中药薤白的研究进展

薤白中含有挥发油、皂苷、含氮化合物、酸性物质等,为临床治疗"胸痹"之要药,也是治疗泄痢常用之品。因薤白具有很高的药用价值,故历来已有较多研究。通过查阅相关文献及书籍,本文对薤白的生药来源、化学成分、药理作用以及合用历史沿革等方面进行了整理和归纳,旨在为薤白的进一步研究开发提供新的思路。     

Can individually targeted and optimized multi-channel tDCS outperform standard bipolar tDCS in stimulating the primary somatosensory cortex?

BackgroundTranscranial direct current stimulation (tDCS) has emerged as a non-invasive neuro-modulation technique. Most studies show that anodal tDCS increases cortical excitability, however, with variable outcomes. Previously, we have shown in computer simulations that our multi-channel tDCS (mc-tDCS) approach, the distributed constrained maximum intensity (D-CMI) method can potentially lead to better controlled tDCS results due to the improved directionality of the injected current at the target side for individually optimized D-CMI montages.ObjectiveIn this study, we test the application of the D-CMI approach in an experimental study to stimulate the somatosensory P20/N20 target source in Brodmann area 3b and compare it with standard bipolar tDCS and sham conditions.MethodsWe applied anodal D-CMI, the standard bipolar and D-CMI based Sham tDCS for 10 min to target the 20 ms post-stimulus somatosensory P20/N20 target brain source in Brodmann area 3b reconstructed using combined magnetoencephalography (MEG) and electroencephalography (EEG) source analysis in realistic head models with calibrated skull conductivity in a group-study with 13 subjects. Finger-stimulated somatosensory evoked fields (SEF) were recorded and the component at 20 ms post-stimulus (M20) was analyzed before and after the application of the three tDCS conditions in order to read out the stimulation effect on Brodmann area 3b.ResultsAnalysis of the finger stimulated SEF M20 peak before (baseline) and after tDCS shows a significant increase in source amplitude in Brodmann area 3b for D-CMI (6–16 min after tDCS), while no significant effects are found for standard bipolar (6–16 min after tDCS) and sham (6–16 min after tDCS) stimulation conditions. For the later time courses (16–26 and 27–37 min post-stimulation), we found a significant decrease in M20 peak source amplitude for standard bipolar and sham tDCS, while there was no effect for D-CMI.ConclusionOur results indicate that targeted and optimized, and thereby highly individualized, mc-tDCS can outperform standard bipolar stimulation and lead to better control over stimulation outcomes with, however, a considerable amount of additional work compared to standard bipolar tDCS.     

The primary somatosensory cortex largely contributes to the early part of the cortical response elicited by nociceptive stimuli

Research on the cortical sources of nociceptive laser-evoked brain potentials (LEPs) began almost two decades ago (Tarkka and Treede, 1993). Whereas there is a large consensus on the sources of the late part of the LEP waveform (N2 and P2 waves), the relative contribution of the primary somatosensory cortex (S1) to the early part of the LEP waveform (N1 wave) is still debated.To address this issue we recorded LEPs elicited by the stimulation of four limbs in a large population (n = 35). Early LEP generators were estimated both at single-subject and group level, using three different approaches: distributed source analysis, dipolar source modeling, and probabilistic independent component analysis (ICA).We show that the scalp distribution of the earliest LEP response to hand stimulation was maximal over the central-parietal electrodes contralateral to the stimulated side, while that of the earliest LEP response to foot stimulation was maximal over the central-parietal midline electrodes. Crucially, all three approaches indicated hand and foot S1 areas as generators of the earliest LEP response.Altogether, these findings indicate that the earliest part of the scalp response elicited by a selective nociceptive stimulus is largely explained by activity in the contralateral S1, with negligible contribution from the secondary somatosensory cortex (S2).     

Frequency-dependent functional connectivity within resting-state networks: an atlas-based MEG beamformer solution

The brain consists of functional units with more-or-less specific information processing capabilities, yet cognitive functions require the co-ordinated activity of these spatially separated units. Magnetoencephalography (MEG) has the temporal resolution to capture these frequency-dependent interactions, although, due to volume conduction and field spread, spurious estimates may be obtained when functional connectivity is estimated on the basis of the extra-cranial recordings directly. Connectivity estimates on the basis of reconstructed sources may similarly be affected by biases introduced by the source reconstruction approach.Here we propose an analysis framework to reliably determine functional connectivity that is based around two main ideas: (i) functional connectivity is computed for a set of atlas-based ROIs in anatomical space that covers almost the entire brain, aiding the interpretation of MEG functional connectivity/network studies, as well as the comparison with other modalities; (ii) volume conduction and similar bias effects are removed by using a functional connectivity estimator that is insensitive to these effects, namely the Phase Lag Index (PLI).Our analysis approach was applied to eyes-closed resting-state MEG data for thirteen healthy participants. We first demonstrate that functional connectivity estimates based on phase coherence, even at the source-level, are biased due to the effects of volume conduction and field spread. In contrast, functional connectivity estimates based on PLI are not affected by these biases. We then looked at mean PLI, or weighted degree, over areas and subjects and found significant mean connectivity in three (alpha, beta, gamma) of the five (including theta and delta) classical frequency bands tested. These frequency-band dependent patterns of resting-state functional connectivity were distinctive; with the alpha and beta band connectivity confined to posterior and sensorimotor areas respectively, and with a generally more dispersed pattern for the gamma band. Generally, these patterns corresponded closely to patterns of relative source power, suggesting that the most active brain regions are also the ones that are most-densely connected.Our results reveal for the first time, using an analysis framework that enables the reliable characterisation of resting-state dynamics in the human brain, how resting-state networks of functionally connected regions vary in a frequency-dependent manner across the cortex.     

Investigating spatial specificity and data averaging in MEG

This study shows that the spatial specificity of MEG beamformer estimates of electrical activity can be affected significantly by the way in which covariance estimates are calculated. We define spatial specificity as the ability to extract independent timecourse estimates of electrical brain activity from two separate brain locations in close proximity. Previous analytical and simulated results have shown that beamformer estimates are affected by narrowing the time frequency window in which covariance estimates are made. Here we build on this by both experimental validation of previous results, and investigating the effect of data averaging prior to covariance estimation. In appropriate circumstances, we show that averaging has a marked effect on spatial specificity. However the averaging process results in ill-conditioned covariance matrices, thus necessitating a suitable matrix regularisation strategy, an example of which is described. We apply our findings to an MEG retinotopic mapping paradigm. A moving visual stimulus is used to elicit brain activation at different retinotopic locations in the visual cortex. This gives the impression of a moving electrical dipolar source in the brain. We show that if appropriate beamformer optimisation is applied, the moving source can be tracked in the cortex. In addition to spatial reconstruction of the moving source, we show that timecourse estimates can be extracted from neighbouring locations of interest in the visual cortex. If appropriate methodology is employed, the sequential activation of separate retinotopic locations can be observed. The retinotopic paradigm represents an ideal platform to test the spatial specificity of source localisation strategies. We suggest that future comparisons of MEG source localisation techniques (e.g. beamformer, minimum norm, Bayesian) could be made using this retinotopic mapping paradigm.     

控制传染源为主的综合策略在洞庭湖区血吸虫病防治中的实践与思考

湖南省通过4种模式试点,实施以控制传染源为主的综合防治血吸虫病策略,取得了明显效果。     

Source reconstruction of brain electromagnetic fields — Source iteration of minimum norm (SIMN)

A recursive scheme aiming at obtaining sparse and focal brain electromagnetic source distribution is proposed based on the interpretation that the weighted minimum norm is the minimum norm estimates of amplitudes on grid points for the source distribution specified by the diagonal elements of the weight matrix. The source distribution is updated so that, at each grid point, the number of current dipoles equals the total source strength estimate of the pre-specified current dipoles. The source strength of a pre-specified current dipole is estimated by projecting the vector of minimum norm estimate to the space spanned by the three column vectors, corresponding to the three amplitudes of the current dipole, of the resolution matrix. The norm of the projected vector yields the source strength estimate of the current dipole. Exact inverse solutions are obtained by this source iteration of minimum norm (SIMN) algorithm for noiseless MEG signals from multi-point sources provided the sources are sufficiently sparse and there are no substantial cancellations among the signals of the sources. For noisy data, a set of “noise sources” is introduced. The diagonal matrix formed by the “noise source numbers” plays the role of regularization matrix and Tikhonov regularization is applied to initialize the “noise source numbers”. Application to the source localization of real EEG data is also presented.     

Simultaneous MEG and intracranial EEG recordings during attentive reading

The relationship between neural oscillations recorded at various spatial scales remains poorly understood partly due to an overall dearth of studies utilizing simultaneous measurements. In an effort to study quantitative markers of attention during reading, we performed simultaneous magnetoencephalography (MEG) and intracranial electroencephalography (iEEG) recordings in four epileptic patients. Patients were asked to attend to a specific color when presented with an intermixed series of red words and green words, with words of a given color forming a cohesive story. We analyzed alpha, beta, and gamma band oscillatory responses to the word presentation and compared the strength and spatial organization of those responses in both electrophysiological recordings. Time-frequency analysis of iEEG revealed a network of clear attention-modulated high gamma band (50–150 Hz) power increases and alpha/beta (9–25 Hz) suppressions in response to the words. In addition to analyses at the sensor level, MEG time-frequency analysis was performed at the source level using a sliding window beamformer technique. Strong alpha/beta suppressions were observed in MEG reconstructions, in tandem with iEEG effects. While the MEG counterpart of high gamma band enhancement was difficult to interpret at the sensor level in two patients, MEG time-frequency source reconstruction revealed additional activation patterns in accordance with iEEG results. Importantly, iEEG allowed us to confirm that several sources of gamma band modulation observed with MEG were indeed of cortical origin rather than EMG muscular or ocular artifact.     

90年代鄂西北地区钩端螺旋体病流行病学研究

目的：调查鄂西北地区90年代钩端螺旋体（简称钩体）病流行情况。方法：病人血清检测采用MAT和Dot-ELISA法。健康人群免疫水平检测采用MAT法,传染源调查用夹夜法捕鼠,培养鼠肾和猪肾皮质,分离钩体并鉴定钩体菌群。结果：90年代前鄂西北地区很少发生钩体病,90年代后,该地区竹溪,竹山,襄阳,宜城等县市发生钩体病964例,占该地区40年总发病数的88．93％,钩体病暴发时间主要集中在9－10月,钩体病人临床类型以流感伤寒型和肺出血型为主,分别占调查总数的70．47％和21．12％,鼠密度3．62％,鼠带菌率14．37％,健康人群血清抗体阳性率41．50％,结论：钩体病人感染菌群以黄疸出血群为主,与当地鼠,猪感染的钩体菌群一致。     

Necrotizing skin and soft-tissue infections in the intensive care unit

BackgroundNecrotizing skin and soft-tissue infections (NSTI) are rare but potentially life-threatening and disabling infections that often require intensive care unit admission.ObjectivesTo review all aspects of care for a critically ill individual with NSTI.SourcesLiterature search using Medline and Cochrane library, multidisciplinary panel of experts.ContentThe initial presentation of a patient with NSTI can be misleading, as features of severe systemic toxicity can obscure sometimes less impressive skin findings. The infection can spread rapidly, and delayed surgery worsens prognosis, hence there is a limited role for additional imaging in the critically ill patient. Also, the utility of clinical scores is contested. Prompt surgery with aggressive debridement of necrotic tissue is required for source control and allows for microbiological sampling. Also, prompt administration of broad-spectrum antimicrobial therapy is warranted, with the addition of clindamycin for its effect on toxin production, both in empirical therapy, and in targeted therapy for monomicrobial group A streptococcal and clostridial NSTI. The role of immunoglobulins and hyperbaric oxygen therapy remains controversial.ImplicationsClose collaboration between intensive care, surgery, microbiology and infectious diseases, and centralization of care is fundamental in the approach to the severely ill patient with NSTI. As many aspects of management of these rare infections are supported by low-quality data only, multicentre trials are urgently needed.