经皮质感染性失语患者的深部失读

分析治语失读特点并探讨其机制。方法 对６例经皮质感染性失语并深部失读患者做补充阅读检查－－９２个词先朗读，后配画或解释。结果 ６例有８５个错读词。４８个词义错读词中大多可正确配画或解释；１９近形错读词和１１个近音错读词中大多不能正确配画或解释。７个部分词郎读中３个疔正确配画。结论 字的视觉传入可激活义系统，但由于字位－音位转换有缺陷致不能正确选择出现词义错读。错读的语音可激活语音系统，但从同音异义     

经皮质感觉性失语患者的阅读障碍

分析９例经皮质感觉性失语患者的阅读障碍特点。结果（１）在患者朗读１０个合体字中，无１例有与声旁有关的语音错读，（２）在词，朗读中有很多词义代替一词义错读，表明９例的阅读障碍属深部失读。（３）在词配画作业中，形音失读占２０％，形义失读占１７．７％，未表现形义联系强于形音联系。     

传导性失语患者的复述和朗读障碍

目的 探讨传导性失语患者复述和朗读障碍特点。方法 分析１３例传导性失语患者的词笔述和朗读障碍特点。结果 虽１３例传导性失语患者复述错误主要是音位性错语（６８．４％），但其朗读错误则以词义性错语（２项作业分别为５５．６％和５７．８％）为主，即属深部失读。结论 传导性失语患者复述和朗读是经两条不同的途径及机制激活语音的。     

不同型失语症患者的复述障碍

目的 探讨不同型失语症患者的复述障碍特点。方法 设计8组近音单字词及词的图画,对不同型失语症患者做复述检查。结果 3例传导性失语症患者复述障碍最重,复述错误主要为音位性错语,但大多配画正确;3例经皮质感觉性失语症患者的复述错误中,9个音位性错语及2个词义性错语,大多错语配画正确,但16个复述正确的词配错画;7例经皮质运动性失语症患者中,5例复述和配画全对,另1例口语表达表现为语音障碍,1例在复述中有持续现象。结论 本文三型失语症患者复述障碍的特点不同,揭示其复述障碍各有不同的病理生理机制。     

汉语纯失读症(附1例报告)

目的报道１例汉语纯失读症的临床表现，探索双（多）语双（多）方言纯失读现象。方法详细神经系统临床检查。双语失语症检查法及汉语失语症检查法（普通话及另两语译本）全面测查语言功能，侧重语言学分析，附加自设音乐简谱检查。结果本例认字极差，阅读理解零分。自发书写正常。兼有认偏旁不认整字及认整字不认偏旁。词意错读。数字及简谱正确。结论本例兼有词汇失读及字母失读、一字多音失读。词义错读突出。数字与简谱阅读相关。机理值得探讨。     

正常人手运动功能脑皮质定位的研究

目的 研究正常人手复杂运动时脑皮质的功能定位。方法 采用SIEMENS成像系统的EPI-Bolding程序，采集7例受试运动和静止状态的T1W图像共6个时相，应用相应软件分析得到差异信号图像，在T1W结构图像融合，并进行三维重建。结果 7例受试在执行握拳运动时，对侧皮质中央前回的第一运动区（Broadman 4区）均可见明显激活信号，对侧或双侧的补充运动区均有激活信号，2例运动前区激活，3例可见同侧中央前回运动皮质的激活信号。三维重建显示第一运动区的激活信号主要位于对侧中央沟的中外侧，补充运动区的激活信号位于运动前区（Broadman 6区）近正中的内侧面。结论 正常人手复杂运动时脑皮质运动网络被广泛激活，功能核磁共振的激活信号反映了脑的高级功能活动。     

溶栓治疗急性脑梗死的临床研究

目前，世界各国脑血管专家从临床和动物实验方面都提出：脑梗死应进行早期溶栓治疗，可增加疗效和减少致残率。在目前情况下，影响脑梗死治疗效果的主要因素是来院求治和治疗不及时，未开展早期溶栓治疗。因此我们开展此研究，现报告如下：１ 资料和方法１．１研究对象 依据全国第四次脑血管病学术会议通过的诊断标准，选择急性颈内动脉系统脑梗死，发病在６ｈ内开始溶栓治疗，男１６例，女６例，年龄５６．７±８．２１（４０～７０岁）岁；无明显意识障碍，血压小于１８０／１１０ｍｍＨｇ，６个月内无脑血管意外或大手术史，无出血性疾病…     

心脏电子起搏器时代与生物起搏替代的前沿话题*☆

学术背景：植入电子起搏器是目前治疗症状性缓慢心律失常的主要方法，然而它存在许多缺点。能否利用分子生物学原理发展生物起搏器成为大家关注的热点。通过转染编码If电流的超极化激活环核苷酸门控通道基因，过度表达超极化激活环核苷酸门控通道，增加心脏舒张期内向电流，从而在窦房结被抑制时提供起搏作用，这种利用基因治疗和细胞治疗构建的生物起搏在不久的将来可能会成为电子起搏器最为理想的替代方法。 目的：总结超极化激活环核苷酸门控通道基因构建生物起搏的研究进展。 检索策略：由该论文的研究人员应用计算机检索Pubmed数据库1979-01/2007-06的相关文献，检索词“hyperpolarization-activated cyclic nucleotide-gated channel; biological pacemaker”，并限定文章语言种类为English。共检索到157篇文献，对资料进行初审，纳入标准：①与生物起搏及超极化激活环核苷酸门控通道基因密切相关。②同一领域选择近期发表或在权威杂志上发表的文章。排除标准：重复性研究。 文献评价：文献的来源主要是超极化激活环核苷酸门控通道基因的基础实验。所选用的36篇文献中，10篇为综述，其余均为临床或基础实验研究。 资料综合：①在4种异构体中超极化激活环核苷酸门控通道1,2,4是心脏中的主要部分，超极化激活环核苷酸门控通道3只在胚胎起搏细胞中有低水平表达。起搏活性小的区域（如心室肌），超极化激活环核苷酸门控通道2的表达占优势；而起搏活性高的区域超极化激活环核苷酸门控通道4的表达占优势。此外，超极化激活环核苷酸门控通道2在整个发育阶段，是心室的主要异构体，超极化激活环核苷酸门控通道2:超极化激活环核苷酸门控通道4的相当表达量在乳鼠为5:1，成年鼠为13:1。②超极化激活环核苷酸门控通道通道缺陷可导致病窦综合征。③到目前为止，转染编码If电流的超极化激活环核苷酸门控通道基因被认为是最有可能实现生物起搏的。 结论：基因治疗和细胞治疗必将成为改善生物“起搏”功能最理想的方法，以超极化激活环核苷酸门控通道基因和细胞为主的生物起搏在缓慢性心律失常治疗中必将占有一席之地。     

小剂量硝基安定辅助治疗重症Tourette综合征

１２例选自１９９９年２～１１月我院儿科住院和神经专业门诊患儿。均符合美国精神神经疾病诊断手册第四版（ＤＳＭ－Ⅳ）中 Ｔｏｕｒｅｔｔｅ（ＴＳ）综合征的诊断标准。重症ＴＳ定为抽动频率较快，不能正常生活，不能入学。男１１例，女１例。年龄７～１３岁。临床表现，全部病例均出现频率较快的面部、肢体或腹部的抽动，清醒时平均每分钟抽动大于１５次，其中２例喉部犬吠样叫声。脑电图，１０例正常，２例均可见阵发性４～６ＨＺθ波。病程大于１年，近期加重时间不超过半个月。全部病例近２个月均未接受过治疗。 方法：硝基安定１．２…     

紫外辐射引起DNA损伤的修复*

学术背景：紫外线辐射可造成机体表皮细胞DNA损伤,亦可诱发表皮细胞酶活性进行损害DNA的修复系统的启动。 目的：概述近年来关于紫外辐射引起DNA损伤的修复机制研究成果。 检索策略：应用计算机检索PubMed中1991-01/2007-08关于DNA损伤修复和DNA紫外线损伤的文章,在标题和摘要中以“UV-induced DNA damage and DNA repair”为检索词进行检索, 限定文章语言种类为“English”。选择文章内容与DNA损伤修复和DNA紫外线损伤有关者,同一领域文献则选择近期发表或发表在权威杂志文章。 文献评价：初检得到561篇文献,根据纳入标准选择关于紫外辐射引起DNA损伤及其修复的42篇文章进行综述。 资料综合：环境污染使得紫外辐射增强,而紫外线辐射对机体表皮细胞的DNA具有损害作用,可导致环丁烷嘧啶二聚体和6-4光产物的形成。紫外光可激活光解酶来识别并黏附于环丁烷嘧啶二聚体,进行光酶性修复;还可以在受损的DNA中激活紫外线修复酶,启动剪切修复。光酶性DNA修复主要存在于原核生物或植物体中,紫外线修复酶系统则主要存在于细菌体内,高等生物体中由于缺乏光解酶,修复方式以核酸切除修复为主。 结论： 紫外辐射导致DNA损伤的产物以环丁烷嘧啶二聚体和6-4光产物为主。在多数生物体中,光复活作用用来清除环丁烷嘧啶二聚体产物,而核苷酸切除修复途径则用于6-4光产物的修复。人类DNA的损伤修复主要依赖于核苷酸切除修复途径。     

Reflex reading epilepsy: effect of linguistic characteristics on spike frequency

Reading epilepsy is a rare reflex epilepsy in which seizures are provoked by reading. Several cases have been described in the literature, but the pathophysiological processes vary widely and remain unclear. We describe a 42-year-old male patient with reading epilepsy evaluated using clinical assessments and continuous video/EEG recordings. We administered verbal, nonverbal, and reading tasks to determine factors precipitating seizures. Linguistic characteristics of the words were manipulated. Results indicated that reading-induced seizures were significantly more numerous than those observed during verbal and nonverbal tasks. In reading tasks, spike frequency significantly increased with involvement of the phonological reading route. Spikes were recorded predominantly in left parasagittal regions. Future cerebral imaging studies will enable us to visualize the spatial localization and temporal course of reading-induced seizures and brain activity involved in reading. A better understanding of reading epilepsy is crucial for reading rehabilitation in these patients.     

Overcoming the effect of letter confusability in letter-by-letter reading: A rehabilitation study

Patients who read in a letter-by-letter manner can demonstrate effects of lexical variables when reading words comprised of low confusability letters, suggesting the capacity to process low-confusability words in parallel across the letters (Fiset, Arguin, & McCabe, 2006). Here a series of experiments is presented investigating letter confusability effects in MAH, a patient with expressive and receptive aphasia who shows reduced reading accuracy with longer words, and DM, a relatively “pure” alexic patient. Two rehabilitation studies were employed: (i) a word-level therapy and (ii) a letter-level therapy designed to improve discrimination of individual letters. The word-level treatment produced generalised improvement to low-confusability words only, but the serial processing treatment produced improvement on both high and low confusability words. The results add support to the hypothesis that letter confusability plays a key role in letter-by-letter reading, and suggest that a rehabilitation method aimed at reducing ambiguities in letter identification may be particularly effective for treating letter-by-letter reading.     

氯吡格雷抵抗的检测与防治进展

氯吡格雷是目前广泛应用的抗血小板药物,其对血小板的抑制具有个体差异性.近来氯吡格雷抵抗受到了越来越多的关注,它的检测方法有透光率集合度测定、血小板功能分析仪、全血流式细胞仪等.防治氯吡格雷抵抗的对策是多方面的,主要有避免药物相互作用、增加剂量或联合治疗等.     

Contribution of ultrasound in the assessment of nerve diseases

Background and purpose: Recently, ultrasound (US) has been used to assess the peripheral nervous system; however, there is no real study about its possible significant role in routine practice. Our study aims to assess the contribution of US as a routine tool in a neurophysiological laboratory. Methods: The study assesses 130 patients who presented clinical suspicion of peripheral nerve diseases, excluding motor neuron disease, radiculopathy, hereditary and acquired polyneuropathy. All patients were clinically, neurophysiologically and sonographically assessed in the same session by the same neurologist/neurophysiologist. To avoid interpretation bias, two independent and blinded clinicians, different than the examiners performing electrodiagnosis and US, reviewed clinical, neurophysiological and US findings (also data about follow‐up, when available) and classified the contribution of US as follows: Contributive (US had influence on the diagnostic and therapeutic strategies), Confirming (US confirmed the clinical and neurophysiological diagnosis), Non‐Confirming (US findings were normal) and Incorrect (US findings led to incorrect diagnosis). Results: US impacted, namely modified the diagnostic and therapeutic path in 42.3% of cases (55 patients); US had a confirmatory role in 40% (52 patients); US did not confirm clinical and neurophysiological diagnosis in 17.7% (23 cases); no incorrect US findings were observed. Conclusion: US complements neurophysiological assessment even in routine practice, and this confirms the increasing interest in US for a multidimensional evaluation of peripheral nerve system diseases.     

The frontal predominance in human EEG delta activity after sleep loss decreases with age

Sleep loss has marked and selective effects on brain wave activity during subsequent recovery sleep. The electroencephalogram (EEG) responds to sleep deprivation with a relative increase in power density in the delta and theta range during non-rapid eye movement sleep. We investigated age-related changes of the EEG response to sleep deprivation along the antero-posterior axis (Fz, Cz, Pz, Oz) under constant routine conditions. Both healthy young (20-31 years) and older (57-74 years) participants manifested a significant relative increase in EEG power density in the delta and theta range after 40 h of sleep deprivation, indicating a sustained capacity of the sleep homeostat to respond to sleep loss in ageing. However, the increase in relative EEG delta activity (1.25-3.75 Hz) following sleep deprivation was significantly more pronounced in frontal than parietal brain regions in the young, whereas such a frontal predominance was diminished in the older volunteers. This age-related decrease of frontal delta predominance was most distinct at the beginning of the recovery sleep episode. Furthermore, the dissipation of homeostatic sleep pressure during the recovery night, as indexed by EEG delta activity, exhibited a significantly shallower decline in the older group. Activation of sleep regulatory processes in frontal brain areas by an extension of wakefulness from 16 to 40 h appears to be age-dependent. These findings provide quantitative evidence for the hypothesis that frontal brain regions are particularly vulnerable to the effects of elevated sleep pressure ('prefrontal tiredness') and ageing ('frontal ageing').     

A combined lexical and segmental therapy approach in a participant with pure alexia

Background: Pure alexia is characterized by effortful left-to-right word processing, leading to a pathological length effect during reading aloud. Results of previous therapy outcome research suggest that patients with pure alexia tend to develop and maintain an adaptive sequential reading strategy in an effort to cope with their severe deficit and at least master a slow and laborious reading mode.

Aim: We applied a theory-based, strategy-driven and eye-movement-supported therapy approach on HC, a participant with pure alexia. Our intention was to help optimizing his very persistent sequential reading strategy, while concurrently facilitating fast parallel word processing.

Methods & Procedures: Therapy included a systematic combination of segmental and holistic reading as well as text reading components. Exposure duration and font size were gradually reduced. Following a single case experimental reading design with follow-up testing, we assessed reading performance at four testing points focusing on analyses of linguistic errors and word viewing patterns.

Outcomes & Results: With respect to reading accuracy and oculomotor measures, the combined therapy approach resulted in sustained training effects evident in significant improvements for trained and untrained word materials. Text reading intervention only led to therapy specific improvements. Spatio-temporal analyses of eye fixation positions revealed a more and more efficient adaptive strategy to compensate for reading difficulties. However, spatial changes in fixation position were less pronounced at T4, suggesting some diminishing of success at follow-up.

Conclusions: Our results underscore the need for a continuous systematic training of underlying reading strategies in pure alexia to develop and sustain more economic reading procedures.     

A functional near‐infrared spectroscopic investigation of speech production during reading

This study was designed to test the extent to which speaking processes related to articulation and voicing influence Functional Near Infrared Spectroscopy (fNIRS) measures of cortical hemodynamics and functional connectivity. Participants read passages in three conditions (oral reading, silent mouthing, and silent reading) while undergoing fNIRS imaging. Area under the curve (AUC) analyses of the oxygenated and deoxygenated hemodynamic response function concentration values were compared for each task across five regions of interest. There were significant region main effects for both oxy and deoxy AUC analyses, and a significant region × task interaction for deoxy AUC favoring the oral reading condition over the silent reading condition for two nonmotor regions. Assessment of functional connectivity using Granger Causality revealed stronger networks between motor areas during oral reading and stronger networks between language areas during silent reading. There was no evidence that the hemodynamic flow from motor areas during oral reading compromised measures of language‐related neural activity in nonmotor areas. However, speech movements had small, but measurable effects on fNIRS measures of neural connections between motor and nonmotor brain areas across the perisylvian region, even after wavelet filtering. Therefore, researchers studying speech processes with fNIRS should use wavelet filtering during preprocessing to reduce speech motion artifacts, incorporate a nonspeech communication or language control task into the research design, and conduct a connectivity analysis to adequately assess the impact of functional speech on the hemodynamic response across the perisylvian region.