壁面切应力与颅内动脉瘤的研究进展

壁面切应力(WSS)是血流对血管壁的切向摩擦力,平行作用于血管壁.WSS被认为是与颅内动脉瘤发生、生长和破裂关系最密切的血流动力学参数.由于缺乏统一标准,WSS这一参数如何影响动脉瘤仍存在争议.本文结合文献,对WSS在颅内动脉瘤中的作用研究进展作一综述.     

颅内破裂动脉瘤的血流动力学特征:基于流固耦合技术的计算流体力学模拟分析

目的 探讨颅内破裂动脉瘤破裂点和瘤囊处血流动力学特征。方法 选择2018年1月至2019年6月收治的颅内破裂动脉瘤21例，根据术前CTA、DSA数据三维重建动脉瘤模型，采用ANSYS软件计算动脉瘤破裂点和瘤囊处血流动力相关参数[壁剪切应力（WSS）、切应力震荡指数（OSI）]。结果 动脉瘤破裂点WSS[（0.215±0.047）Pa]明显低于瘤囊WSS[（0.464±0.148）Pa；P<0.001]。动脉瘤破裂点OSI[（0.035±0.024）]与瘤囊OSI[（0.030±0.016）]无统计学差异（P>0.05）。在一个心动周期中，随着血流动力学的变化，动脉瘤形态出现规律的变化，载瘤动脉及动脉瘤的形态变化存在明显差异，即动脉瘤两侧壁的形态变化相对较小，动脉瘤破裂点处形态变化明显。结论 颅内动脉瘤破裂点较动脉瘤囊WSS更低而形态变化更大，颅内动脉瘤破裂与WSS呈负相关，而与形态变化呈正相关。     

血流导向支架治疗颅内动脉瘤的相关并发症现状

血流导向支架(flow diverter,FD)通过增加网丝密度,干扰瘤颈部和动脉瘤内血流动力学,诱发动脉瘤内血栓形成,从而达到治疗动脉瘤的目的[1],而对正常分支内血流无明显影响[2].临床上,已有多个中心大宗病例报道使用FD治疗颅内难治性动脉瘤[3-4],动脉瘤完全闭塞率最高达95％.目前临床上应用较广泛的2种FD为Pipeline (pipeline embolization device,PED)和Silk(silk flow diverter,SFD).FD的应用使颅内动脉瘤的治疗策略由瘤腔填塞转变为载瘤血管的重建[15].然而,这种高金属覆盖率的支架在治疗动脉瘤的同时也会带来新的并发症,包括载瘤血管及分支闭塞、脑梗死、动脉瘤破裂出血和支架内狭窄等,发生率高达38％[7].本文就近年来文献报道的应用FD治疗颅内动脉瘤的主要并发症(表1)及防治策略进行综述.     

RNF213基因相关脑血管病研究进展

颅内大动脉狭窄/闭塞(intracranial major artery stenosis/occlusion,ICASO)是我国缺血性卒中最常见病因之一。既往研究提示其与烟雾病在受累血管分布、种族差异性等方面具有相似性。环指蛋白213(ring finger protein 213,RNF213)基因是烟雾病的易感基因。研究发现该基因与ICASO、大动脉粥样硬化性缺血性卒中、颅内动脉瘤同样具有相关性,提示RNF213基因可能与脑血管病发生、发展存在密切的联系。本文旨在通过回顾国内外相关文献,就RNF213结构、功能、基因多态性及与脑血管病相关性等问题进行概述。     

血流导向装置治疗颅内动脉瘤的技术探讨

在过去20年中,颅内动脉瘤的介入治疗随着新材料的出现而快速发展.微弹簧圈填塞的方法开创了颅内动脉瘤介入治疗的新纪元,颅内专用自膨胀支架辅助弹簧圈栓塞治疗的方法大大减小了动脉瘤的复发率.近3年来,大宗病例报道血流导向装置( flow diverting device)治疗颅内大型、巨大型或梭型动脉瘤取得了良好效果[1-6].这种装置在治疗动脉瘤的机制、支架结构和释放技术等方面与普通颅内支架有较大差异,本文根据作者应用血流导向装置经验和相关文献对这些差异进行综述,以对血流导向装置治疗颅内动脉瘤的技术加以探讨.     

Galen静脉畸形

Galen静脉畸形是危及小儿健康的罕见的先天性颅内血管疾病之一,自然病史中死亡率和致残率均很高.随着脑血管内介入技术的发展,其预后较差的结局已经被明显地改善了[1].Galen静脉畸形名称较多,如Galen静脉瘤、Galen静脉动脉瘤样畸形、Galen静脉动静脉瘘等,是一种罕见的颅内血管异常,占所有脑血管畸形的1％,但在儿童颅内血管畸形的发生中约占30％[2].因其治疗棘手,故对相关文献进行了复习,供同道参考.     

高血压对颅内动脉瘤发病机制影响的研究进展

人类对颅内动脉瘤的诊断和治疗虽取得了很大的进步,但蛛网膜下腔出血的病死率仍可达50％[1-2].高血压、吸烟、雌激素被认为是导致颅内动脉瘤发生的三个主要影响因素,其中高血压与颅内动脉瘤的发生相关性最强[3-4].本文回顾了高血压作用下颅内动脉瘤形成、发展机制的研究,探讨高血压患者颅内动脉瘤形成的可能机制,为进一步研究颅内动脉瘤,预防其发生、发展提供依据. 一、颅内动脉瘤的血流动力学改变     

颅内动脉瘤血流动力学的计算流体动力学数值模拟研究

目的 模拟颅内动脉瘤内的血液流动,进而获得血流动力学的各种参数.方法 利用颅内动脉瘤二维数字减影血管造影容积成像数据,建立颅内动脉瘤三维有限元模型,应用计算流体动力学方法计算颅内动脉瘤血流动力学的各种参数.结果 实验获得了颅内动脉瘤血流动力学相关参数包括血流速度、剪切力、压力等,与数字减影血管造影对比可靠.结论 计算流体动力学数值模拟是研究颅内动脉瘤血流动力学的可靠方法.     

未破裂颅内动脉瘤的治疗

颅内动脉瘤是颅内动脉壁的异常突起,尸检发现率为0.2%～7.9%.颅内动脉瘤破裂所致蛛网膜下腔出血(SAH)约占70%,年发生率为6～35.3/10万[1].未破裂颅内动脉瘤指患者可能没有任何症状,只是在偶尔检查中被发现,也可能是因为瘤体占位效应引起的颅神经麻痹或脑干压迫症状而被发现[2].未破裂动脉瘤的三种治疗手段是观察、开颅手术夹闭和血管内介入.本文复习近年关于未破裂动脉瘤的国内外相关文献,就未破裂动脉瘤的自然史和治疗做一综述.     

颅内动脉瘤相关致病基因的研究现状

近年来人们对颅内动脉瘤的相关致病基因进行了深入研究，其中弹力蛋白基因、血管紧张素转化酶基因、内皮糖蛋白基因、基质金属蛋白酶基因、α1-抗胰蛋白酶基因、Ⅲ型胶原基因和载脂蛋白基因与颅内动脉瘤的发生密切相关，提示颅内动脉瘤可能是一种由多个基因共同作用的多基因疾病。本文对颅内动脉瘤致病基因的研究进展进行综述。     

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     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。