修改Graeb评分标准预测脑室积血并发急性梗阻性脑积水

目的 寻找一种客观实用的方法,预测脑室积血（IVH）并发急性梗阻性脑积水（AOH）的发生概率。方法 用原Graeb及修改Graeb2种评分标准,对积血为主要部位的第四脑室组15例、第三脑室组19例及基底节出血所致侧脑室组38例,根据有无AOH,用四格表确切概率法及Logistic回归分析法分析积分与脑积水的关系。结果 按修改Gradb标准在敏感性和特异性二曲线交点时,敏感性、特异性、误诊率、漏诊率、诊断效率、Youclen和K值分别为0.952、0.90、0.1、0.048、0.93、0.852和0.85。用Logisticl回归分析5-12分者并发AOH的概率分别为：0.02、0.07、0.26、0.62、0.88、0.97、0.99及1.0。结论 修改Graeb标准能较好地预测第三、第四脑室及幕上出血量小于30ml所致IVH并发AOH的发生概率。     

侧脑室出血后并发急性脑积水预测方法研究

目的 探讨侧脑室出血后并发急性脑积水(PHH)的预测方法。方法 67例原发性及幕上脑出血继发侧脑室出血患，分别用Graeb标准和修改Graeb标准给脑室出血评分，以CT复查及侧脑室外引流有无急性梗阻性脑积水(PHH)为金标准，用四格表确切概率法分析各积分区段的敏感性(Se)与特异性(Sp)值，以及诊断界点值时各统计学参数的效度，用L0gistic回归分析法探讨各积分点与PHH发生的关系。结果 按修改Graeb标准其诊断界点时、Se、Sp、Kappa值、诊断效率与诊断指数值分别为0．90、0．87、0．74、0．88与1．77；而从3—12相应各积点并发PHH的概率分别为0．0ll、0．031、0．083、0．204、0．418、0．669、0．850、0．941、0．978与0．993。结论 用Logistic回归分析法结合修改Graeb标准，对侧脑室出血后PHH的预测是可取的，而且具有较高预测价值。     

脑室出血的三级治疗方案

目的探索脑室出血的分级治疗方案。方法按修改Graeb评分标准观察了237例脑室出血（IVH）患者的积血评分、出血后脑积水（PHH）及病程21d内病死率。用Logistic回归法建立并发PHH的预测方程，以5％与95％二概率点将观察样本分为三个段别，提出初步三级治疗方案。应用X^2检验比较各评分点组治疗方法对病死率的影响，修正上述三级治疗方案。结果按修改Graeb评分标准，评分1—4段中各点PHH发生概率小于5％，内科保守治疗的病死率在各点均为0；PHH发生概率大于95％的评分点于11-12间，外科引流能显著降低10-12段内各评分点组的病死率；而评分5～9者，PHH发生概率为9．6％～81．0％，内科保守或外科引流对该段内各评分点组的病死率影响差异无统计学意义。结论按修改Graeb评分标准，据IVH评分大小分三级治疗：一级即评分1～4者行内科保守治疗；二级即评分5～9者可在有外科引流准备的条件下行内科保守治疗；三级即评分10～12者应予以积极的外科引流。     

脑室出血并发脑积水的风险评估与治疗

脑室出血（IVH）约占自发性颅内出血患者的1／3。脑室出血并发出血后脑积水（PHH）是导致不良预后的独立危险因素。在建立修订的Graeb评分标准之后,结合logistic回归分析法建立预测PHH发生概率的数学模型,发现修订的Graeb评分标准比原Graeb评分标准预测不同类型的IVH并发PHH发生更加科学适用。按PHH发生几率大小进行分组,比较各组外科引流与内科保守治疗的病死率,建立了IVH的临床三级治疗方案,即评分1～4分行内科治疗,5～9分者在做好外科引流准备的条件下保守治疗,10～12分者积极引流。同时还对脑室外引流的时间、并发症、引流管拔除等相关问题进行了讨论。     

自发性脑室出血后脑积水的危险因素分析

目的探讨自发性脑室出血后形成脑积水的相关危险因素,以指导临床治疗决策。方法回顾性分析南京医科大学附属逸夫医院2016-06—2020-05收治的152例自发性脑室出血患者的临床资料,其中脑室出血后发生脑积水67例,未发生脑积水85例。将2组患者性别、年龄、格拉斯哥昏迷评分(GCS)、原发出血部位、有无脑疝、Graeb评分、受累及的脑室数量和颅内感染等指标进行比较,多因素Logistic回归分析脑室出血后发生脑积水的危险因素。结果与未发生脑积水组相比,发生脑积水组患者GCS评分≤8分、Graeb评分≥6分、受累及的脑室数量和颅内感染比例较高,差异有统计学意义(P0.05);2组性别、年龄、脑疝、原发出血部位差异无统计学意义(P0.05)。多因素Logistic回归分析表明GCS评分≤8分、Graeb评分≥6分和颅内感染是自发性脑室出血后发生脑积水的独立危险因素。结论 GCS评分、Graeb评分以及是否并发颅内感染是影响自发性脑室内出血后发生脑积水的重要因素。     

脑池及脑池积血在动脉瘤性蛛网膜下腔出血后急性脑积水发生中的作用

目的 探讨脑池及脑池积血在动脉瘤性蛛网膜下腔出血(aSAH)后急性脑积水发生中的作用.方法 对南方医科大学南方医院神经外科201 1年5月至2014年1月经手术治疗且资料完整的306例aSAH患者的临床数据进行回顾性分析,其临床变量进行单因素分析和多因素Logistic回归分析,并对各个脑池的血量进行定量分析.结果 306例患者中有112例发生了急性脑积水,发生率为36.6％.单因素分析表明Fisher分级、脑室积血、动脉瘤的位置、动脉瘤侧别、再出血、治疗方式6项因素比较差异有统计学意义(P＜0.05);多因素Logistic回归分析显示动脉瘤位置与脑室积血为其独立发生因素.在无脑室积血的患者中,急性脑积水的发生率为22.4％,其中脑积水组中的脚间池、右侧侧裂池血量最多,与非脑积水组相比差异有统计学意义(P=0.000;P=0.005).结论 aSAH急性脑积水是多因素共同作用的结果,动脉瘤位置与脑室积血是其独立危险因素;aSAH急性脑积水是梗阻性脑积水,脑池的位置及脑池积血的分布在aSAH急性脑积水发生中有着重要的影响作用;在无脑室积血的aSAH患者中,脚间池、右侧侧裂池的积血血量越大,越容易发生急性脑积水.     

改良的Graeb评分对幕上自发性脑室出血患者术后慢性脑积水预测价值

目的 探讨脑室改良的Graeb评分(m GS)对幕上自发性脑室出血(IVH)患者术后慢性脑积水(HCP)的预测价值。方法 回顾性分析169例行手术治疗的幕上自发性IVH患者的临床资料,根据患者出院后3个月内是否形成慢性HCP,将其分为慢性HCP组(49例)和非慢性HCP组(120例)。使用m GS评分评估自发性IVH严重程度。通过单因素和多因素Logistic回归分析,揭示HCP的危险因素,采用受试者特征工作(ROC)曲线分析m GS评分预测HCP的能力。结果 通过多因素Logistic回归分析,脑室m GS评分与HCP独立相关(OR=1.395,95%CI:1.239～1.572,P <0.001),同时结果还显示GCS评分为HCP的独立影响因素(P <0.05)。脑室m GS评分的曲线下面积(AUC)为0.870(95%CI:0.810～0.917,P <0.001),灵敏度89.8%,截断值14分。结论 m GS评分具有预测幕上自发性IVH患者术后慢性HCP的价值。脑室m GS评分>14时,患者术后更易形成慢性HCP。     

婴幼儿脊髓脊膜膨出术后并发脑积水的影响因素及治疗方法分析

目的 探讨婴幼儿脊髓脊膜膨出修补术后合并脑积水的影响因素及治疗方法.方法 回顾性分析182例显微外科手术治疗脊髓脊膜膨出病儿的临床资料.根据术后是否并发脑积水分为脑积水组和对照组,多变量Logistic回归分析术后并发脑积水的影响因素;对脑积水组均先采取内科脱水治疗,再根据病情选择脑室外引流术(引流术)、第三脑室底造瘘术(造瘘术)和脑室-腹腔分流术(分流术)治疗.结果 本组病儿术后发生脑积水26例,多变量Logistic回归分析:膨出部位在颈胸段、术后并发感染或脑脊液漏、脊膜膨出平均周径大、术前颅高压均为术后并发脑积水的影响因素.脑积水组采用单纯脱水治疗2例,脱水+引流术3例,脱水+引流术+造瘘术3例,脱水+引流术+分流术16例,脱水+引流术+造瘘术+分流术2例;经治疗治愈23例,死亡3例.结论 针对脊髓脊膜膨出修补术后产生脑积水的不同病因,综合采用不同的治疗方式,可取得较好疗效.     

去铁敏对大鼠脑室出血后慢性脑积水与脑组织Wnt1、Wnt3a表达的影响

目的 观察去铁敏对大鼠脑室出血(IVH)后脑积水的干预效果及脑组织Wnt1、Wnt3a的表达影响.方法 雄性SD大鼠130只随机分为正常组、假性IVH组、IVH组及IVH加去铁敏组.采用脑室出血后慢性脑积水大鼠模型,于术后1 d、7 d及28 d处死大鼠,观察脑积水的发生率和脑组织中Wnt基因及蛋白表达情况.结果 正常组、假性IVH组未见脑积水发生,IVH组28 d脑积水发生率80%(12/15),显著高于IVH加去铁敏组28 d脑积水发生率20%(3/15).IVH后Wnt1、Wnt3amRNA及蛋白表达在7 d及28 d均显著高于假性IVH组,而去铁敏治疗组Wnt1、Wnt3a mRNA及蛋白表达在28 d较IVH组均显著降低.结论 去铁敏治疗可降低大鼠IVH后慢性脑积水发生率,Wnt信号通路参与了IVH后脑积水发生及去铁敏干预机制.     

去铁敏对大鼠脑室出血后慢性脑积水与脑组织Wnt1、Wnt3a表达的影响

目的 观察去铁敏对大鼠脑室出血(IVH)后脑积水的干预效果及脑组织Wnt1、Wnt3a的表达影响.方法 雄性SD大鼠130只随机分为正常组、假性IVH组、IVH组及IVH加去铁敏组.采用脑室出血后慢性脑积水大鼠模型,于术后1 d、7 d及28 d处死大鼠,观察脑积水的发生率和脑组织中Wnt基因及蛋白表达情况.结果 正常组、假性IVH组未见脑积水发生,IVH组28 d脑积水发生率80%(12/15),显著高于IVH加去铁敏组28 d脑积水发生率20%(3/15).IVH后Wnt1、Wnt3amRNA及蛋白表达在7 d及28 d均显著高于假性IVH组,而去铁敏治疗组Wnt1、Wnt3a mRNA及蛋白表达在28 d较IVH组均显著降低.结论 去铁敏治疗可降低大鼠IVH后慢性脑积水发生率,Wnt信号通路参与了IVH后脑积水发生及去铁敏干预机制.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.