大剂量纳洛酮治疗急性脑出血疗效观察

目的观察大剂量纳洛酮对急性脑出血的临床疗效。方法对60例急性脑出血患者随机分为2组,常规组30例采用脱水等常规脑出血治疗;治疗组30例在常规治疗基础上加用纳洛酮4.0mg,1次/d静滴。2组均治疗14d,同时观察意识状态恢复时间及治疗后评价神经功能缺损恢复情况。结果纳洛酮治疗组意识恢复时间及神经功能缺损减少程度均明显优于对照组。结论大剂量纳洛酮治疗急性脑出血不仅可以缩短昏迷时间,而且可明显改善神经功能,安全可靠。     

海洛因依赖伴发意识障碍与苯二氮滥用关系

目的了解海洛因依赖者脱毒时伴发意识障碍与苯二氮     

"提高意识"活动在大学英语精读课中的体现 --对医学护理专业学生精读课改革的重新思考

语法翻译教学法多年来一直主宰着大学英语精读课的教学。随着中国经济突飞猛进的发展,各行各业的人们与国外同行交流的机会和要求也随之增加。面对社会发展而带来的这种变化,显然,古老传统的教学方法已不能适应。通过具体详尽的理论分析,对语法翻译教学法提出了自己的看法。     

Isoflurane disrupts anterio-posterior phase synchronization of flash-induced field potentials in the rat

Consciousness presumes a set of integrated functions such as sensory processing, attention, and interpretation, and may depend upon both local and long-range phase synchronization of neuronal activity in cerebral cortex. Here we investigated whether volatile anesthetic isoflurane at concentrations that produce loss of consciousness (LOC) disrupts long-range anterio-posterior and local anterior synchronization of neuronal activity in the rat. In six rats, deep electrodes were chronically implanted in the primary visual cortex (V1) and in two areas of the motor cortex (M1 and M2) for recording of intracortical event-related potentials (ERP). Thirty discrete flashes were presented at random interstimulus intervals of 15–45 s, and ERPs were recorded at stepwise increasing isoflurane concentrations of 0–1.1%. Neuronal synchronization was estimated using wavelet coherence computed from the ERP data band-pass filtered at 5–50 Hz. We found that (1) in the waking state, long-range anterio-posterior coherence in 5–25 Hz and 25–50 Hz frequency bands was significantly higher than local anterior coherence; (2) anterio-posterior coherence in both 5–25 Hz and 26–50 Hz bands was significantly reduced by isoflurane in a concentration-dependent manner; (3) local anterior coherence was not affected by isoflurane at any of the concentrations studied. These findings suggest that a disruption of long-range anterio-posterior rather than local anterior synchronization of neuronal activity precedes the anesthetic-induced loss of consciousness.     

Hypothesized neural dynamics of working memory: several chunks might be marked simultaneously by harmonic frequencies within an octave band of brain waves

The capacity of working memory (WM) for up to about seven simple items holds true both for humans and other species, and may depend upon a common characteristic of mammalian brains. This paper develops the conjecture that each WM item is represented by a different brain wave frequency. The binding-by-synchrony hypothesis, now being widely investigated, holds that the attributes of a single cognitive element cohere because electroencephalogram (EEG) synchrony temporarily unifies their substrates, which are distributed among different brain regions. However, thought requires keeping active more than one cognitive element, or WM "chunk," at a time. If there is indeed a brain wave frequency code for cognitive item-representations that are copresent within the same volume of neural tissue, the simple mathematical relationships of harmonies could provide a basis for maintaining distinctness and for orderly changes. Thus, a basic aspect of music may provide a model for an essential characteristic of WM. Music is a communicative phenomenon of "intermediate complexity," more highly organized than the firing patterns of individual neurons but simpler than language. If there is a distinct level of neural processing within which the microscopic physiological activity of neurons self-organizes into the macroscopic psychology of the organism, it might require such moderate complexity. Some of the obvious properties of music--orderly mixing and transitions among limited numbers of signal lines-are suggestive of properties that a dynamic neural process might need in order to organize and reorganize WM markers, but there are a number of additional, nonobvious advantageous properties of summating sinusoids in music-like relationships. In particular, harmonies register a stable periodic signal in the briefest possible time. Thus, the regularity of summating sinusoids whose frequencies bear harmony ratios suggests a particular kind of tradeoff between parallel and serial processing. When there are few copresent waves, at EEG frequencies, this sort of parallel coding retains behaviorally meaningful brief periods. A necessary companion hypothesis is that the brain wave frequencies underlying WM are confined to a single octave; that is, the upper and lower bounds of the band are in the ratio of 2:1. This hypothesized restriction, suggested by an empirical property of EEG bands that has been widely reported but rarely commented upon, has the important property of precluding spurious difference rhythms. A restriction to an octave, of "harmonious" frequency-markers for WM items, also seems consistent with a great deal of behavioral data suggesting that WM comprises a rapidly fading trace process in which only up to three or four item-representations are strongly activated simultaneously. There is also an additional, sequential renewal-or-revision process, within which up to another three or four items are being actively refreshed by rehearsal or replaced. Such serial processing may involve a less stringent octave band crowding problem.     

Consciousness and disturbances of consciousness

Summary The problem of consciousness is discussed briefly, including the contrary views of consciousness as a transcendental phenomenon and as an animistic fiction. Measurement of consciousness is possible only indirectly by means of quantitative assessment of accompanying behavioral deficits.Knowledge of the structural basis of consciousness is incomplete. The ascending reticular activating system (ARAS) is necessary for the maintenance of the state of consciousness. The monoamine and a great number of descending projections modulate the ARAS. The contents of consciousness depend also on telencephalic structures, primarily on the telencephalic cortex. Certain localized telencephalic lesions bring about disturbances of consciousness. The role of the corpus callosum in the problem of consciousness is discussed (one brain—two minds hypothesis).Then a classification of the various disturbances of consciousness is proposed. The term disturbances of vigilance is used for all disturbances of consciousness which are caused by a lesion in or a functional disorder of the ARAS or any of its modulating subsystems. The term disturbances of the contents of consciousness refers to disturbances of consciousness due to global or localized lesions or functional disorders of telencephalic structures. A list of characteristic features is given for each class of disturbance of consciousness.

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Zusammenfassung Das Problem Bewußtsein wird kurz skizziert. Dabei werden die gegensätzlichen Auffassungen über Bewußtsein als transzendentales Phänomen bzw. als animistische Fiktion erörtert. Die Messung von Bewußtsein ist indirekt nur über die Bestimmung des begleitenden Verhaltensdefizits möglich. Die Kenntnis über die strukturellen Grundlagen des Bewußtseins ist lückenhaft. Für die Aufrechterhaltung des Bewußtseinsgrades kommt dem aufsteigenden retikulären aktivierenden System (ARAS) eine notwendige — wenngleich nicht hinreichende — Bedeutung zu. Das ARAS wird durch monoaminerge und eine große Zahl vom Großhirn absteigender Projektionssysteme moduliert.Telenzephale Strukturen und vor allem der telenzephale Kortex scheinen für die Entfaltung von Bewußtseinsinhalten unentbehrlich. Auch umschriebene telenzephale Läsionen können partielle Störungen der Bewußtseinsinhalte verursachen. Die Bedeutung des Balkens für das Bewußtsein wird diskutiert (one brain—two minds-Hypothese).Im letzten Abschnitt wird eine Taxonomie der verschiedenartigen Bewußtseinsstörungen versucht. Unter dem Begriff Vigilanzstörungen werden alle Bewußtseinsstörungen zusammengefaßt, die durch Läsion oder Funktionsstörungen des aufsteigenden retikulären aktivierenden Systems (ARAS) — einschließlich seiner modulierenden Subsysteme — bedingt sind. Unter Störung der Bewußtseinsinhalte werden Bewußtseinsstörungen verstanden, die durch globale oder lokale Läsion bzw. Funktionsstörung telenzephaler Strukturen verursacht werden. Für beide Klassen von Bewußtseinsstörungen wird ein Merkmalskatalog beschrieben.

     

The vigilance scale: An analysis of elicited behavioral responses

Summary The Vigilance Scale (VS) is a 12-step additive scale (Guttman scale) that allows assessment of the behavioral deficit in the unconscious state and the state of clouding of consciousness. Despite restrictions on its applicability, which are discussed in detail, the VS seems to be a useful measuring device that indicates the level of brain function a patient with a disturbance of consciousness can actually attain. There are two categories of scale errors to be found, the first being caused by various instrumental disorders, i.e., severe motor deficits, the second resulting from the probabilistic approach of the VS to a Guttman scale.     

Where is the self? A neuroanatomical theory of consciousness

The enigmatic nature of the experience of self-awareness is examined in the light of recent discoveries and, on this basis, combined with inferences derived introspectively from the experience of the phenomenon itself; a specific physical locus of this experience within the human brains is deduced-proposed. The fundamental premise in this work is that whereever conscious self-awareness is generated, the neuronal structure(s) involved must continually have access to an extremely precise representation of information derived from the sense of vision plus a great variety of other kinds of information so as to permit it to make decisions regarding actions (movements and their implementation) that promote the survival and perpetuation of the biological system in which the self is generated. First, a definitve set of criteria that define most of the inputs to and operations carried out by the self-awareness entity were assembled. This ensemble of functions was then compared with the connections and possible roles of specific neuroanatomical structures described in published literature, particularly the recent literature and particularly that concerned with the sense of vision. It was discovered that only one brain structure receives the prerequisite information from the sense of vision plus information derived from cortical memory stores plus a variety of other relevant sources needed to generate a coherent sense of selfness. This structure is the superior colliculus of the tectum. The superior colliculi not only receive a highly precise retinotopic representation of inputs to the eyes, but also receive inputs from a great variety of other structures, including many areas of the cerebral cortex, vestibular inputs, auditory inputs, "affective" inputs, and inputs that putatively define the positions of the eyes and of the head. This information, it is deduced, not only allows this structure to generate a continuing synthesis of representations of the self-vs.-environment, but also allows a part of it to assess the significance (probable meaning) of these integrated inputs with respect to the selection of an implementation of actions that serve the interests of the physical structure in which the self-experience is generated. The function of memory in this system not only involves the continually updated representation of where the self is with respect to items and objects in its environment, but also provides means through which the relevance of recorded experiences representing the past may be caused to affect the decision-making process.(ABSTRACT TRUNCATED AT 400 WORDS)     

中西医结合对重症脑外伤昏迷病人促苏醒疗效观察

目的 :探讨醒脑开窍疗法对治疗重症颅脑损伤患者促苏醒作用以及对预后的影响。方法 :将 80例颅脑损伤患者 (GCS≤ 8)随机分成 2组 ,治疗组 4 0例 (在常规治疗基础上加用中药针刺疗法 ) ;对照组 4 0例。两组于伤后 1月按GCS预后评分评定预后 ,两组在促醒后 1月内意识好转率作一比较。结果 :治疗组预后恢复良好为 87 5 % ,显著高于对照组 6 2 5 % ,P <0 0 1;两组病死率差异无显著性意义 (P >0 0 5 )。治疗组 1月内清醒 32例 ,对照组 2 0例 ,P <0 0 1。结论 :中西医结合疗法在治疗重症脑外伤昏迷患者时 ,能加速促醒和提高生存质量。     

论英语写作教学中批判性阅读模式的培养

无论采取哪种英语写作教学法，前提是使学生具备英语语言意识，而语言意识的获得依赖于大量阅读，批判性阅读作为一种高效的阅读模式能大大促进写作活动。本文分析了批判性阅读模式的三个发展阶段和英语写作活动的密切关系。