神经型布氏杆菌病周围神经损害的临床与电生理研究

目的研究神经型布氏杆菌病周围神经损害的临床特征,探讨电生理对其的诊断价值。方法对32例神经型布氏杆菌病周围神经损害患者(病例组)和32名性别及年龄与病例组匹配的正常对照组进行神经电生理检查,并对所得检查结果进行统计学分析。结果病例组与对照组在运动末梢潜伏期(distal motor latency,DML)、复合肌肉动作电位(compound motor active potentials,CMAP)波幅、运动神经传导速度(motor nerve conduction velocity,MCV)、感觉神经动作电位潜伏期(sensory nerve action potential latency,SL)、感觉神经动作电位(sensory nerve action potential,SNAP)波幅及感觉神经传导速度(sensory nerve conduction velocity,SCV)方面的比较,差异均有统计学意义(P0.05)。电生理检查提示上下肢周围神经损害,感觉神经及运动神经均受累,其中感觉神经占55.47%,运动神经占16.80%,上肢以正中神经(64条)最多见,下肢以腓肠神经(16条)最多见。四肢运动神经256条中43条传导速度减慢,占16.80%,四肢感觉神经256条中142条传导速度减慢,占55.47%,SCV较MCV改变明显,上肢病变重于下肢。结论神经电生理检查为神经型布氏杆菌病周围神经损害的临床诊断提供了客观依据。     

糖尿病前期周围神经病的神经电生理研究

目的 探讨神经电生理(神经传导、F波及皮肤交感反应)检查对糖尿病前期周围神经病的诊断价值。方法 选取100例糖尿病前期患者、50例糖尿病患者及50例健康志愿者,糖尿病前期患者又分为糖耐量异常及空腹血糖受损组,分别为55例及45例; 对上述对象进行四肢神经传导(Nerve conduction studies, NCS)、F波、皮肤交感反应(Skin sympathetic response,SSR)检查。结果(1)糖耐量异常组正中神经感觉动作电位(Sensory nerve active potential,SNAP)、胫后和腓总神经SNAP及感觉传导速度(Sensory nerve conduction velocity,SCV)均低于正常对照组及空腹血糖受损组,空腹血糖受损组腓总神经SNAP、胫后神经SCV均低于正常对照组(P均<0.05);(2)空腹血糖受损组、糖耐量异常组上肢及下肢SSR波幅均低于正常对照组(P均<0.05),糖耐量异常组下肢SSR波幅低于空腹血糖受损组(P均<0.05);(3)糖耐量异常组F波、感觉神经NCS,SSR异常的比例多于正常对照组,空腹血糖受损组SSR异常比例多于正常对照组,糖耐量异常组感觉神经NCS异常的比例多于空腹血糖受损组(P均<0.05)。结论 糖尿病前期患者存在周围有髓鞘大感觉神经纤维及无髓鞘小神经纤维损害,其中糖耐量异常患者周围神经损害重于空腹血糖受损患者,电生理检查以感觉神经NCS及SSR异常为主,利用神经电生理技术利于其周围神经损害的早期诊断。     

Rapid genetic screening of Charcot-Marie-Tooth disease type 1A and hereditary neuropathy with liability to pressure palsies patients

We used the allele-specific PCR-double digestion method on peripheral myelin protein 22 (PMP22) to determine duplication and deletion mutations in the proband and family members of one family with Charcot-Marie-Tooth disease type 1 and one family with hereditary neuropathy with liability to pressure palsies. The proband and one subclinical family member from the Charcot-Marie-Tooth disease type 1 family had a PMP22 gene duplication; one patient from the hereditary neuropathy with liability to pressure palsies family had a PMP22 gene deletion. Electron microscopic analysis of ultrathin sections of the superficial peroneal nerve from the two probands demonstrated demyelination and myelin sheath hyperplasia, as well as an ’onion-like’ structure in the Charcot-Marie-Tooth disease type 1A patient. We observed an irregular thickened myelin sheath and ’mouse-nibbled’-like changes in the patient with hereditary neuropathy with liability to pressure palsies. In the Charcot-Marie-Tooth disease type 1A patient, nerve electrophysiological examination revealed moderate-to-severe reductions in the motor and sensory conduction velocities of the bilateral median nerve, ulnar nerve, tibial nerve, and sural nerve. Moreover, the compound muscle action potential amplitude was decreased. In the patient with hereditary neuropathy with liability to pressure palsies, the nerve conduction velocity of the bilateral tibial nerve and sural nerve was moderately reduced, and the nerve conduction velocity of the median nerve and ulnar nerve of both upper extremities was slightly reduced.     

中英文对照名词词汇(三)

正副肿瘤综合征paraneoplastic neurological syndrome(PNS)改良Gomori三色modified Gomori trichrome(MGT)干扰素-γinterferon-γ(IFN-γ)甘油三酯triglyceride(TG)感觉神经传导速度sensory nerve conduction velocity(SNCV)感觉运动皮质sensorimotor cortex(SMC)     

糖尿病大鼠周围神经形态、功能及电生理指标的动态变化

目的观察链尿佐菌素(STZ)诱导的1型糖尿病大鼠周围神经病变的发生、发展变化。方法用STZ(60mg/kg)腹腔注射诱导1型糖尿病大鼠模型,选取造模成功的大鼠随机分为造模后2周、4周、6周及8周组,对照组给予腹腔注射生理盐水,亦随机分为2周、4周、6周及8周组,每组8只。测定大鼠各时间点热痛阈值、尾神经感觉神经传导速度及腓肠神经的超微结构,观察以上3个指标的动态变化。结果 STZ诱导糖尿病大鼠模型制作成功率为83.3%。造模后4周,模型组热缩足反应潜伏期(TWL)明显长于对照组(P0.05),尾神经感觉传导速度明显慢于对照组(P0.05),模型组少数腓肠神经有髓纤维髓鞘扭曲,部分髓鞘板层松散。造模后6周,模型组TWL显著长于对照组(P0.01),尾神经传导速度显著慢于对照组(P0.01),模型组多数腓肠神经有髓纤维髓鞘板层松散明显,轴突变性。造模后8周,模型组腓肠神经有髓纤维可见典型髓球样改变。结论糖尿病大鼠周围神经功能改变早于形态改变。STZ造模后6周,周围神经形态和功能均有显著改变。     

Amplitude of sensory nerve action potential in early stage diabetic peripheral neuropathy： an analysis of 500 cases

Early diagnosis of diabetic peripheral neuropathy is important for the successful treatment of diabetes mellitus. In the present study, we recruited 500 diabetic patients from the Fourth Affiliated Hospital of Kunming Medical University in China from June 2008 to September 2013：221 cases showed symptoms of peripheral neuropathy （symptomatic group） and 279 cases had no symptoms of peripheral impairment （asymptomatic group）. One hundred healthy control subjects were also recruited. Nerve conduction studies revealed that distal motor latency was longer, sensory nerve conduction velocity was slower, and sensory nerve action potential and amplitude of compound muscle action potential were significantly lower in the median, ulnar, posterior tibial and common peroneal nerve in the diabetic groups compared with control subjects. Moreover, the alterations were more obvious in patients with symptoms of peripheral neuropathy. Of the 500 diabetic patients, neural conduction abnormalities were detected in 358 cases （71.6%）, among which impairment of the common peroneal nerve was most prominent. Sensory nerve abnormality was more obvious than motor nerve abnormality in the diabetic groups. The amplitude of sensory nerve action potential was the most sensitive measure of peripheral neuropathy. Our results reveal that varying degrees of nerve conduction changes are present in the early, asymptomatic stage of diabetic peripheral neuropathy.     

卒中后肩痛周围神经电生理学研究

目的 通过对卒中后肩痛患者上肢进行神经传导速度检查及针极肌电图检查，观察卒中后肩痛患者周围神经电生理指标的变化。方法 选择符合入选标准的卒中住院患者40例，根据数字疼痛评分法（Numerical Pain Rating Scale，NPRS）分为肩痛组（26例）与无肩痛组（14例）。分别进行双侧上肢神经传导速度检查和针极肌电图（electromyography，EMG）检查。结果 肩痛组患侧腋神经、肌皮神经、正中神经复合肌肉动作电位（compound muscle action potential，CMAP）波幅较无肩痛组患侧降低，差异有显著性（P=0.000，0.001，0.000）；无肩痛组患侧尺神经CMAP波幅较同组健侧降低，差异有显著性（P=0.000）；肩痛组患侧尺神经感觉神经动作电位（sensory nerve action potential，SNAP）波幅较无肩痛组患侧降低，差异有显著性（P=0.000）。三角肌、肱二头肌自发电位出现率，肩痛组较无肩痛组增高，差异具有显著性（P=0.044，0.044）。结论 卒中后肩痛患者伴有上肢周围神经的损伤，且肩痛的发生可能与运动神经损伤有关。     

拇指感觉神经传导速度诊断轻度腕管综合征的临床应用价值

目的:探讨拇指感觉神经传导速度(sensory nerve conduction velocity,SCV)诊断轻度腕管综合征的临床应用价值。方法:对18例(26只手)轻度腕管综合征的患者和15例(30只手)年龄性别相匹配的正常人,测定了腕部正中神经和桡神经的感觉神经传导速度,并进行对比研究。结果:中指正中神经SCV的异常率为50%,腕部正中神经/桡神经(刺激拇指)SCV差值的异常率为84.6%,明显大于用常规检查方法组(刺激中指),有8例12只手腕部正中神经感觉动作电位(刺激拇指)中出现双峰电位,而对照组则无。结论:在腕管综合征肌电图的诊断中,比较正中神经和桡神经SCV的差值是早期诊断腕管综合征的敏感指标之一。     

高频超声联合神经电生理检查在尺神经肘管卡压中的应用价值

目的探讨高频神经超声联合神经电生理检查在尺神经肘管卡压中的应用价值。方法回顾性分析186例尺神经肘管卡压病人的临床资料,其中Mc GowanⅠ级96例,Ⅱ级68例,Ⅲ级22例;均进行尺神经皮下前置减压手术。所有病人随访2年,手术前后检测尺神经横截面积(cross section area,CSA)、运动传导速度(motor conduction velocity,MCV)、感觉传导速度(sensory conduction velocity,SCV)和神经动作电位(nerve action potential,NAP)作为诊断和疗效评估指标。结果 Mc GowanⅠ、Ⅱ、Ⅲ级皮下前置术后的优良率分别为87.5%、72.1%、63.6%。术前Mc GowanⅠ级健侧与病侧CSA、MCV、SCV、NAP差异均有统计学意义(P 0.05);术前Mc GowanⅠ、Ⅱ、Ⅲ级间CSA、MCV、SCV、NAP差异均有统计学意义(P 0.05);Mc GowanⅠ、Ⅱ、Ⅲ级术后2年的CSA、MCV、SCV、NAP均较术前显著改善(P 0.05)。结论高频神经超声联合神经电生理检查可应用于尺神经肘管卡压的临床诊断和手术疗效评价。     

髓鞘碱性蛋白免疫治疗对出血性卒中大鼠的保护作用研究

目的研究髓鞘碱性蛋白(myelin basic protein,MBP)主动免疫,对大鼠出血性卒中的保护作用,探讨其预防继发性脑损害的可能机制。方法SD大鼠84只,采用随机数字表法,分为MBP、卵白蛋白(Ovalbumin,VOA)、PBS和空白对照四组(n=21)。制备脑出血模型后24小时内,用不完全福式佐剂(Incom-plete Freund's Adjuvant,IFA)乳化的MBP、VOA、PBS分别免疫三组大鼠,对照组只做脑出血模型,在相应时间点行为学评分,并标本取材,行胶质纤维酸性蛋白(Glial fibrillary acid protein,GFAP)和神经微丝蛋白200(Neurofilament protein,NF200)免疫染色,电镜观察血肿周围脑组织的超微结构变化。结果(1)MBP组免疫后第1～3天行为学评分明显优于其它三组(P<0.05);(2)出血免疫后第1～5天,MBP组GFAP阳性细胞数与其它三组相比有显著性差异(P(0.05),后三组相比无统计学意义(P>0.05)。(3)MBP组NF200阳性细胞数在免疫后第3～14天与后三组相比有显著性差异(P(0.05),后三组之间相比无明显差异(P>0.05)。(4)免疫后第7天,MBP组神经元亚细胞器较丰富,神经微丝排列整齐,其他三组亚细胞器变形或消失,神经微丝排列紊乱。结论MBP免疫治疗能阻断出血性卒中的继发性脑损害,促进神经症状的改善,即血肿周围神经元的恢复。     

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.