关联。方法采用威斯康星卡片分类测验、数字广度测试、词语流畅性测试、Stroop测试、连线测试评估42例首发未服药精神分裂症患者的执行功能、工作记忆、信息处理速度等变化;阳性和阴性症状量表评定患者精神症状;多元回归分析探讨认知功能与精神症状的关联。结果治疗前,患者组威斯康星测验持续错误数较对照组多(P0.001),完成分类数较对照组少(P=0.009);数字广度测试及词语流畅性分数(Ps0.001)均降低;Stroop及连线测试完成时间均较对照组延长(Ps0.001)。治疗后,患者组Stroop_B(P=0.022)、Stroop_C(P=0.033)完成时间较治疗前减少。治疗前连线测试A/B成绩越差,则阴性症状及总症状(Ps0.05)越严重;连线测试A成绩越差,阳性症状的改善越少(P=0.019)。结论精神分裂症患者发病早期存在认知功能损害;急性期治疗可改善精神病性症状及信息处理速度,但不改善执行功能及工作记忆;提示患者早期信息处理受损可能更接近状态性生物学标记,而执行功能、工作记忆受损更接近素质性生物学标记。     

多发性硬化患者生活质量评估及其影响因素探讨

目的评估多发性硬化患者生活质量水平,并探讨其影响因素。方法收集2012年7月~2016年12月就诊于河南省人民医院复发缓解型多发性硬化患者(relapsing-remitting MS,RRMS)36例,继发进展性多发性硬化患者(secondary progressive MS,SPMS)21例作为研究对象。采用多发性硬化生活质量54项评分(Multiple Sclerosis Quality of Life-54 instrument,MSQo L-54)测试MS患者的生活质量;对所有研究对象进行认知功能、抑郁状态、疲劳、睡眠质量及日常生活能力评估。结果 (1)RRMS组及SPMS组患者躯体生活质量(RRMS组58.62±16.32;SPMS组28.77±15.99,P=0.000)、精神生活质量(RRMS组57.33±16.72;SPMS组36.27±23.50,P=0.000)均有下降,SPMS组下降更明显。多元逐步回归法分析,与MS生活质量相关因素中,Hamilton抑郁量表评分处于第一位(β=-0.516,P<0.001),其次为反应躯体化残疾程度的EDSS评分(β=-0.372,P<0.001),第三位为疲劳评分(β=-0.250,P=0.002)。结论 MS患者有不同程度的生活质量下降,SPMS患者更明显。EDSS评分、抑郁、疲劳影响患者生活质量,早期干预抑郁及疲劳,对于改善MS患者生活质量有益。     

快速眼球运动睡眠行为障碍患者的神经心理学评价及其与客观睡眠的相关性

目的评价快速眼球运动睡眠行为障碍(rapid eye movement sleep behavior disorder,RBD)患者的神经心理学表现,并进一步分析其与客观睡眠参数的相关性。方法收集就诊于天津医科大学总医院神经内科门诊并由视频多导睡眠监测(v-PSG)确诊的22例RBD患者及23例性别、年龄、受教育程度匹配的,并经v-PSG排除RBD的健康对照者,对两组研究对象进行神经心理学评价,包括简易精神状态检查(MMSE)、听觉词语学习测试(AVLT)、Rey复杂图形测试(RCFT)、画钟测试(CDT)、数字符号转换测试(SDMT)、连线测试A和B(TMT A和TMT B)、Stroop色词测试A、B、C、动物流畅性测试(AFT)、城市流畅性测试(CFT)、动物-城市交替流畅性测试、波士顿命名测试(BNT),比较两组之间神经心理学表现与客观睡眠参数的差异,并分析RBD组神经心理学表现与客观睡眠参数的相关性。结果与对照组相比,RBD组的MMSE评分减少,AVLT即刻记忆总分减少,短延时回忆词语数减少,长延时回忆词语数减少,RCFT、TMT A、TMT B、Stroop色词测试A、B、C用时增加,非快速眼动期(NREM)-I期睡眠比例增多,NREM-II、NREM-III睡眠比例减少,周期性肢体运动指数(PLMI)增高,以上差异均具有统计学意义(P 0. 05)。RBD患者中,睡眠效率分别与SDMT及CFT得分呈正相关(分别为r=0. 491,P=0. 020; r=0. 436,P=0. 043),与TMT A用时呈负相关(r=-0. 654,P=0. 001),总睡眠时间与RCFT及BNT得分呈正相关(分别为r=0. 600,P=0. 003; r=0. 482,P=0. 023),与TMT A用时(r=-0. 573,P=0. 005)呈负相关。结论 RBD患者总体认知功能下降,神经心理学受损领域为言语记忆能力、视空间能力、执行功能,并且存在客观睡眠结构紊乱、腿动指数增高。总睡眠时间减少和睡眠质量下降可能恶化RBD患者的神经心理学表现。     

CD4~-CD8~-双阴性T淋巴细胞在视神经脊髓炎谱系疾病与多发性硬化中的表达差异

目的对比分析视神经脊髓炎谱系疾病(NMOSDs)与多发性硬化患者急性期外周血CD4~-CD8~-双阴性T细胞(DNT)表达差异。方法纳入2017年1月至2019年12月诊断明确的NMOSDs(53例)和多发性硬化(20例)患者,以及性别、年龄相匹配的正常对照者(27例),流式细胞术测定外周血DNT细胞数目。结果 3组受试者外周血DNT细胞数目差异具有统计学意义(F=4.362,P=0.015),其中NMOSDs组DNT细胞数目分别高于正常对照组(t=2.415,P=0.023)和多发性硬化组(t=2.415,P=0.018),而多发性硬化组与正常对照组DNT细胞数目差异无统计学意义(t=0.149,P=0.881)。结论NMOSDs急性期患者外周血DNT细胞数目高于多发性硬化患者和正常对照者,推测DNT细胞可能参与NMOSDs的发病机制。     

首发精神分裂症和双相障碍患者认知功能、血清同型半胱氨酸水平及rs821616基因多态性的研究

目的:比较首发精神分裂症和伴有精神病性症状的双相障碍患者的血清同型半胱氨酸(Hcy)水平、认知功能、精神分裂症断裂基因1(DISC1) rs821616多态性。方法:采用酶联免疫法测定100例首发精神分裂症患者(精神分裂症组)和100例伴精神病性症状的双相障碍患者(双相障碍组)血清Hcy水平;采用认知成套测验(MCCB)进行认知功能评定;提取外周血细胞DNA,采用聚合酶链反应(PCR)方法对DISC1 rs821616位点进行多态性分析。结果:两组血清Hcy水平均高于实验室正常值(5～15μmol/L)(P均0.01),但两组间差异无统计学意义;精神分裂症组MCCB中连线测试、Stroop色词测验、简易视觉和空间记忆测验成绩明显差于双相障碍组(P 0.05);两组持续操作测验评分差异无统计学意义;两组rs821616位点基因型和等位基因频率差异有统计学意义(χ~2=9.53,P=0.0085;等位基因AT,χ~2=5.59,P=0.018)。结论:首发精神分裂症及伴有精神病性症状的双相障碍患者血清Hcy水平均异常升高;但精神分裂症患者在信息处理速度、工作记忆和视觉学习方面缺损程度更重,伴有精神病性症状的双相障患者DISC1 rs821616位点A等位基因及AA基因型频率更高。     

多发性硬化患者血清尿酸水平变化及与致残状况相关性研究

目的 探讨多发性硬化(MS)患者血清尿酸水平变化及其与致残状况的相关性.方法 收集复发缓解型多发性硬化患者42例,作为MS组,将MS组患者根据不同发作时期再分为MS-复发组和MS-缓解组；收集健康体检者42例作为对照组；比较MS与对照组间以及MS-复发组与MS-缓解组间血清尿酸水平,EDSS量表评价所有MS患者致残状况,对MS患者血清尿酸水平与EDSS评分进行相关性分析.结果 MS组血清尿酸浓度为(205.19±42.99) μmol/L,显著低于正常对照人群的(301.81±87.98) μmol/L,两组间比较差异有统计学意义(t=2.143,P＜0.05)；MS组EDSS评分为(3.9±1.1)分,较正常人群表现出显著的功能障碍；MS-复发组血清尿酸浓度为(171.47±38.33)μmol/L,显著低于MS-缓解组的(238.91±47.64) μmol/L,两组间比较差异有统计学意义(t=1.917,P＜0.05)；MS患者血清尿酸水平与其EDSS评分呈显著负相关(r=-0.365,P=0.011).结论 机体内尿酸水平的缺失在某种程度上可以影响多发性硬化的发生与进展,还与MS患者功能残障的发生及发展密切相关.     

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。     

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。     

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。     

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.     

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.     

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.