CTA和MRA在闭塞性脑血管疾病诊断中的对比研究

目的对比分析螺旋CT血管成像技术及磁共振血管成像技术在闭塞性脑血管疾病诊断中的应用价值。方法选择2012-02—2015-01收治的100例闭塞性脑血管病患者(200条受检血管)为研究对象,将其随机分为观察组和对照组2组各50例(100条受检血管),观察组接受MRA检查,对照组接受CTA检查,对2组患者闭塞性脑血管疾病的血管检出情况、检出率及准确率进行分析。结果在100例患者共200条受检血管中,观察组MRA检查血管轻度狭窄或正常45.00%,中度狭窄37.00%,重度狭窄18.00%;对照组CTA检查血管轻度狭窄或正常46.00%,中度狭窄35.00%,重度狭窄19.00%,2组比较差异无统计学意义(P0.05);观察组50例患者中,MRA对闭塞性脑血管疾病的检出率为100.00%,准确率为94.00%。对照组中CTA对闭塞性脑血管疾病的检出率为100.00%,准确率为94.00%。2组检出率和准确率方面差异无统计学意义(P0.05)。结论 CTA与MRA闭塞性脑血管疾病诊断中各有优势,临床可联合应用以提高其检出率和确诊率。     

缺血性脑血管病TCD、CTA与DSA检查的对比分析

目的探讨经颅多普勒(TCD)、CT血管造影术(CTA)与数字减影血管造影术(DSA)在缺血性脑血管病中的应用价值。方法选取已接受脑血管DSA检查的缺血性脑血管病患者40例,并与其术前TCD和脑血管CAT检查结果进行三者分析比较。结果 TCD、CTA与DSA符合性DSA为标准,CTA对诊断血管狭窄或闭塞的敏感性83.3%,特异性93.6%,符合率91.4%;TCD对诊断血管狭窄或闭塞的敏感性70.8%,特异性87.5%,符合率83.9%。结论 TCD、CTA与DSA检查结果之间有较高的符合率,可作为缺血性脑血管病诊断的重要参考。     

评价TCD对急性缺血性脑卒中患者颅内动脉狭窄的诊断准确率

目的评价TCD对于急性缺血性脑卒中患者颅内动脉狭窄诊断的准确率。方法选取我院神经内科收治的急性缺血性脑卒中患者130例,均行CTA检查、TCD检查,记录并统计CTA检查和TCD检查对各动脉诊断的结果,以CTA检查结果为标准,计算TCD诊断颅内动脉狭窄的敏感性、特异性、阳性预测值、阴性预测值及准确率。结果以CTA结果为准,TCD检查对于不同动脉的血管狭窄诊断结果间存在差异,其中以MCA狭窄诊断的诊断准确率最高,准确率高达99.3%,VA狭窄诊断的效果最差,敏感性仅为63.4%,准确率为86.2%;MCA狭窄患者的MV、SV、DV随着CTA显示狭窄程度的加重而显著上升(P0.05),而搏动指数PI间差异无统计学意义(P0.05);对于MCA闭塞者,TCD检查多出现低流速、低搏动的血流变化。结论 TCD检查对于急性缺血性脑卒中患者颅内动脉狭窄诊断具有较高的准确率,尤其对于大脑中动脉狭窄,同时可提供实时的血流动力学信息,可于CTA检查中互补使用,提高诊断准确率。     

CT血管造影在脑血管病诊治中的临床应用

目的　评估 CT血管造影 (CTA)在脑血管病诊断中的价值。方法　对 5 0例脑血管病患者进行了CTA检查 ,其中颅内动脉瘤 2 4例、脑血管畸形 14例、脑缺血性疾病 3例、自发性颅内出血 9例。除 4例外其余患者均行数字减影血管造影 (DSA)检查 ,并与 CTA结果对照。结果　 45例 CTA的结果与 DSA相同。 1例多发性动脉瘤 ,CTA漏检 1个动脉瘤。 4例未行 DSA的患者 ,其 CTA结果被手术或临床症状证实。CTA在描绘脑血管三维结构以及毗邻骨结构上优于 DSA。结论　CTA是脑血管病诊断的一种简单、快速、非侵袭和可靠的方法。它特别有助于术前手术方案的制定、术中病灶定位以及长期系列随访研究     

大脑中动脉狭窄的TCD、CTA、DSA检测对比研究

目的以数字减影脑血管造影(DSA)为参照,比较TCD、CTA、DSA诊断大脑中动脉狭窄的准确性,评价其临床价值。方法对40例经DSA确诊的单双例72处大脑中动脉狭窄的患者,回顾分析TCD、CTA的检查结果,比较其对大脑中动脉(MCA)M1段、M2段狭窄诊断的准确率。结果TCD、CTA、DSA诊断MCA M1段、M2段狭窄的准确率分别为82.5%、96.5%、100%及26.7%、80.0%、100%。三者对MCA M1段狭窄的诊断差异无显著性(P>0.05),而诊断M2段狭窄,TCD与CTA、DSA比较有显著差异(P<0.05),CTA与DSA无显著差异(P>0.05)。结论CTA、DSA均能准确显示MCA狭窄,TCD有局限性,均能为临床提供诊断价值。     

CT血管造影在缺血性脑病诊断上的临床应用

目的探讨CT血管造影(CTA)对急性缺血性脑病的诊断价值。方法采用螺旋CT扫描获得原始图像,用非离子造影剂(优维显)表面阴影形成像和最大强度投影技术进行三维重建,在60例脑梗死病人中血管狭窄的检出率97.6%。结果CTA在神经内科诊断脑血管病的病因及指导治疗上具有较高的阳性率和确诊率。结论CTA作为一种安全、可靠、简便的血管检查手段,具有重要的临床价值。     

多层螺旋CT血管造影在脑血管疾病中的应用

目的探讨多层螺旋CT血管造影(CTA)对脑血管病变的诊断价值。方法选择临床上怀疑为脑血管病变患者39例,均行CTA检查,其中CTA示正常表现者15例,脑血管病变24例;扫描数据在工作站进行MPR、MIP、SSD、VR及VE等技术后处理。结果15例CTA表现正常者均能显示Willis’环及大脑前、中、后动脉主干及其4级以上分支的血管,24例脑血管病变显示清楚,诊断明确。结论多层螺旋CTA可作为脑血管病变的诊断和筛选、制定手术方案、观察疗效的重要手段。     

CT血管造影在椎动脉狭窄诊断中的临床价值

目的通过与数字减影(DSA)比较,探讨CT血管造影(CTA)在诊断椎动脉狭窄中的临床应用价值。方法 98例缺血性脑血管病患者行CTA及DSA检查,并行资料分析。以DSA为标准,计算CTA诊断椎动脉狭窄的特异度、灵敏度等。结果以DSA结果为金标准,CTA诊断的灵敏度91.8%,特异度90.5%,符合率87.8%;Kappa值0.8053,CTA与DSA检出率具有一致性(P<0.05)。结论 CTA对椎动脉脉狭窄的诊断具有重要的临床意义。     

蛛网膜下腔出血患者的护理

蛛网膜下腔出血(SAH)是神经内科常见病,是指颅内血管破裂,血液流入蛛网膜下腔所致。发病原因有高血压、脑血管病、脑血管畸形和颅动脉瘤等多种因素,急性脑血管疾病占10%左右,颅内动脉瘤破裂约占50%[1]。现将在我院神经内科2009-07~2011-02住院30例蛛网膜下腔出血患     

脑动脉狭窄的CTA、DSA对比研究临床意义

目的以数字减影血管造影(DSA)为参照,比较电子计算机断层扫描血管成像(CTA)诊断脑动脉狭窄的准确性,评价其临床价值。方法对150例1月内进行CTA和DSA检查的可疑脑血管狭窄的患者进行对比,研究CTA对脑动脉狭窄的诊断价值。结果从所研究的总的病变部位来分析:CTA与DSA符合率为98.27%(454/462);CTA阴性而DSA阳性者为1.73%(8/462);CTA阳性而DSA阴性者为1.30%(6/462);以DSA作为"金标准";CTA诊断脑动脉狭窄的敏感性为99.57%(460/462),特异性为98.27%(454/462),假阳性为1.32%(6/454),假阴性为1.76%(8/454)。按不同部位分层分析:颈总动脉、颈内动脉起始段、大脑中动脉M1段、椎动脉开口、椎动脉V1、V2段的敏感性和特异性均为100%;颈内动脉岩段至终末端假阴性为10.26%(8/78),椎动脉V3、V4段和基底动脉假阳性为15.34%(6/39)。结论 CTA在诊断脑动脉狭窄方面的敏感性、特异性均很高,可以作为脑血管病的重要诊断和筛查方法。但对颈内动脉岩段至终末端和椎动脉V3、V4段还存在一定的漏诊和误诊率,对于在脑血管病的诊断和治疗方案的决定中还要结合DSA进行全面评价。     

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。     

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.     

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.     

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.     

《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。     

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。