轻微肝性脑病患者经颈静脉肝内门体分流术后不同预后组肠道菌群的变化

目的对比分析肝硬化轻微肝性脑病(MHE)患者经颈静脉肝内门体分流术(TIPS)后不同预后组肠道菌群结构与术前的差异。方法选取2016年7月—2017年7月西京医院消化病院住院并接受TIPS治疗的28例MHE患者,分别于术前1~3 d和术后1个月收集粪便样本及采样时临床资料信息,根据术后预后不同分为3组:无HE组(n=8)、MHE组(n=12)和显性脑病(OHE)组(n=8)。对粪便样本采取16S rRNA高通量测序技术进行测序得到菌群相对丰度并在属水平使用SPSS和R语言对各组间菌群物种多样性,术后变化和变化差异展开分析。计数资料组间比较采用χ^2检验,计量资料3组间比较采用Kruskal-Wallis H检验,采用Bonferroni法进行多个样本的多重比较,同组患者术前术后的比较采用Wilcoxo符号秩检验。微生物组Beta分析基于Bray Curtis距离矩阵进行主坐标分析(PCoA),使用Adonis法(PerMANOVA)对比组间差异。结果基于Bray Curtis距离矩阵的PCoA分析显示,仅MHE组术前和术后的beta多样性明显改变(F=2.71,P=0.049)。术后无HE组原生菌群小杆菌属、粪球菌属、瘤胃菌科某属、解黄酮菌属和狭义梭菌属丰度较术前明显升高(Z值分别为2.521、2.1、2.1、2.1和1.96,P值均<0.05);MHE组术后有害菌群颗粒链菌属(Z=2.521,P=0.012)、肠球菌属(Z=2.51,P=0.012)、链球菌属(Z=2.432,P=0.015)和罗氏菌属(Z=2.001,P=0.045)丰度较术前明显下降,但韦荣球菌属(Z=2.353,P=0.019)和巨球菌属(Z=1.955,P=0.05)丰度却明显上升;OHE组术后仅观察到韦荣球菌属丰度较术前升高(Z=2.38,P=0.017)。3组间菌群变化量(术后丰度/术前丰度)比较差异有统计学意义[无HE组vs MHE组vs OHE组:2.00(1.11~91.61)vs 1.21(0.26~6.79)vs 0.09(0.01~0.92),χ^2=6.249,P=0.043]。结论TIPS术后不同预后患者肠道菌群的变化有明显的差异,原生菌群丰度的升高可能对缓解HE病情有一定影响。     

Adult‐onset drug‐refractory seizure disorder associated with anti–voltage‐gated potassium‐channel antibody

Voltage‐gated potassium channels are widely expressed throughout the entire nervous system. These channels play a critical role in establishing the resting membrane potential and generation of neuronal action potentials. There is mounting evidence that autoantibodies reactive to neuronal cell surface antigens, such as voltage‐gated potassium channels, play a pathogenic role in a wide spectrum of central and peripheral nervous system disorders. We report a case of new‐onset drug‐refractory seizure disorder associated with the presence of high levels of serum anti–voltage‐gated potassium channel antibodies that responded only to immunotherapy. As demonstrated by this case report, anti–voltage‐gated potassium channel antibody associated drug‐refractory seizure disorder, although rare, should be considered in patients with unexplained adult‐onset seizure activity. Once the diagnosis has been established the initiation of immunotherapy should be undertaken without delay.     

脑病生理治疗仪在颅脑损伤病人康复期物理治疗的应用观察

目的进一步研究应用清华德人脑病生理治疗仪在颅脑损伤病人康复期的临床疗效。方法将120例颅脑损伤病人随机分为治疗组（即常规治疗和治疗仪结合）60例，对照组（仅使用常规治疗）60例，对两组患者进行动对比。结果治疗组总有效率达到95％，对照组总有效率为77％，比较差异有显著性（P〈0．01）;治疗组的治疗效果较对照组改善十分明显。结论治疗组的治疗效果优于对照组，说明药物加治疗仪同时治疗在颅脑损伤病人康复期比单纯药物治疗效果更好。     

Classification of acute encephalopathy in respiratory syncytial virus infection

Infection with respiratory syncytial virus (RSV) is known to be associated with central nervous system symptoms such as convulsions. We investigated cytokines, nitrogen oxide (NO) _x , and the viral genome in cerebrospinal fluid (CSF) obtained from children with RSV infection-related convulsions or central nervous symptoms and compared the data with type of encephalopathy. Of nine patients enrolled (six boys and three girls; aged 10 days–3 years), one metabolic error, five excitotoxicity, one cytokine storm, and two hypoxia cases were found. The patients presented with unilateral convulsions, generalized convulsions, and convulsions following cardiopulmonary arrest, apnea, and nuchal rigidity. In all patients, a rapid check for RSV of nasal fluid was positive. The RSV genome (subgroup A) was detected in the CSF of five of the nine patients; two patients with hypoxic encephalopathy were negative for the RSV genome. The CSF interleukin (IL)-6 levels were high only in patients with the excitotoxicity and cytokine storm type of encephalopathy. NO _x levels were high in all the subject cases. In the excitotoxicity type, NO _x levels were significantly higher than those in the control and other groups. NO _x level may become an important parameter for the diagnosis and classification of acute encephalopathy in RSV. Strategies to treat each type of encephalopathy, targeting cytokines and free radicals, should be established.     

Environmental cooling of the newborn pig brain during whole‐body cooling

Aim: Therapeutic hypothermia after perinatal asphyxia decreases brain injury in newborns, whereas hyperthermia worsens the brain injury. We examined how different clinical practices influence regional brain temperatures during hypothermia. Methods: Six newborn pigs, which have comparable physiology and brain maturation to human term infants, were maintained at hypothermia (33.5°C) or normothermia with a servo‐controlled whole‐body cooling device that is in clinical use. Pigs were anesthetized and fully instrumented for cardiovascular and temperature (rectal and regional brain) monitoring. Changes in brain temperatures were measured during four different paradigms to mimic different clinical practices. Results: Inserting an insulating pillow between the head and the heated surface reduced cortex temperature by 1 or 2°C during normothermia (core temperature T_core 37°C) or hypothermia, T_core 33.5°C. Reducing ambient temperature from 28°C to 23°C reduced cortex temperature by 3.9 ± 1.9°C. Without a hat and overhead heater at normothermia, cortex and deep brain temperatures were reduced by 1.2 ± 0.8 and 0.7 ± 0.7°C, respectively. Direct overhead heating abolished the normal cortex to deep brain temperature gradient that was maintained if using a head shield. Conclusion: Brain temperature may differ from core temperature during therapeutic hypothermia influenced by different clinical practices.     

MRI in a case of adult-onset citrullinemia

A 42-year-old man presented with a history of repeated episodes of consciousness disturbance for 5 years. The MRI showed abnormally high signal intensities on T2-weighted images at bilateral cingulate gyri, temporal lobes and insular regions, mimicking the finding of herpes simplex encephalitis. Hyperammonemia was disclosed. Serial work-up led to the diagnosis of adult-onset citrullinemia, deficiency of argininosuccinate synthetase. The clinical symptoms improved after diet control and medication. Follow-up MRI showed resolution of the abnormal signal intensities. The MRI findings of citrullinemia and other urea-cycle defects might be attributed to hyperammonemic encephalopathy, but the manifestations were varied. Similar distribution of the abnormalities in the MRI could be found in some reported cases and indicates probably vulnerable sites of hyperammonemic brain injury. Received: 31 July 2000/Accepted: 1 February 2001     

慢性酒精中毒性脑病的临床观察和护理

本文报告8例慢性酒精中毒性脑病患者的护理经验.通过对病情观察、癫痫发作前后、用药安全、饮食、心理和健康教育等护理措施,7例患者好转出院,1例因合并肺部感染、肾衰、心衰死亡.随访1年半,5例戒酒成功,2例间有少量饮酒.