功能磁共振成像评价肝性脑病患者大脑基线活动的改变

目的 采用fMRI技术观察肝性脑病(HE)患者大脑基线活动改变。方法 对24例HE患者行静息态fMRI扫描,获取低频振幅(ALFF),其中临床症状明显的肝性脑病(OHE组)及临床症状隐匿的轻微型肝性脑病(MHE组)各12例。另选12名健康志愿者作为对照组。并进行统计学分析。结果 3组ALFF差异有统计学意义(P均<0.05)的脑区主要集中于额叶、顶叶及颞叶。与对照组比较,OHE组ALFF升高的脑区包括右侧小脑后叶、左侧小脑前叶、左侧海马旁回及左侧额下回/岛叶皮质,MHE组ALFF升高的脑区包括右侧缘上回/颞上回;OHE组ALFF减低的脑区包括双侧内侧前额叶皮质、双侧后扣带回/左侧楔叶、右侧中央后回/中央前回、左侧中央旁小叶及左侧辅助运动区,MHE组ALFF减低的脑区包括左侧距状裂皮质、双侧后扣带回/右侧楔前叶、左侧中央后回、双侧中央旁小叶及双侧辅助运动区(P均<0.05)。与MHE组比较,OHE组ALFF减低的脑区包括左侧前扣带回、双侧内侧前额叶皮质、双侧后扣带回、右侧角回/枕上回及右侧额中回(P均<0.05)。OHE组及MHE组双侧后扣带回ALFF均与血氨水平呈负相关(P均<0.05)。结论 OHE及MHE患者均存在静息态下脑功能异常。     

客观评价近视眼配镜过矫对人眼调节功能影响的临床研究

目的探讨客观评价近视眼配镜过矫对人眼调节功能影响的价值。 方法收集2010年1月至2014年6月就诊于首都医科大学附属北京同仁医院北京同仁眼科中心视光学门诊的近视眼配镜过矫伴视疲劳患者16例(30只眼)。其中,男性10例(19只眼),女性6例(11只眼),年龄14~38岁,平均年龄(23.7±7.2)岁。所有患者均进行视力检查、显然验光、复方托吡卡胺散瞳验光、原框架眼镜屈光度检查、主观调节幅度检查及客观调节功能检查。根据近视眼配镜过矫状态下患者主观调节幅度下降、客观调节不足、客观调节异常及客观调节微波动高频成分增加进行分组。使用均数±标准差描述年龄的分布情况;采用眼数和百分比描述各组的病例数量与病例分布情况。使用McNemar配对资料卡方检验和用Kappa一致性检验比较近视眼配镜过矫状态下主观调节幅度下降组与客观调节不足组、客观调节异常组及客观调节微波动高频成分增加组的差异。 结果近视眼配镜过矫伴视疲劳患者16例(30只眼)中,主观调节幅度正常者有8例(11只眼),占36.7%(11/30);主观调节幅度下降者有11例(19只眼),占63.3%(19/30);客观调节检查结果正常者有6例(7只眼),占23.3%(7/30);客观调节异常者有13例(23只眼),占76.7%(23/30);单纯客观调节不足者有3例(3只眼),占10.0%(3/30);单纯客观调节过度者有1例(2只眼),占6.7%(2/30);单纯客观调节紧张者有4例(7只眼),占23.3%(7/30);单纯客观调节痉挛者有1例(2只眼),占6.7%(2/30);客观调节不足伴调节紧张者有4例(7只眼),占23.3%(7/30);客观调节不足伴调节痉挛者有1例(2只眼),占6.7%(2/30)。客观调节紧张者有7例(14只眼),占46.7%(14/30);客观调节不足者有8例(12只眼),占40.0%(12/30);客观调节微波动高频成分增加者有10例(18只眼),占60.0%(18/30)。自身配对资料McNemar精确概率法卡方检验提示主观调节幅度下降组与客观调节不足组的差异有统计学意义(χ²＝5.143,P<0.05)。对比主观调节幅度下降组与客观调节异常组以及客观调节微波动的高频成分增加组的差异均无统计学意义(χ²＝2.250,0.000;P>0.05)。进一步经过Kappa一致性检验,主观调节幅度下降组与客观调节异常组有高度一致性(κ＝0.689,P<0.05),而主观调节幅度下降组与客观调节微波动高频成分增加组一致性弱(κ＝0.366,P<0.05)。 结论近视眼配镜过矫常伴随调节功能异常的类型以调节不足和调节紧张为主。人眼调节功能客观检查可对近视眼配镜过矫视疲劳状态进行客观量化的评估。鉴于本研究中主观调节幅度下降组与客观调节异常组的高度一致性,推荐近视眼配镜过矫伴视疲劳患者中使用主观调节幅度检查作为客观调节功能详细检查的筛查指标。     

Approach to seizures in the neonatal period: a European perspective

In the neonatal period, seizures rank among the most common neurological symptoms, often indicating an underlying serious neurological condition. It is remarkable that although new tools have been incorporated into the diagnosis of neonatal seizures, there is no consensus about the therapeutic approach among different doctors and institutions. Hence, although phenobarbital is still considered the initial drug of choice, the protocols reported in the literature show a great variability in the approach to treatment of refractory seizures. We used a questionnaire to gain information regarding the treatment of seizures in the neonatal period in different European institutions. Conclusion: We conclude that phenobarbital is still the initial drug of choice followed by benzodiazepines, except in preterm infants with a birth weight below 1800 g. In refractory seizures, the use of continuous lidocaine infusion is most common. Of note, clinical studies with newer drugs have been mostly performed in the United States but not in Europe.     

肌萎缩性侧索硬化症患者神经传导速度的研究

目的：探讨肌萎缩性侧索硬化症（ALS）患者神经传导速度（NCV）的改变及其在诊断和鉴别诊断中的价值。方法：以106例确诊为ALS的患者和123例正常人为研究对象，应用Keypoint肌电图仪进行正中、尺、胫和腓总神经的NCV检查，记录和刺激电极均为表面电极。结果：ALS组正中神经感觉神经传导速度（SCV）和正中、尺、腓总神经运动神经传导速度（MCV）较正常对照组明显降低，除正中神经感觉神经潜伏期外，两组比较，差异均有显著性意义；正中、尺、胫神经复合肌肉动作电位波幅ALS组明显低于正常组，但多无神经传导阻滞。结论：ALS组的MCV和SCV较正常对照组明显减慢，但在诊断和鉴别诊断方面，临床表现及针极肌电图比NCV更有价值。     

帕金森病模型大鼠经颅磁刺激运动诱发电位波幅的研究

目的:探讨帕金森病(PD)模型大鼠经颅磁刺激运动诱发电位波幅的变化(amplitude of motor evoked potential,MEP amp)。方法:实验分两组,健康Sprague-Dawley(SD)雄性大鼠40只,随机分为2组:①实验组(PD模型组)28只,②对照组(生理盐水组)12只,选取右侧黑质致密部(substantia nigra pars compacta,SNc)与中脑腹侧背盖(ventra tegmental area,VTA)为手术靶点,实验组注射6-羟基多巴胺(6-OHDA)制备帕金森病动物模型,对照组注射同等剂量的生理盐水,于制模前、制模后1周、3周分别行双下肢运动诱发电位波幅检查。结果统计采用SPSS 11.5统计软件处理,P<0.05为差异有显著性。结果:术后1周,实验组大鼠左下肢MEP amp与对照组比较无统计学意义(P>0.05),实验组自身左右侧TMS-MEP比较,左下肢波幅较右下肢增加(P<0.05);制模前、术后1周、术后3周实验组大鼠左下肢MEP amp进行性增加(P<0.01),实验组大鼠右下肢波幅三个时间点比较无统计学意义(P>0.05);对照组大鼠左侧及右侧下肢波幅三个时间点比较均无显著性差异(P>0.05)。结论:PD模型大鼠损毁侧皮层兴奋性增加,PD模型大鼠病情越重、病程越长,波幅增加越明显。     

Differences in Human Group Mean SEP between Sexes: with Reference to the Rohrer's Index*

Abstract: With 200 SEPs of normal subjects, the differences in the Group Mean SEP between sexes were defined eliminating the differences attributable to another peripheral factor relating to the nutritional condition represented by the Rohrer's index. The differences in the baseline amplitude of the Group Mean SEP between males vs. females in the sections between roughly 23–111 msec, around 330 msec, and behind 389 msec in latency were verified, subtracting the differences between the groups with a high vs. low value of the Rohrer's index, not attributable to the different nutritional condition, and might be the central origin. Applying the Amplitude Scaling, the differences in the sections 23–104 msec in latency were verified similarly, being more a significant indication of the sex difference per se.     

Suppression of experimental allergic encephalomyelitis in rats by 50-nT, 7-Hz amplitude-modulated nocturnal magnetic fields depends on when after inoculation the fields are applied

Female Lewis rats (n= 88) were inoculated with an emulsion of spinal cord and complete Freund's adjuvant. They were then exposed in 11 separate blocks of experiments over a year period for approximately 6 min every hour between midnight and 08:00 h during post-inoculation nights 1–7, 8–16, 1–16, or 9 and 10 to 50-nT, 7-Hz, amplitude-modulated magnetic fields or to sham field (control) conditions. Compared to the control rats those exposed to the magnetic fields for nights 1–7 and nights 9–10 displayed more severe clinical symptoms while those exposed for nights 1–16 or 8–16 showed less severe symptoms. There was a strong correlation between the severity of the clinical symptoms in the control groups and the global geomagnetic activity 9 and 10 days after inoculation. These results suggest that the immunosuppressive effects of weak nocturnal magnetic fields may depend upon when they are applied during various stages in the development of a disease.