草酸艾司西酞普兰联合心理治疗对脑梗死后抑郁的疗效观察

目的：观察草酸艾司西酞普兰联合心理治疗对脑梗死后抑郁的治疗效果。方法96例脑梗死后抑郁状态患者按照治疗方法不同分为治疗组52例与对照组44例,对照组给予安慰剂及心理治疗,治疗组在心理治疗基础上加用草酸艾司西酞普兰口服,连续治疗8周为1个疗程,比较2组临床疗效。结果2组治疗前HAMD、NIHSS及BI评分比较无明显差异（P＞0.05）,治疗后均较治疗前有所改善（P＜0.05）,但同期比较治疗组改善更加明显（P＜0.05）,治疗组总有效率明显高于对照组,差异有统计学意义（χ2＝8.025,P＝0.027）。结论草酸艾司西酞普兰联合心理治疗对脑梗死后抑郁疗效理想,值得推广应用。     

Attention modulates step initiation postural adjustments in Parkinson freezers

BackgroundIn view of freezing of gait's circumstances of occurrence in Parkinson's disease, attentional resources appear to be involved in step initiation failure. Anticipatory postural adjustments (APAs) are essential because they allow unloading of the stepping leg and so create the conditions required for progression.Our main objective was to establish whether or not a change in attentional load during step initiation modulates APAs differently in patients with vs. without freezing of gait.MethodsThree groups of 15 subjects were recruited: elderly people and parkinsonian patients with or without freezing of gait. Attention was modulated before step execution by means of an auditory oddball discrimination task with event-related potential recording. The primary endpoint was the occurrence of inappropriate APAs following the attentional task, i.e. APAs not followed by a step after an intercurrent auditory stimulus.ResultsIn parkinsonian patients with freezing of gait, inappropriate APAs were recorded in 63% of the trials and were observed more frequently than in patients without freezing of gait (51%) and elderly controls (48%). Furthermore, inappropriate APAs in freezers were longer and more ample than in parkinsonian non-freezers and controls. Lastly, postural preparation was impaired in the parkinsonian patients.ConclusionOur results indicate that allocation of attentional resources during step preparation influences the release of APAs differently in freezers and non-freezers. Modulating attentional load is partly responsible for triggering an inappropriate motor program. This difficulty in focusing attention or resisting interference may contribute (at least in part) to the gait initiation failure observed in parkinsonian freezers.     

北海市海城区小学生屈光状态调查分析

目的：了解北海市海城区小学生屈光状态的流行现状。

方法：采用横断面研究,整群抽样调查的方法。选取2019-10/2020-01参加体检的北海市海城区共15所小学30 716名6～14岁学生,检测视力、小瞳下屈光度。采用SPSS17.0统计学软件进行数据分析。

结果：本次监测的15所小学30 716名61 432眼中,屈光状态以轻度近视(29.62%)、0.50D<散光<2.00D(25.43%)、正视(21.05%)及轻度远视(15.85%)为主。随着年龄的增长,正视及远视所占比例呈整体下降趋势; 而近视所占比例呈整体上升趋势。配戴框架眼镜者共1 894例3 788眼,视力不良眼戴镜率为23.30%,框架眼镜矫正合格率为64.57%。左眼和右眼等效球镜比较有差异,且右眼等效球镜P₅₀较左眼更趋于负值。男生和女生等效球镜比较有差异,且女生等效球镜P₅₀较男生更趋于负值。

结论：随着年龄的增长,轻度远视及正视眼的比例逐年下降; 近视眼的比例逐年上升。在视力不良的学生中,常规配戴眼镜的人数较少; 而戴镜后,仍有部分学生的框架眼镜矫正视力不达标。右眼较左眼的屈光状态更趋于负值; 女生较男生屈光状态更趋于负值。     

不同年龄原发性开角型青光眼患者手术前后心理特征和生存质量的变化

目的探讨不同年龄原发性开角型青光眼(POAG)患者手术前后心理特征及生存质量变化的差别。方法纳入POAG患者76例,其中青年患者38例、中老年患者38例。所有POAG患者术前采用家庭支持量表、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及低视力者生活质量量表(LVQOL)进行测试;术后3 d采用HAMA、HAMD进行测试,术后1个月采用HAMA、HAMD、LVQOL进行测试。结果术后1个月,青年组HAMA总分A、HAMD总分B与术后3 d差异无统计学意义(PA=0.585,PB=0.313);而中老年组HAMA总分A、HAMD总分B较术后3 d下降(PA=0.012,PB=0.014)。术后1个月,LVQOL总分较术前升高,差异有统计学意义(P=0.007);青年患者LVQOL总分与术前差异无统计学意义(P=0.238)。多元逐步回归分析显示,术后1个月LVQOL总分的主要影响因素是较好眼视野MD(β=0.410,P=0.002)、健康教育(β=10.134,P<0.01)、术后1个月HAMD总分B(β=-0.795,P<0.01)。结论心理特征及生存质量在青年及中老年POAG患者手术治疗前后发生不同变化,尤其对于青年POAG患者应加强必要的心理支持。     

The neural basis of unwanted thoughts during resting state

Human beings are constantly engaged in thought. Sometimes thoughts occur repetitively and can become distressing. Up to now the neural bases of these intrusive or unwanted thoughts is largely unexplored. To study the neural correlates of unwanted thoughts, we acquired resting-state fMRI data of 41 female healthy subjects and assessed the self-reported amount of unwanted thoughts during measurement. We analyzed local connectivity by means of regional homogeneity (ReHo) and functional connectivity of a seed region. More unwanted thoughts (state) were associated with lower ReHo in right dorsolateral prefrontal cortex (DLPFC) and higher ReHo in left striatum (putamen). Additional seed-based analysis revealed higher functional connectivity of the left striatum with left inferior frontal gyrus (IFG) in participants reporting more unwanted thoughts. The state-dependent higher connectivty in left striatum was positively correlated with rumination assessed with a dedicated questionnaire focussing on trait aspects. Unwanted thoughts are associated with activity in the fronto-striatal brain circuitry. The reduction of local connectivity in DLPFC could reflect deficiencies in thought suppression processes, whereas the hightened activity in left striatum could imply an imbalance of gating mechanisms housed in basal ganglia. Its functional connectivity to left IFG is discussed as the result of thought-related speech processes.     

Linguistic and pragmatic aspects of narration in Finnish typically developing children and children with specific language impairment

This study investigates narratives of Finnish children with specific language impairment (SLI) from linguistic and pragmatic perspectives, in order to get a comprehensive overview of these children’s narrative abilities. Nineteen children with SLI (mean age 6;1 years) and 19 typically developing age-matched children participated in the study. Their picture-elicited narrations were analysed for linguistic productivity and complexity, grammatical and referential accuracy, event content, the use of mental state expressions and narrative comprehension. Children with SLI showed difficulties in every aspect of narration in comparison to their peers. Only one measure of productivity, the number of communication units, did not reach statistical significance. Not only was linguistic structure fragile but also pragmatic aspects of storytelling (referencing, event content, mental state expressions and inferencing) were demanding for children with SLI. Results suggest that pragmatic aspects of narration should be taken into account more often when assessing narrative abilities of children with SLI.     

Clinically Significant Response to Zolpidem in Disorders of Consciousness Secondary to Anti-N-Methyl-d-Aspartate Receptor Encephalitis in a Teenager: A Case Report

BackgroundAnti-N-methyl-d-aspartate receptor encephalitis has been associated with a prolonged neuropsychiatric phase that may last for months to years.PatientWe report the case of a 16-year-old girl who was diagnosed with anti-N-methyl-d-aspartate receptor encephalitis resulting from left ovarian mature teratoma 2 weeks after presentation with psychosis. Following tumor removal and immunotherapy, recovery from a minimally conscious state was accelerated significantly by zolpidem that was used for her sleep disturbance. Our patient was discharged home 8 weeks after admission with marked improvement in her neurological function. Zolpidem has been reported to improve arousal in disorders of consciousness but there are no previous reports of its benefit among patients with anti-N-methyl-d-aspartate receptor encephalitis.ConclusionZolpidem would be a reasonable consideration as an adjunctive treatment in anti-N-methyl-d-aspartate receptor encephalitis after tumor removal and immunotherapy to accelerate recovery and rehabilitation.     

Affective and inflammatory responses among orchestra musicians in performance situation

A number of studies have shown that mental challenge under controlled experimental conditions is associated with elevations in inflammatory markers such as interleukin-6 (IL-6) and C-reactive protein (CRP). However, relatively little work has been done on the effects of ‘naturalistic’ stressors on acute changes in inflammatory markers. The present study examined whether perceived arousal, valence and dominance in musicians are associated with pro-inflammatory and oxidative responses to a concert situation. Blood and salivary samples obtained from 48 members of a symphony orchestra on the day of rehearsal (i.e. control situation) and on the following day of premiere concert (i.e. test situation) were used to determine changes in salivary cortisol, pro-inflammatory markers (plasma myeloperoxidase, serum CRP, plasma IL-6), oxidative stress markers (paraoxonase1 activity and malondialdehyde), and homocysteine, a risk factor for vascular disease. Results of regression analyses showed a significant trend to increased myeloperoxidase (MPO) response in individuals with low valence score. Both affective states, valence and arousal, were identified as significant predictors of cortisol response during concert. In addition, control levels of plasma malondialdehyde were positively correlated with differences in IL-6 levels between premiere and rehearsal (r = .38, p = .012), pointing to higher oxidative stress in individuals with pronounced IL-6 response. Our results indicate that stress of public performance leads to increased concentrations of plasma MPO (20%), IL-6 (27%) and salivary cortisol (44%) in musicians. The decreasing effect of pleasantness on the MPO response was highly pronounced in non-smokers (r = −.60, p < .001), suggesting a significant role of emotional valence in stress-induced secretion of MPO. Additional studies are needed to assess the generalizability of these findings to other ’naturalistic’ stress situations.