棱镜适应治疗单侧空间忽视

单侧窄间忽视足影响脑损伤尤其是卒中后患者功能康复的重要因素,寻求有效的康复治疗措施对于提高患者生活质量具有重要意义.棱镜适应是目前使用最广泛并且研究最深入的忽视症治疗方法,但国内研究较少.文章对单侧空间忽视棱镜适应的治疗机制、在卒中后单侧空间忽视中的应用以及疗效等方面的研究进展进行综述.     

要重视脑卒中后认知和情感障碍的评价及其康复

脑卒中时,可以出现偏瘫及神经系统定位症状和体征以及多种大脑高级功能的障碍,如:智能和记忆障碍、失语、失认、失用、视空间障碍、忽视等认知功能障碍;也可发生焦虑、抑郁等情感障碍.这些脑卒中后的认知和情感障碍也同样是患者致残的原因,但未能引起大家足够的重视.这些障碍通过临床神经心理学的检查方法即可揭示出来,同样有神经系统定位诊断的意义,还可以指导药物和康复治疗.可根据评价后这些障碍的类型和严重程度,来制定患者个体化的、有针对性的康复治疗程序和康复措施--认知神经心理康复,提高疗效,改善预后.因此揭示脑卒中后所发生的认知和情感障碍,并给予评价与康复是非常重要的.     

经颅直流电刺激联合高压氧疗治疗脑卒中后单侧空间忽略患者的临床效果研究

背景 研究表明,经颅直流电刺激能有效改善单侧空间忽略患者的运动功能和认知功能,但临床上对经颅直流电刺激联合高压氧疗治疗脑卒中后单侧空间忽略患者的临床效果尚不明确.目的 观察经颅直流电刺激联合高压氧疗治疗脑卒中后单侧空间忽略患者的临床效果.方法 选取2015年9月至2021年2月南京医科大学附属淮安第一医院收治的82例脑...     

五羟色胺含量在丹参改善颞叶缺血大鼠记忆障碍中的变化

目的 探讨五羟色胺(5-HT)含量在丹参改善单侧颞叶缺血性损害大鼠空间记忆障碍中的变化。方法采用立体定向光化学技术选择性地导致大鼠左侧颞叶皮层缺血,术前30min及术后第3天分别给丹参组大鼠腹腔注射丹参10g／kg体重,用Morris水迷宫及图像自动监视系统监测大鼠行为。然后取脑组织进行病理观察及5-HT免疫组化分析：结果经丹参治疗,颞叶缺血性损害大鼠的空间记忆障碍得到显改善,颞叶缺血性损害显减轻,缺血灶内5-HT表达明显减少。结论在丹参改善单侧颞叶缺血大鼠空间记忆障碍中,5-HT起一定作用。     

单侧疏忽的康复

1 引言 单侧疏忽是脑损伤后的一种认知和行为障碍综合征,它可能严重影响患者的痊愈、康复的成功和独立生活的长久重建.对转归的研究表明,疏忽及其相关后果通常以患者不能自理,依赖性增强和生活质量降低等预示卒中预后不良.     

卒中后情感淡漠

情感淡漠是卒中后的一种常见神经精神并发症.识别卒中后情感淡漠及其相关因素并对其进行有效干预,有助于卒中患者的康复.文章对卒中后情感淡漠的发病率、病理生理学机制、诊断评估和治疗等进行了综述.     

综合性医院抑郁障碍患者95例临床分析

目的 研究综合性医院抑郁障碍患者的临床特征,为正确诊断和及时治疗抑郁症提供临床依据。方法 用前瞻性的方法对95例抑郁患者进行了临床特点和相关因素的分析,治疗前后Zung量表评分分析。结果 抑郁患者最主要的躯体症状为睡眠障碍,其次为疲乏、头痛、心慌和胃肠不适。脑血管病后、胃肠疾病后以及心因性抑郁障碍分别为15.7％、13.7％和66.3％。其中脑血管病后抑郁障碍发病年龄和抑郁病程均明显高于其它两组(P<0.05)。结论 以躯体症状就诊是综合性医院抑郁患者的特点。脑血管病后抑郁障碍不能忽视。     

生物反馈疗法配合作业治疗改善老年脑卒中患者单侧空间忽略症

单侧空间忽略症(unilateral spatial neglect,USN)是脑损伤造成的损伤半球对侧空间未知或有意义的刺激不能反应或定向.本文回顾性分析20例脑卒中后USN患者采用肌电生物反馈疗法配合作业治疗的临床效果.     

单侧肺循环短暂阻断术应用于局限性T4期肺癌外科治疗中的临床分析

相关研究结果表明,对于局限性T4期肺癌,通过外科手术对肺内病灶进行切除能够明显改善患者的预后[1].然而在手术方案的选择方面,传统的单纯肺动脉阻断术等方案存在术野较差、术中出血量较多等问题,一定程度上影响了手术的疗效以及患者术后的康复[2].单侧肺循环短暂阻断术具有术野较好、手术操作方便且能够尽量保存健康的肺组织等优点,应用于局限性T4期肺癌的治疗.本研究通过观察单侧肺循环短暂阻断术治疗局限性T4期肺癌的临床疗效,探讨局限性T4期肺癌治疗方案的选择.     

镜像视觉反馈对脑梗死后单侧空间忽略患者的康复疗效

目的探讨镜像视觉反馈对脑梗死后单侧空间忽略患者的康复疗效。方法选择脑梗死后单侧空间忽略患者42例,按照随机信封法隐藏分配方案分为对照组20例和镜像组22例。对照组采用常规治疗和康复,镜像组在常规治疗和康复基础上采用镜像视觉反馈治疗。对治疗前、治疗4周后进行评价,忽略程度采用凯瑟林-波哥量表(CBS)评分,平衡功能采用Berg平衡量表(BBS)评分,日常生活活动能力采用功能独立性评定法(FIM)评分。结果与治疗前比较,2组治疗后CBS评分明显降低,BBS和FIM评分明显升高,差异有统计学意义(P 0. 05)。与对照组比较,镜像组治疗后CBS评分明显降低[(10. 65±4. 17)分vs (15. 76±8. 89)分,BBS和FIM评分明显升高(56. 10±20. 23)分vs (44. 43±11. 38)分,(74. 69±17. 71)分vs (57. 82±12. 11)分,P 0. 05]。结论镜像视觉反馈对脑梗死后单侧空间忽略患者能显著改善平衡功能及生活自理能力,是临床便捷有效的康复治疗方法。     

脑氧供相关的术后认知功能障碍危险因素的研究进展

POCD指患者在麻醉或手术后出现的精神活动、人格、社交活动以及认知能力等功能的变化,主要表现为记忆力、注意力以及语言理解能力等的损害和社交能力的降低,其发生率相当高,尤其是在老年人当中。围绕POCD展开的临床试验及动物实验较多,对POCD的危险因素以及发病机制进行研究能够为减少POCD的发生提供线索。足够的大脑氧供是大脑组织发挥正常功能的必要条件,各种导致大脑供氧不足因素均有可能导致POCD的发生,本文围绕可能由于脑供氧不足因素导致的POCD进行综述。     

Pathways between childhood maltreatment and life satisfaction in adolescents with eating disorders: A network analysis

Objective

This study explored the association between Childhood maltreatment (CM) experiences and life satisfaction in adolescents with eating disorders (EDs).

Methods

Adolescent inpatients with EDs completed the Childhood Trauma Questionnaire, the Satisfaction With Life Scale, the Brief Symptom Inventory and the Eating Disorder Inventory–2 at admission (n = 361) and discharge (n = 354). A network analysis was conducted to identify the shortest pathways between different types of CM and life satisfaction at admission and discharge.

Results

General psychopathology, life satisfaction, and ED symptoms improved from admission to discharge. At admission, emotional abuse and emotional neglect were included in the pathway between sexual/physical abuse and life satisfaction. Emotional neglect was directly connected with life satisfaction while emotional abuse was connected through feeling disliked by others, feelings of inferiority and worthlessness. At discharge, only the direct negative connection between emotional neglect and perception of excellent conditions in the life persisted.

Conclusions

Emotional maltreatment experiences and general psychopathology, but not disordered eating symptoms, are involved in the association between sexual/physical CM and life satisfaction in adolescents with EDs. Emotional neglect may affect life satisfaction regardless of symptoms severity. These findings inform clinicians for assessment and treatment of maltreated adolescents with EDs.     

Decoding the anatomical network of spatial attention

The study of stroke patients with modern lesion-symptom analysis techniques has yielded valuable insights into the representation of spatial attention in the human brain. Here we introduce an approach—multivariate pattern analysis—that no longer assumes independent contributions of brain regions but rather quantifies the joint contribution of multiple brain regions in determining behavior. In a large sample of stroke patients, we found patterns of damage more predictive of spatial neglect than the best-performing single voxel. In addition, modeling multiple brain regions—those that are frequently damaged and, importantly, spared—provided more predictive information than modeling single regions. Interestingly, we also found that the superior temporal gyrus demonstrated a consistent ability to improve classifier performance when added to other regions, implying uniquely predictive information. In sharp contrast, classifier performance for both the angular gyrus and insular cortex was reliably enhanced by the addition of other brain regions, suggesting these regions lack independent predictive information for spatial neglect. Our findings highlight the utility of multivariate pattern analysis in lesion mapping, furnishing neuroscience with a modern approach for using lesion data to study human brain function.     

Understanding the potency of stressful early life experiences on brain and body function

Early life experiences have powerful effects on the brain and body lasting throughout the entire life span and influencing brain function, behavior, and the risk for a number of systemic and mental disorders. Animal models of early life adversity are providing mechanistic insights, including glimpses into the fascinating world that is now called "epigenetics" as well as the role of naturally occurring alleles of a number of genes. These studies also provide insights into the adaptive value as well as the negative consequences, of early life stress, exposure to novelty, and poor-quality vs good-quality maternal care. Animal models begin to provide a mechanistic basis for understanding how brain development and physiological functioning is affected in children exposed to early life abuse and neglect, where there is a burgeoning literature on the consequences for physical health and emotional and cognitive development. An important goal is to identify interventions that are likely to be most effective in early life and some guidelines are provided.     

The stomach–brain axis

The stomach has distinct functions in relation to the ingestion and handling of solids and liquids. These functions include storage of the food before it is gradually emptied into the duodenum, mechanical crushing of larger food particles to increase the surface area, secretion of an acidic enzyme rich gastric juice and mixing the ingested food with the gastric juice. In addition, the stomach ‘senses’ the composition of the gastric content and this information is passed via the vagal nerve to the lateral hypothalamus and the limbic system, most likely as palatability signals that influence eating behaviour. Other sensory qualities related to the stimulation of gastric tension receptors are satiety and fullness. Receptors that respond to macronutrient content or gastric wall tension influence appetite and meal related hormone responses.The ingestion of food – in contrast to an infusion of nutrients into the stomach – has distinct effects on the activation of specific brain regions. Brain areas such as thalamus, amygdala, putamen and praecuneus are activated by the ingestion of food. Gastric nutrient infusion evokes greater activation in the hippocampus and anterior cingulate. The brain integrates these interrelated neural and hormonal signals arising from the stomach as well as visual, olfactory and anticipatory stimuli that ultimately influence eating and other behavioural patterns. Furthermore, there is now good evidence from experimental studies that gastric afferents influence mood, and animal studies point towards the possibility that gastric dysfunction may be a risk factor for mood disorders such as anxiety and depression. The stomach is also not only colonised by Helicobacter pylori but a large array of bacteria. While there is sufficient evidence to suggest that H. pylori may alter caloric intake and mood, the role of other gastric microbiome for the brain function is unknown. To address this appropriate targeted gastric microbiome studies would be required instead of widely utilised opportunistic stool microbiome studies.In summary, it is now well established that there are important links between the brain and the stomach that have significant effects on gastric function. However, the stomach also influences the brain. Disturbances in the crosstalk between the stomach and the brain may manifest as functional GI disorders while disturbances in the stomach–brain communication may also result in an altered regulation of satiety and as a consequence may affect eating behaviour and mood. These observations may enable the identification of novel therapies targeted at the gastroduodenum that positively alter brain function and treat or prevent conditions such as obesity or functional gastrointestinal disorders.     

Functional brain imaging of gastrointestinal sensation in health and disease

It has since long been known, from everyday experience as well as from animal and human studies, that psychological processes-both affective and cognitive- exert an influence on gastrointestinal sensorimotor function. More specifically, a link between psychological factors and visceral hypersensitivity has been suggested, mainly based on research in functional gastrointestinal disorder patients. However, until recently, the exact nature of this putative relationship remained unclear, mainly due to a lack of non-invasive methods to study the （neurobiological） mechanisms underlying this relationship in non-sleeping humans. As functional brain imaging, introduced in visceral sensory neuroscience some 10 years ago, does provide a method for in vivo study of brain-gut interactions, insight into the neurobiological mechanisms underlying visceral sensation in general and the influence of psychological factors more particularly, has rapidly grown. In this article, an overview of brain imaging evidence on gastrointestinal sensation will be given, with special emphasis on the brain mechanisms underlying the interaction between affective ＆ cognitive processes and visceral sensation. First, the reciprocal neural pathways between the brain and the gut （brain- gut axis） will be briefly outlined, including brain imaging evidence in healthy volunteers. Second, functional brain imaging studies assessing the influence of psychological factors on brain processing of visceral sensation in healthy humans will be discussed in more detail. Finally, brain imaging work investigating differences in brain responses to visceral distension between healthy volunteers and functional gastrointestinal disorder patients will be highlighted.     

La stimulation magnétique transcrânienne répétée : une piste thérapeutique pour les maladies neurocognitives ?

Considering the limited effectiveness of drugs treatments in cognitive disorders, the emergence of noninvasive techniques to modify brain function is very interesting. Among these techniques, repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability and have potential therapeutic effects on cognition and behaviour. These effects are due to physiological modifications in the stimulated cortical tissue and their associated circuits, which depend on the parameters of stimulation. The objective of this article is to specify current knowledge and efficacy of rTMS in cognitive disorders. Previous studies found very encouraging results with significant improvement of higher brain functions. Nevertheless, these few studies have limits: a few patients were enrolled, the lack of control of the mechanisms of action by brain imaging, insufficiently formalized technique and variability of cognitive tests. It is therefore necessary to perform more studies, which identify statistical significant improvement and to specify underlying mechanisms of action and the parameters of use of the rTMS to offer rTMS as a routine therapy for cognitive dysfunction.     

重复经颅磁刺激对血管性认知功能障碍大鼠学习记忆的干预作用

目的探讨重复经颅磁刺激(rTMS)对血管性认知功能障碍(vascualr cognitive impairment,VCI)大鼠学习记忆的干预作用及海马CA1区脑电功率谱的影响。方法选择健康雄性SD大鼠40只,随机分为以下4组:对照组8只,VCI组10只,低频率组11只,复合频率组11只。对VCI组、低频率组、复合频率组大鼠采用异时性双侧颈总动脉结扎法制备VCI大鼠模型。并于造模前、造模后及经颅磁刺激治疗后行Morris水迷宫实验和立体定位仪定位记录大鼠海马CA1区脑电活动。结果 rTMS治疗5个疗程后,低频率组和复合频率组大鼠Morris水迷宫结果均较VCI组明显改善(P<0.05);而VCI组较造模后5d明显欠佳(P<0.05)。脑电分析显示,rTMS后,低频率组、复合频率组大鼠脑电δ、θ功率较VCI组显著降低,α、β频带脑电功率明显升高,且复合频率组α、β频带脑电功率明显优于低频率组(P<0.05);VCI组α、β频带脑电功率较造模后5d显著降低,δ、θ频带脑电功率较造模后5d显著升高(P<0.05)。结论 VCI大鼠学习记忆功能障碍随时间推移可进行性加重。rTMS干预可在一定程度上对抗VCI造模对大鼠脑功能的损害,延缓VCI的进展。     

Eating disorders,obesity and addiction

An addiction model of both eating disorders and obesity has received increasing attention in the popular and scientific literature. The addiction is viewed as a brain disease that must be directly targeted if treatment is to succeed. Evidence from laboratory feeding studies, epidemiology, genetic and familial research, psychopathological mechanisms, and treatment outcome research on cognitive behaviour therapy (CBT) is inconsistent with the clinical validity or utility of the addiction model of eating disorders. Neurobiological research has shown commonalities in brain reward processes between obesity and substance abuse disorders. Yet emphasis on apparent similarities overlooks important differences between obesity and drug addiction. Interest in obesity as a brain disease should not detract from a public health focus on the ‘toxic food environment’ that is arguably responsible for the obesity epidemic and related nutrition‐based chronic disease. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.