癫痫患儿共患注意缺陷多动障碍的临床特点分析

目的 分析癫痫患儿中注意缺陷多动障碍(ADHD)的临床特点,评估癫痫患儿共患ADHD的患病情况及危险因素,为临床干预治疗提供科学依据。方法 2018年1月1日-12月31日收集西安交通大学第二附属医院小儿内科神经专业住院部依据国际癫痫联盟规定诊断的120例6～15岁癫痫患儿,采用《美国精神障碍诊断与统计手册》第5版(DSM-5)检测其中共患ADHD的患儿,分析癫痫患儿共患ADHD的临床特点。结果 120例癫痫患儿中23例合并有ADHD(19.2%),且以注意缺陷为主(65.2%)。性别、起病年龄、患病时间及多种抗癫痫药物联用在共患ADHD中发挥重要作用(χ²＝4.90、7.42、7.75、5.23,P＜0.05),而癫痫发作形式及脑电图放电起始部位在共患ADHD中无明显作用(P＞0.05)。结论 癫痫患儿中ADHD的检出率高,与癫痫患儿的性别、首次发作年龄、病程及抗癫痫药物的联合应用密切相关,应引起临床重视。     

基于近红外光谱的注意缺陷多动障碍患儿前额叶皮质功能研究

目的 分析基于近红外光谱成像的注意缺陷多动障碍(ADHD)患儿的前额叶皮质功能,为ADHD的脑功能分析提供参考依据。方法 选取2019年7月-2020年2月就诊于上海市儿童医院儿童保健科ADHD门诊及体检门诊的各100名儿童,由家长填写ADHD评估量表和人口学资料,临床医师进行综合访谈和体格检查,治疗师进行韦氏智力测试及基于近红外光谱的前额叶皮质功能检测。结果 选取筛选后的有效样本共70名儿童,35名为确诊ADHD的患儿,匹配同期(年龄及性别相仿)的35名正常对照儿童。ADHD组平均年龄(8.2±1.3)岁,正常对照组平均年龄(8.9±1.0)岁,ADHD组和对照组左侧前额叶皮质氧和血红蛋白浓度统计值分别为-0.005±0.033、0.020±0.021,两组间差异具有统计学意义(t=3.781, P<0.001)。在ADHD组患儿中,左侧脑皮质激活明显低于右侧(t=2.272,P<0.05),不同性别和年龄段ADHD患儿前额叶皮质功能水平差异均无统计学意义(P＞0.05),不同亚型ADHD患儿右侧前额叶皮质功能差异有统计学意义(F=7.138,P<0.01),多动冲动型患儿可能存在右侧前额叶皮质功能补偿。结论 ADHD患儿存在左侧前额叶皮质功能受损,前额叶皮质功能水平与年龄及性别无明显相关性。     

儿童常见发育异常性疾病的情绪行为与社交功能问题

孤独症谱系障碍(ASD)、注意缺陷多动障碍(ADHD)和语言障碍(LD)等神经发育障碍性疾病是儿童常见的发育异常性疾病,常伴心理行为与社交功能问题,早期识别、诊断和早期针对性的干预措施,对改善其预后具有重要意义。本文就儿童常见发育异常性疾病的心理行为与社交功能进行介绍,供相关专业人员参考。     

儿童注意缺陷多动障碍个性及智力特征探讨

目的 :了解注意缺陷多动障碍 (ADHD)儿童的个性及智力特点。方法 :采用艾森克个性问卷 (EPQ)和韦氏儿童智力量表 (WISC R)对 40例ADHD患儿进行测试。结果 :ADHD组EPQ测验中神经质和精神质量表T分高于正常对照组 ,掩饰性量表T分低于正常对照组。WISC R测验中 ,ADHD组总智商 (FIQ)在正常范围 ,但与正常对照组比较有显著性差异(P <0 .0 5 )。在言语智商 (VIQ)与操作智商 (PIQ)平衡上 ,ADHD组的算术、理解、译码分测验量表分较正常组低 ,两组比较有显著性差异。结论 :ADHD儿童情绪稳定性差 ,心理成熟能力延迟 ,同时可能存在言语理解、记忆 /不分心因子缺陷     

颈动脉支架植入术后谵妄风险列线图模型构建

目的 分析与提取颈动脉支架植入术后患者发生谵妄的危险因素,为针对性干预提供参考.方法 统计350例颈动脉狭窄支架植入术后患者谵妄发生率,行单因素和多因素分析获得术后患者谵妄相关危险因素,基此构建列线图预测模型,采用校正曲线和ROC曲线评估其准确度和区分度.结果 60例术后发生谵妄,发生率17.14％;高龄、术前NIHSS评分和术前焦虑是术后发生谵妄的独立危险因素(均P＜0.05);由3项独立危险因素构建的谵妄风险列线图预测模型,预测曲线和观察曲线基本吻合,AUC=0.888.结论 颈动脉支架植入术后患者谵妄发生率较高;高龄、术前焦虑及脑卒中倾向是术后患者发生谵妄的危险因素;构建的列线图预测模型具有较好的准确度和区分度,可提高筛选效能.     

补中益气汤调控JAK2/STAT3信号通路对气虚发热证大鼠肠道菌群、免疫功能及神经功能的影响

目的:分析补中益气汤调控Janus激酶2(JAK2)/信号传导与活化转录因子3(STAT3)/STAT3信号通路对气虚发热证大鼠肠道菌群、免疫功能及神经功能的影响。方法:将30只大鼠随机分为正常组、气虚发热模型组、补中益气汤组,每组10只。气虚发热模型组、补中益气汤组大鼠用于建立气虚发热模型,第18天开始,补中益气汤组给予补中益气汤灌胃治疗5 d,气虚发热模型组给予等体积蒸馏水。16SrRNA基因序列分析技术检测大鼠肠道菌群;ELISA法检测CD4⁺、CD8⁺、补体C3水平、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平;放免法测定乙酰胆碱(Ach)、环磷酸腺苷(cAMP)和环磷酸鸟苷(cGMP)水平;蛋白质印迹法(Western blot)检测p-JAK2、p-STAT3蛋白表达水平。结果:补中益气汤可改善气虚发热所致的疣微菌门、互养菌门菌落减少,螺旋体门、埃普西隆杆菌门菌落增多情况(P<0.05)。补中益气汤可改善气虚发热所致的血清CD4⁺、C3、IgM、IgG水平及淋巴细胞转化率降低,血清CD8^...     

Novel approach to an early assessment of a patient’s potential for neurological remission after acute spinal cord injury: Analysis of hemoglobin concentration dynamics

Context/objective: Examining hemoglobin (Hb) dynamics with regard to the potential of neurological remission in patients with traumatic spinal cord injury (TSCI).Design: Prospective Clinical Observational Study.Setting: BG Trauma Centre Ludwigshafen, Department of Paraplegiology, Rhineland-Palatinate, Germany.Methods: From 2011 to 2017 a total of 80 patients with acute spinal injury were enrolled and divided into three groups: initial neurological impairment either with (G1; n = 33) or without subsequent neurological remission (G0; n = 35) and vertebral fractures without initial neurological impairment as control group (C; n = 12). Blood samples were taken for 3 months at 11 time-points after injury. Analyses were performed using routine diagnostics.Outcome measures: Multiple logistic regression was used to determine the prognostic value of Hb regarding neurological remission respecting clinical covariates.Results: Data showed elevated mean Hb concentrations in G1 from the third day to 1 month compared to G0, Hb levels were significantly higher in G1 after 3 days (P = 0.03, G1 > G0). The final multiple logistic regression model based on this data predicting the presence of neurological remission resulted in an AUC (area under the curve) of 80.5% (CI: 67.8%–93.2%) in the ROC (receiver operating characteristic) analysis.Conclusion: Elevated Hb concentrations are associated with a higher likelihood of neurological remission. Elevated concentrations of Hb in G1 compared to G0 over time might be linked to both a better initial oxygen supply response and a decreased ECM (extracellular matrix) degradation highlighting the role of Hb as a valuable biomarker for neural regeneration after TSCI.     

Enhanced safety surveillance study of ACAM2000 smallpox vaccine among US military service members

ObjectivesTo evaluate the rates of myopericarditis (primary objective) and rates of cardiovascular and neurological adverse events (secondary objectives) in temporal association with ACAM2000® smallpox vaccine.MethodsObservational cohort study conducted through monthly surveillance from 2009 to 2017 of electronic medical records of military service members (SM) for pre-specified cardiac and neurological International Classification of Diseases (ICD) codes reported in the 30 days following smallpox vaccination. ICD codes potentially predictive of myopericarditis and codes for encephalitis, Guillain-Barré syndrome, and sudden death were classified into Group 1. All other cardiovascular and neurological ICD codes were classified into Group 2. Medical records containing Group 1 codes were individually reviewed to confirm coding accuracy and to seek additional data in support of myopericarditis adjudication, which was performed by an independent clinical panel. Chart reviews were not performed for Group 2 codes, which were reported in aggregate only.Results897,227 SM who received ACAM2000 smallpox vaccine and 450,000 SM who received Dryvax smallpox vaccine were included in the surveillance population. The rate of adjudicated myopericarditis among ACAM2000 smallpox vaccine recipients was 20.06/100,000 and was significantly higher for males (21.8/100,000) than females (8.5/100,000) and for those < 40 years of age (21.1/100,000) than for those 40 years or older (6.3/100,000). Overall rates for any cardiovascular event (Group 1 plus Group 2) were 113.5/100,000 for ACAM2000 vaccine and 439.3/100,000 for Dryvax vaccine; rate ratio, 0.26 (95% CI, 0.24–0.28). The rates of subjects with one or more defined neurological events were 2.12/100,000 and 1.11/100,000 for ACAM2000 and Dryvax vaccines respectively; rate ratio, 1.91 (95% CI, 0.71–5.10).ConclusionsElectronic records surveillance of the entire vaccinated SM population over a ten-year period found rates of myopericarditis, of defined neurological events, and of overall cardiac events that were consistent with those of prior passive surveillance studies involving Dryvax or ACAM2000 smallpox vaccines.Clinical trials registration: ClinicalTrials.gov NCT00927719.     

注意缺陷多动障碍伴孤独症特征患儿行为和家庭环境研究

目的 探讨注意缺陷多动障碍（ADHD）伴孤独症特征（ATs）患儿社交行为和家庭环境特点。方法 收集2019年3月至2021年12月安徽省儿童医院儿童保健科就诊的106例ADHD患儿临床资料,根据社交反应量表（SRS）评分分为ADHD-ATs组（SRS评分≥60分）和对照组（SRS评分<60分）,各53例。比较两组SRS、中文版ADHD评定量表-父母版（SNAP-IV）、家庭环境量表中文版（FES-CV）评估结果。结果 ADHD-ATs组SRS总分、社交知觉、认知、沟通、动机和孤独症行为方式评分高于对照组（P<0.05）。ADHD-ATs组SNAP-IV总分、注意缺陷、对立违抗评分高于对照组（P<0.05）。ADHD-ATs组FES-CV亲密度和独立性评分低于对照组（P<0.05）。结论 ADHD-ATs患儿较一般ADHD患儿存在显著的社交困难,并且注意缺陷和对立违抗症状更突出,家庭环境中的亲密度和独立性较低。