白质纤维束示踪成像技术在高血压脑出血中的初步应用

目的探讨白质纤维束示踪成像技术在高血压脑出血中的临床应用价值。方法对我院8例急性期情况稳定的高血压脑出血患者进行磁共振弥散张量成像,应用日本东京大学的Volume-one1.72和Diffusion Ten-sor Visualizer(dTV)软件进行三维白质纤维束示踪成像,观察以内囊为主的白质纤维束的压迫、推移、破坏情况。结果8例患者均行磁共振弥散张量成像并行内囊白质纤维束示踪成像,可清楚看到内囊白质纤维束受血肿压迫、推移、破坏情况,由患侧内囊追踪到的相对纤维束条目数少于健侧内囊(P<0.005)。结论白质纤维束示踪成像技术可以清楚显示高血压脑出血后内囊白质纤维束的受累情况。     

弥散张量成像在高血压性脑出血中的临床应用初探

目的 应用磁共振弥散张量成像技术观察基底节区高血压性脑出血皮质脊髓束的受损情况,为临床干预治疗提供可靠依据.方法 对9例基底节区HICH患者进行磁共振弥散张量成像检查,分别测量患侧皮质脊髓束受压区及健侧皮质脊髓束相应区域的FA值,并重建一名患者的FA图、方向编码彩色图、双侧皮质脊髓束3D纤维束图.结果 患侧皮质脊髓束的FA值均较对侧降低,两侧相比差异有显著性意义(t=4.9041,P<0.05);患侧皮质脊髓束区FA值下降百分比和NIHSS评分有明显相关性(r=0.8336,P<0.05);皮质脊髓束3D纤维束图可显示病变侧皮质脊髓束受损情况.结论 通过弥散张量成像可以了解基底节区HICH患者的皮质脊髓束的损伤情况,这有助于临床医生全面掌握病情,开展干预性治疗.     

磁共振弥散张量成像对成人基底节脑出血内囊传导束损伤的诊治价值

目的研究磁共振弥散张量成像纤维示踪技术(MR-DTT)在成人基底节脑出血内囊传导束中的改变情况及其与预后的关系。方法分析2015-06—2016-10深圳市第九人民医院神经外科收治的高血压基底节急性脑出血患者42例,均只接受保守治疗,利用MR-DTT分析评估内囊皮质脊髓束损伤程度,并于发病后1个月、2个月、3个月分别进行患侧上下肢肌力评估、运动功能评分(FM量表)并分析其与CST损伤分级的关系,分析发病后1个月FA值的变化。结果 42例患者均得到完整的DTT图像,根据CST损伤程度分级,其中1级7例,2级16例,3级19例,患侧肢体肌力和FM评分均与CST损伤分级呈负相关;治疗1个月后患侧FA值得到明显提高。结论磁共振弥散张量成像纤维示踪技术能准确评估CST受损情况,且能预示脑出血患者肢体肌力预后情况。     

磁共振弥散张量成像在基底节区高血压脑出血致皮质脊髓束损伤中的应用研究

目的 探讨磁共振弥散张量成像(DTI)技术评价基底节区高血压脑出血(HICH)患者皮质脊髓束(CST)受损程度的意义及其与肌力恢复的关系.方法 徐州医学院附属医院神经外科自2006年11月至2009年5月行小骨窗开颅血肿清除术治疗单侧基底节区HICH患者35例,术后10 d应用3.0T磁共振DTI技术检测患者和10例健康志愿者CST,应用Functool软件进行图像分析观察CST损伤程度,HICH患者康复治疗2月后采用Brunnstrom标准进行肢体肌力检查,分析CST损伤程度与肢体肌力的相关性.结果 10例健康志愿者CST显示清晰.35例HICH患者CST受损的模式有3种:纤维束显示达正常侧的2/3或相仿(11例),患者肢体肌力恢复最好;纤维束显示小于正常侧的2/3(18例),患者肢体肌力恢复较好;纤维柬显示小于正常侧的1/3(6例),患者肢体肌力恢复最差.CST受损患者患侧的FA值均较健侧降低,差异有统计学意义(P<0.05).3种模式CST损伤患者患侧的FA值、肢体肌力不同,差异均有统计学意义(P=0.000).患者CST损伤程度与肌力恢复水平存在负相关关系(r=0.931,P=0.000).结论 应用磁共振DTI技术可显示脑内白质纤维束的走形及分布,能够早期检测HICH患者CST的损伤程度,对患者肢体运动功能损伤的评估、判断预后有重要的临床意义.     

带状灰质异位的磁共振弥散张量白质束成像研究

目的采用磁共振弥散张量白质束成像技术,观察带状灰质异位脑白质异常分布情况,探讨异位灰质的神经病理机制以及弥散张量白质束成像技术的应用价值。方法采用磁共振弥散张量白质束成像技术,对1例癫痫症状的带状灰质异位患者进行白质束描绘,观察其不同灰、白质的分布情况,并和1例正常人进行对比研究。结果弥散张量白质束成像技术很好地描绘了白质束结构。整体观察发现带状灰质异位患者脑白质整体结构紊乱,与正常人相比其联络弓状纤维稀疏、大部缺失,胼胝体纤维稀疏不整;局部分析发现内层灰质为主要的白质纤维发出处,而外层灰质仅发出细碎短小的纤维。结论对于带状灰质异位,异位的内层灰质不仅具有神经生理功能,并且可能起着主要作用,外层"正常"的灰质由于脑结构紊乱而丧失主要功能地位;灰质结构的紊乱导致白质纤维结构的缺失;弥散张量白质束成像技术可以很好地应用于带状灰质异位的神经机制研究。     

磁共振张量成像对脑梗死预后的评价

目的利用磁共振弥散张量成像(DTI)探讨脑梗死病人脑白质纤维束各向异性特征和白质纤维束受损与临床预后关系。方法对23例脑梗死患者行DTI检查,以三维立体弥散张量成像为基础的色彩图进行图像后处理,评价脑梗死区周边纤维束的情况,将纤维束分为受压移位、变细萎缩和破坏中断三类,并与临床预后、神经功能缺损程度比较。结果三维成像所见与病人预后关系密切。所有脑白质纤维束萎缩和中断的患者,在随访过程中存在不同程度脑功能损伤,而脑白质受压移位的病人神经功能完全或近乎完全恢复。结论在脑梗死中,DTI能直接观察到白质纤维束的变化,对于评估临床预后具有重要作用。     

磁共振弥散张量成像对脑出血致皮质脊髓束损害的诊断价值

目的 研究磁共振弥散张量成像(DTI)对脑出血致皮质脊髓束(CST)损害的诊断价值.方法 对20例基底节区脑出血患者(急性期14例,亚急性期6例,均有偏瘫)进行DTI检查,分别测量患侧CST损害区及健侧相应区域的各向异性分数(FA)值、表观弥散系数(ADC)值.结果 DTI显示20例脑出血患者患侧CST受压、移位、变薄或显示不清,患侧CST受损区FA值(0.43±0.16)均较健侧(0.70±0.06)明显降低(t=9.11,P<0.01);14例急性期患者患侧受损CST区ADC值(0.60±0.11)较健侧(0.76±0.10)明显降低(t=7.03,P<0.01).6例亚急性期患者两侧CST区ADC值的差异无统计学意义.结论 DTI可以清楚地显示脑出血患者CST的损害状况,这对判断脑出血患者的病情和预后有参考价值.     

纤维束示踪成像导航技术的应用

磁共振弥散张量成像是在分子水平上研究组织中水分子随机运动的一种功能性磁共振成像技术.应用弥散i量成像进行的白质纤维束示踪成像可以显示脑内主要白质纤维束的走行、方向及病理改变等信息,是目前唯一能够活1绘制人类白质纤维束的方法,将其应用于神经导航系统可使外科医生在术前计划和术中参考白质纤维束的因素而使手:更加安全有效,再结合术中实时电生理监测等技术手段,可显著改善神经外科手术中脑功能的保护.     

应用扩散张量和功能磁共振成像技术探讨皮质脊髓束与肌力的相关性

目的探讨脑梗死与脑肿瘤患者皮质脊髓束(corticospinaltract,CST)损伤对肢体肌力的影响。方法应用磁共振扩散张量成像(diffusiontensorimaging,DTI)和扩散张量纤维束成像(diffusiontensortractography,DTT)技术,并将DTI与功能磁共振成像(functionalMRimaging,fMRI)相结合,对脑梗死和脑肿瘤引起的皮质脊髓束损伤进行定位诊断,并观察皮质脊髓束损伤对患者肢体肌力的影响。对40例急性脑梗死(发病时间<72h)和113例脑肿瘤患者行MRI和扩散加权成像检查,其中部分患者再行增强扫描和fMRI检查。收集全部患者的磁共振扩散张量成像原始数据,然后行扩散张量纤维束成像,重建双侧皮质脊髓束,并将患侧皮质脊髓束的病理性改变对肢体肌力的影响进行相关性分析。结果(1)梗死区各向异性(FA)阈值为(0.336±0.065),对侧半球正常白质区FA阈值为(0.705±0.069),梗死白质区FA值显著低于健侧,两侧相比差异有显著性意义(t=15.823,P<0.001)。(2)扩散张量纤维束成像显示,脑梗死和脑肿瘤患者病变侧皮质脊髓束受压、变形、移位,部分断裂。(3)脑梗死皮质脊髓束损伤患者的肢体肌力降低率为67.50%(27/40),脑肿瘤为16.81%(19/113);组间差异有显著性意义(χ2=36.096,P<0.001)。(4)急性脑梗死和脑肿瘤累及皮质脊髓束内囊后肢致肌力降低率分别     

高血压脑出血患者偏瘫相关弥散张量成像研究

目的利用磁共振弥散张量成像(DTI)技术研究脑出血患者偏瘫肢体功能障碍情况。方法运用DTI技术检测32例脑出血患者发病3周左右病变侧皮质脊髓束(CST)受损情况,分析其与患肢Brunnstrom评分及NIHSS评分之间的关系。结果 DTI所显示的CST受损程度与Brunnstrom评分呈负相关(P0.001),与NIHSS评分呈正相关(P0.001)。结论 DTI可直观显示与脑出血患者肢体运动功能障碍密切相关的CST受损情况,有助于病情的客观评估。     

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.