唤醒状态联合中央沟定位切除脑运动区胶质瘤对患者运动功能保护作用探讨

目的 探究唤醒状态联合中央沟定位对脑运动区胶质瘤切除术患者运动功能的保护作用。方法 选取本院2016年12月—2017年10月期间收治的脑运动区胶质瘤患者70例。所有患者均行唤醒状态联合中央沟定位运动区胶质瘤切除术。观察患者术后复发情况及术后第6、12个月的Kamofsky评分,并记录并发症发生情况。结果 所有患者均成功完成手术,未出现术中大出血、死亡等严重并发症。70例患者中,有40例全切除,26例次全切除,4例大部分切除。术后,感觉减退者有6例,肌力下降者有5例,肌力下降伴感觉减退者有2例,并发症发生率为18.57%(13/70)。6个月后,应用增强MRI显示有4例患者肿瘤灶周围明显强化,进一步使用正电子发射断层显像发现有1例患者肿瘤复发。术前及术后第6、12个月的Kamofsky评分分别为(89.62±11.88)及(80.73±9.91)、(65.82±12.36)。结论 唤醒状态联合中央沟定位能最大限度切除脑运动区胶质瘤,提高患者预后效果。     

Impact of sampling rate on statistical significance for single subject fMRI connectivity analysis

A typical time series in functional magnetic resonance imaging (fMRI) exhibits autocorrelation, that is, the samples of the time series are dependent. In addition, temporal filtering, one of the crucial steps in preprocessing of functional magnetic resonance images, induces its own autocorrelation. While performing connectivity analysis in fMRI, the impact of the autocorrelation is largely ignored. Recently, autocorrelation has been addressed by variance correction approaches, which are sensitive to the sampling rate. In this article, we aim to investigate the impact of the sampling rate on the variance correction approaches. Toward this end, we first derived a generalized expression for the variance of the sample Pearson correlation coefficient (SPCC) in terms of the sampling rate and the filter cutoff frequency, in addition to the autocorrelation and cross‐covariance functions of the time series. Through simulations, we illustrated the importance of the variance correction for a fixed sampling rate. Using the real resting state fMRI data sets, we demonstrated that the data sets with higher sampling rates were more prone to false positives, in agreement with the existing empirical reports. We further demonstrated with single subject results that for the data sets with higher sampling rates, the variance correction strategy restored the integrity of true connectivity.     

Which behaviours are first to emerge during recovery of consciousness after severe brain injury?

BackgroundEarly detection of consciousness after severe brain injury is critical for establishing an accurate prognosis and planning appropriate treatment.ObjectivesTo determine which behavioural signs of consciousness emerge first and to estimate the time course to recovery of consciousness in patients with severe acquired brain injury.MethodsRetrospective observational study using the Coma Recovery Scale-Revised and days to recovery of consciousness in 79 patients (51 males; 34 with traumatic brain injury; median [IQR] age 48 [26–61] years; median time since injury 26 [20–36] days) who transitioned from coma or unresponsive wakefulness syndrome (UWS)/vegetative state (VS) to the minimally conscious state (MCS) or emerged from MCS during inpatient rehabilitation.ResultsVisual pursuit was the most common initial sign of MCS (41% of patients; 95% CI [30–52]), followed by reproducible command-following (25% [16–35]) and automatic movements (24% [15–33]). Ten other behaviours emerged first in less than 16% of cases. Median [IQR] time to recovery of consciousness was 44 [33–59] days. Etiology did not significantly affect time to recovered consciousness.ConclusionRecovery of consciousness after severe brain injury is most often signalled by reemergence of visual pursuit, reproducible command-following and automatic movements. Clinicians should use assessment measures that are sensitive to these behaviours because early detection of consciousness is critical for accurate prognostication and treatment planning.     

Improved dynamic connection detection power in estimated dynamic functional connectivity considering multivariate dependencies between brain regions

To estimate dynamic functional connectivity (dFC), the conventional method of sliding window correlation (SWC) suffers from poor performance of dynamic connection detection. This stems from the equal weighting of observations, suboptimal time scale, nonsparse output, and the fact that it is bivariate. To overcome these limitations, we exploited the kernel‐reweighted logistic regression (KELLER) algorithm, a method that is common in genetic studies, to estimate dFC in resting state functional magnetic resonance imaging (rs‐fMRI) data. KELLER can estimate dFC through estimating both spatial and temporal patterns of functional connectivity between brain regions. This paper compares the performance of the proposed KELLER method with current methods (SWC and tapered‐SWC (T‐SWC) with different window lengths) based on both simulated and real rs‐fMRI data. Estimated dFC networks were assessed for detecting dynamically connected brain region pairs with hypothesis testing. Simulation results revealed that KELLER can detect dynamic connections with a statistical power of 87.35% compared with 70.17% and 58.54% associated with T‐SWC (p‐value = .001) and SWC (p‐value <.001), respectively. Results of these different methods applied on real rs‐fMRI data were investigated for two aspects: calculating the similarity between identified mean dynamic pattern and identifying dynamic pattern in default mode network (DMN). In 68% of subjects, the results of T‐SWC with window length of 100 s, among different window lengths, demonstrated the highest similarity to those of KELLER. With regards to DMN, KELLER estimated previously reported dynamic connection pairs between dorsal and ventral DMN while SWC‐based method was unable to detect these dynamic connections.     

手术室心理护理对手术患者精神状态的影响

目的探讨手术室心理护理对手术患者焦虑、抑郁状态及护理满意度的影响。方法以医院2017年1月—2019年4月在医院接受手术治疗的1200例患者展开研究,随机将其划分为研究组(n=600)与对照组(n=600),分别接受常规基础上的心理护理以及单纯常规护理,对比分析患者抑郁、焦虑评分、护理满意度。结果治疗后,与对照组比,观察组抑郁、焦虑评分均更低;且研究组(97.0%)患者护理满意度高于对照组(83.7%),差异有统计学意义(P<0.05)。结论心理护理干预对于手术患者精神干预结果比较好,不仅可以改善患者的抑郁、焦虑情况,也能提升其护理满意度。     

伊布利特联合胺碘酮转复持续性房颤的有效性及安全性研究

目的 探讨运用循证护理模式对脑卒中恢复期患者在社区家庭康复中的干预效果。 方法 选取80例首发脑卒中患者作为研究对象，采用随机数字表法分为常规组和观察组各40例。常规组采用常规社区家庭康复护理方法，而观察组实施循证护理模式，即采用循证护理路径制定出适合患者的最佳社区家庭康复护理方案。评估2组患者干预前后的心理状态、神经功能缺损程度、日常生活能力和运动功能，比较2组患者干预后的总有效率、生活质量、疾病复发率和护理满意度。 结果 观察组干预后的总有效率高于常规组（P＜0.05）；观察组干预后的DSI评分、CSS评分、Barthel指数和MAS评分均优于常规组（P＜0.05）；观察组患者干预后的复发率低于常规组，护理满意度高于常规组（P＜0.05）。 结论 在脑卒中恢复期患者的社区家庭康复中，实施循证护理模式能够改善患者的心理状况及运动功 和日常生活能力，降低复发率，提高患者生活质量；能够增进护患间信任及和谐关系。     

赋能心理护理对ICU患者家属心理压力及应对方式的影响

目的 探讨赋能心理护理对ICU患者家属心理压力及应对方式的影响。方法 选取2017年1-12月我院收治的120例ICU患者的主要照顾家属为研究对象,采用随机数字表法将其分为观察组及对照组,每组各60例。对照组行常规健康宣教,观察组在对照组基础上行赋能心理干预,比较2组心理压力、自我效能及应对方式。结果 干预后,观察组自我效能评分、积极应对方式评分均明显高于对照组(t=8.477,P<0.001;t=10.845,P<0.001),而消极应对方式评分明显低于对照组(t=8.935,P<0.001)。观察组紧张感、失控感及心理压力总评分均明显低于对照组(P<0.001)。结论 赋能心理干预能有效提高ICU重症患者家属自我效能,使家属能积极面对患者病情,减轻患者家属心理负担。     

Hubs disruption in mesial temporal lobe epilepsy. A resting‐state fMRI study on a language‐and‐memory network

Mesial temporal lobe epilepsy (mTLE) affects the brain networks at several levels and patients suffering from mTLE experience cognitive impairment for language and memory. Considering the importance of language and memory reorganization in this condition, the present study explores changes of the embedded language‐and‐memory network (LMN) in terms of functional connectivity (FC) at rest, as measured with functional MRI. We also evaluate the cognitive efficiency of the reorganization, that is, whether or not the reorganizations support or allow the maintenance of optimal cognitive functioning despite the seizure‐related damage. Data from 37 patients presenting unifocal mTLE were analyzed and compared to 48 healthy volunteers in terms of LMN‐FC using two methods: pairwise correlations (region of interest [ROI]‐to‐ROI) and graph theory. The cognitive efficiency of the LMN‐FC reorganization was measured using correlations between FC parameters and language and memory scores. Our findings revealed a large perturbation of the LMN hubs in patients. We observed a hyperconnectivity of limbic areas near the dysfunctional hippocampus and mainly a hypoconnectivity for several cortical regions remote from the dysfunctional hippocampus. The loss of FC was more important in left mTLE (L‐mTLE) than in right (R‐mTLE) patients. The LMN‐FC reorganization may not be always compensatory and not always useful for patients as it may be associated with lower cognitive performance. We discuss the different connectivity patterns obtained and conclude that interpretation of FC changes in relation to neuropsychological scores is important to determine cognitive efficiency, suggesting the concept of “connectome” would gain to be associated with a “cognitome” concept.     

藏药珊瑚七十味丸中重金属含量及Hg元素化学形态研究＊

目的 测定珊瑚七十味丸（Ratanasampil，RNSP）中5种重金属元素的含量，并确定Hg元素存在的各种化学形态，为名贵藏药重金属含量及元素形态的确定提供准确的新型研究方法。方法 采用强酸消解法处理珊瑚七十味丸，利用电感耦合等离子体原子发射光谱（Inductively coupled plasma atomic emission spectrometry，ICP-OES）测定样品中不同重金属元素的含量，同时采用X射线光电子能谱技术（X-ray photoelectron spectroscopy，XPS）对样品中的Hg元素进行价态分析。结果 不同批次的珊瑚七十味丸中Hg、As、Cr、Cd及Cu这5种重金属元素含量存在一定的差异；Hg元素存在游离Hg2+、HgS、HgO共3种形式，且差异较大。结论 ICP-OES和XPS对药物中的5种重金属含量和Hg元素的价态进行的检测和分析，得到的数据较为准确、可靠，能够为珊瑚七十味丸的临床使用提供数据上的参考依据，也为传统道地藏药材中的重金属含量检测及价态分析提供了一种新的研究思路和方法。