山东省癫癎流行病学调查研究

目的 了解中国山东省的癫癎）病流行现况及其危险因素.方法 以调查问卷为基础,运用国际统一癫癎诊断标准,采用多级分层随机整群抽样方法,逐户进行调查.结果 调查人数251 492名,癫癎患者335例,癫（痫）患病率为1.33‰;男性患病率为1.35‰o,女性患病率为1.31‰;城市患病率为1.20‰,农村患病率为1.39‰,均差异无统计学意义.癫癎发病率为18.69/10万.发作类型以全面性发作为主为60.90％;部分性发作为34.33％;发作不能分类为4.78％.首次发病平均年龄为（15.37±15.77）岁.特发性癫癎为60.90％,症状性癫（痫）为39.10％.大部分患者未进行正规治疗,治疗缺口为54.33％.结论 山东省癫癎患病率、发病率处于全国较低水平,治疗缺口与国内文献报道一致.癫癎发作类型以全面性发作为主;癫癎发病以特发性癫（痫）为主,症状性癫癎病因中以脑炎为主.     

“双心医学”模式下社区老年心脏病患者的抑郁症状

目的：探讨双心医学模式下社区老年常见心脏疾病与抑郁症状共患情况。方法采用横断面调查法,共调查771名社区老年患者,采用流调研究用抑郁量表（CES-D）调查抑郁症状,追踪老年患者的门诊或住院病历记录调查其心血管疾病：包括心绞痛、冠心病和高血压。结果心血管疾病（不包括高血压）总患病率为22.7%,其中冠心病为20.5%,心绞痛为10.9%;高血压患病率为49.3%。抑郁症状在所有心血管疾病患者中的发生率是20.9%。伴心血管疾病老年人的抑郁症状发生率（33.1%）高于无心血管疾病者（18.3%）,差异有统计学意义（χ^2=17.59,P〈0.001）;有冠心病者的抑郁症状发生率（34.8%）高于无冠心病者（18.3%）,差异有统计学意义（χ^2=20.25,P〈0.001）;有心绞痛疾病患者的抑郁症状发生率（34.5%）高于无心绞痛疾病者（20.1%）,差异有统计学意义（χ^2=9.19,P=0.002）;有高血压患者的抑郁症状发生率（25.0%）高于无高血压者（18.4%）,差异有统计学意义（χ^2=4.93,P=0.026）。结论社区老年人心血管疾病的罹患率高,在心血管疾病患者中抑郁症状的检出率比无心血管疾病患者高。需加强双心医学模式下对伴心血管疾患老年人的心理干预。     

EGFRvⅢ单链抗体治疗小鼠脑胶质瘤的研究

目的探讨表皮生长因子受体III型突变体单链抗体(EGFRvIIIscFv)对小鼠脑胶质瘤的治疗效果。方法人工合成EGFRvIIIscFv基因序列并构建到原核表达载体中,诱导表达重组蛋白,经电泳和western blotting鉴定;再通过纯化和复性,得到有功能的EGFRvIIIscFv;用酶联免疫吸附分析(ELISA)测定抗体的亲和常数后,通过立体定向仪将其注射到胶质瘤小鼠的脑内,观察荷瘤鼠的生存期,免疫荧光法检测肿瘤血管内皮生长因子(VEGF)的表达。结果双酶切鉴定和测序结果证实人工合成的EGFRv Ⅲ scFv序列与基因数据库中完全一致;经过诱导表达,电泳显示重组蛋白在大肠杆菌中以包涵体形式表达;western-blotting鉴定蛋白分子量为63kDa,与预期大小基本一致;该单链抗体亲和常数为0.203×10-8mol/L;将蛋白注射到荷瘤鼠的脑内,与对照组相比,实验组肿瘤VEGF表达量明显减少、荷瘤鼠中位生存期明显延长(P<0.01)。结论 EGFRvscFv重组蛋白可与EGFRvⅢ特异性结合;脑内注射EGFRvⅢscFv可明显降低胶质瘤血管形成,延长荷胶质瘤小鼠生存期。     

Concentration of valproate during pregnancy, in the newborn and in breast milk

The serum-valproate level of four patients with epilepsy was followed during pregnancy. A decrease in serum level occurred late in pregnancy and was followed by a pronounced increase in the first week after delivery. The maternal serum concentration of valproate was compared to that of the umbilical cord. The level in cord blood was 145-219% higher than that in maternal blood. The concentration of valproate in breast milk was found to be 5-10% of the maternal serum concentration. The serum concentration was measured in one breastfed child. The level was 7.6% of the maternal serum concentration. All children were healthy without any signs of intoxication or malformation. Based on our experience, pregnant patients treated with valproate must be carefully controlled especially during the last month of pregnancy and in the first two weeks after delivery. The amount of valproate excreted into the breast milk was negligible and should not prevent breast feeding.     

Calpain induces proteolysis of neuronal cytoskeleton in ischemic gerbil forebrain

We investigated the relationship between the activity of calcium-dependent protease (calpain) and the ischemic neuronal damage. We also investigated the mechanism of ischemic resistance in astrocytes. In gerbil, a 10-min forebrain ischemia was induced by occlusion of both common carotid arteries. The calpain-induced proteolysis of cytoskeleton (fodrin) was examined by immunohistochemistry. Immunolocalization of micro and m-calpain was also examined. Intact fodrin was observed both in neurons and astrocytes, but proteolyzed fodrin was not observed in normal brain. Fifteen minutes after ischemia, proteolysis of fodrin took place in putamen, parietal cortex and hippocampal CA1. The proteolysis extended to thalamus 4 h after ischemia after which the immunoreactivity faded down in all areas except hippocampus. On day 7, the proteolysis was still observed only in hippocampus. Neurons with the proteolysis of soma resulted in neuronal death. Throughout the experiment, the proteolysis was not observed in astrocytes. micro -Calpain was observed only in neurons but m-calpain was observed both in neurons and astrocytes. The ischemia induced only micro -calpain activation, which resulted in fodrin proteolysis of neurons with differential spatial distribution and temporal course. The proteolysis was developed rapidly and was completed within 24 h in all vulnerable regions except hippocampal CA1. The proteolysis preceded the neuronal death. The mechanism of the proteolysis seemed to be involved by Ca(2+) influx via glutamate receptor and rapid neuronal death seemed reasonable. The reason why neuronal death in CA1 evolved slowly was not clarified. In astrocytes, fodrin was not proteolyzed by m-calpain. The low Ca(2+)-sensitivity of m-calpain may be the reason of ischemic resistance in astrocytes.     

颅内神经节细胞胶质瘤(附8例报告)

目的探讨颅内神经节细胞胶质瘤的临床特征及治疗效果。方法回顾性分析8例颅内神经节细胞胶质瘤的临床资料。结果平均发病年龄27岁,肿瘤位于大脑半球6例,脑干2例。临床表现主要为癫,影像学检查无特异性表现。显微手术全切5例,大部切除3例,放、化疗4例。随访3个月～5年,7例症状明显缓解,1例复发。结论神经节细胞胶质瘤呈相对良性过程,癫为其主要临床表现,治疗上应手术全切;对有术后残留或间变者可给予放、化疗,预后相对良好。     

Distribution of calcium-activated neutral proteinase activity in quaking mouse brain: a subcellular study

The distribution of calcium-activated neutral proteinase (CANP) activity was examined in the subcellular fractions of quaking and control mouse brain. The CANP activity was determined in purified myelin, cytosol and pellet (P2, consisting of nuclei, mitochondria and microsomes) fractions using [14C]azocasein as substrate. The enzyme activity in quaking brain was 1.3-fold greater than control. Fifty-seven percent of the control brain activity was in purified myelin compared to only 7% in quaking myelin. The specific activity of the control purified myelin was 4-fold greater than homogenate while that of the quaking was two-fold greater. In contrast, 51% of the quaking brain activity was present in cytosol compared to only 18% in the control. Triton X-100 greatly increased the control brain activity (10-fold) while the quaking brain activity was increased by only 1.2-fold. The total calcium content in the quaking brain was greatly elevated (6-fold) compared to control. Approximately 30% of the brain 2',3'-cyclic nucleotide 3'-phosphohydrolase (CNPase) activity was in quaking myelin while 77% of the CNPase activity in control brain was in myelin. These results suggest that in quaking brain much of the CANP is not incorporated into the myelin membrane and remains cytosolic.     

复杂性肾结石的手术治疗(附30例报告)

本文报告我院1986年10月～1993年3月中30例复杂性肾结石手术治疗的方法,提出根据不同的结石情况选择各种术式。其中4例采用肾原位低温,15例静注肌苷肾热缺血下保护肾脏,阻断肾血流平均59分钟,仪一例术后残留一枚小结石,29例恢复良好,作者对复杂性肾结石的术式选择问题加以讨论。     

Head direction cells in the primate pre‐subiculum

The function of the primate hippocampus and related structures was analysed by making recordings from the hippocampus, subiculum, presubiculum, and parahippocampal gyrus in monkeys actively walking in the laboratory. Head direction cells were found in the presubiculum. The firing rate of these cells was a function of the head direction of the monkey, with a response that was typically 10–100 times larger to the best as compared to the opposite direction. The mean half‐amplitude width of the tuning of the cells was 76°. The response of head direction cells in the presubiculum was not influenced by the place where the monkey was, there being the same tuning to head direction at different places in a room, and even outside the room. The response of these cells was also independent of the “spatial view” observed by the monkey, and also the position of the eyes in the head. The average information about head direction was 0.64 bits, about place was 0.10 bits, about spatial view was 0.27 bits, and about eye position was 0.04 bits. The cells maintained their tuning for periods of at least several minutes when the view details were obscured or the room was darkened. This representation of head direction could be useful together with the hippocampal spatial view cells and whole body motion cells found in primates in such spatial and memory functions as path integration. Hippocampus 1999; 9:206–219. © 1999 Wiley‐Liss, Inc.     

异丙酚和咪唑安定预处理对大鼠全脑缺血损伤的保护及递质机制

目的阐明异丙酚及咪唑安定预处理是否具有脑保护作用及其神经递质机制。方法雄性SD大鼠18只,随机分组,每组6只。建立清醒全脑缺血模型(4血管闭塞法)。收集清醒、缺血及再灌注后微透析标本。记录再灌注后的BIS变化,并观察反正反射恢复的时间。于缺血再灌注后进行运动功能双盲评定。全脑缺血3d后,迅速开颅取脑,10%甲醛固定后进行HE染色,并用TUNEL法进行细胞凋亡检测。双盲计数海马CA1区神经细胞及细胞凋亡率。结果异丙酚及咪唑安定预处理组与对照组相比,脑电BIS恢复较快;缺血期间谷氨酸递质浓度明显降低(P<0.01);反正反射恢复时间明显缩短(P<0.05);海马CA1区神经细胞计数明显增高(P<0.01);海马细胞凋亡率明显降低(P<0.01);两预处理组间无明显差异(P>0.05)。结论异丙酚及咪唑安定预处理脑缺血再灌注损伤具有脑保护作用,与减少缺血期间谷氨酸递质的释放有关;两组脑保护效能相同。     

微血管减压术后复发性三叉神经痛的原因分析及再手术对策

目的对微血管减压术后复发性三叉神经痛进行再次手术,术中探查复发的致病原因。方法对6例复发性三叉神经痛的患者进行再手术探查,1例进行了微血管再减压术,5例进行了感觉根部分切断术。结果 1例患者为垫棉位置不理想,重新减压手术,5例血管减压充分,但明显有蛛网膜增厚、垫棉与神经根粘连、包裹,锐性分离困难,只能行感觉根部分切断。术后均疼痛消失,切断患者遗留有面部麻木。结论垫棉粘连可能是导致复痛的主要原因,感觉根部分切断术是该种情况下的首选。     

Prevalence of mental disorders among adults in Finland: basic results from the Mini Finland Health Survey

The Mini Finland Health Survey was an extensive epidemiological study of the Finnish population aged 30 or over; the prevalence of mental disorders was one aspect studied. Prevalence of symptoms in the General Health Questionnaire as well as the prevalence of self-perceived and clinically assessed mental disorders was studied. The total prevalence of clinically assessed mental disorders was 17.4%, 14.8% in the men and 19.5% in the women. A definite disorder was observed for 11.7% of the subjects. About half of the subjects suffering from a mental disorder according to clinical assessment also reported a self-perceived disorder. Of various diagnoses, the most common were phobic and anxiety neurosis (6.2%) and neurotic depression (4.6%). The prevalence of schizophrenia was 1.3%. The highest prevalence was found in the ages 50 to 64 years. The prevalence of psychoses was highest in northern and eastern Finland, and that of neuroses in southern Finland.     

CORRELATION BETWEEN HAND PREFERENCE AND DISTANCE OF FOCUSING POINTS OF TWO EYES IN THE HORIZONTAL PLANE

Relationships among hand preference, ocular dominance, and the degree of ocular shifting were studied in 78 right-handed and 16 left-handed subjects. Ocular dominance was assessed with the Miles test. The shifting degree of eye was assessed using a modified Miles test. The shifting distance of the right-eye was marginally greater, although significant, in the left-handers as compared to the right-handers. The shifting distance of the left-eye was greater in the right-handers than in the left-handers. The distance of focusing points of two eyes in the horizontal plane was greater in the right-handers than in the left-handers. In the total sample, there was a significant negative Pearson correlation between hand-preference and the shifting distance of the right-eye, and there was a positive correlation between hand-preference and the shifting distance of the left-eye. In addition, there was a significant positive correlation between hand preference and the distance of focusing points of two eyes. These results suggest that hand preference may be related to the degree of ocular asymmetry.     

谷氨酸促进星形胶质细胞释放丙酮酸的体外实验

目的探讨在谷氨酸毒性作用时星形胶质细胞是否释放作为三羧酸循环中重要介质的丙酮酸来保护神经元,以及可能的机理。方法本实验第一步采用离体培养星形胶质细胞,加入浓度达到神经元毒性作用的谷氨酸,用分光光度计测量培养液中的丙酮酸含量。设立两组,一组为相同浓度谷氨酸作用下,不同时间段的丙酮酸浓度测定。另一组为在梯度浓度的谷氨酸作用下,同一时间段的丙酮酸浓度测定。以不加谷氨酸的培养液作为对照。第二步离体培养神经元细胞,加入具有神经元毒性的谷氨酸,并同时加入丙酮酸,观察神经元的生存情况。第三步在神经元培养液中加入谷胱苷肽合成抑制剂BSO,观察神经元存活情况。结果①加入谷氨酸后星形胶质细胞培养液中的丙酮酸浓度增加大于对照组,且丙酮酸浓度与谷氨酸的浓度有关。②丙酮酸加入已加有谷氨酸的神经元培液,神经元死亡数显著减少。③单独用低浓度BSO及单独用10mM丙酮酸作用5小时都没有使神经元死亡量增加,但当两者同时加入培养液中,神经元的死亡量显著上升。结论①体外实验中谷氨酸可促进星形胶质细胞释放丙酮酸,这可能与其保护神经元有关。②丙酮酸能抵制谷氨酸的神经毒性作用。③丙酮酸对谷氨酸神经毒性的保护作用需要谷胱甘肽(GSH)的参加,因而认为丙酮酸保护神经元的机理与增加细胞能量代谢有关。     

社区老人代谢综合征伴发抑郁障碍3年发展趋势流行病学调查

目的:探索社区老人抑郁障碍与代谢综合征间的发生发展关系。方法:采用分层随机抽样法,对上海浦东新区55岁的老年人进行调查,并在3年后对上述老人进行复查。以DSM-Ⅳ轴Ⅰ障碍定式临床检查患者版本为调查诊断工具,以内科诊断结果为代谢性疾病诊断依据。分析入组者抑郁障碍及代谢性疾病的患病率和易感因素。结果:调查第1年抑郁障碍发生率为16.76%,第3年为17.61%;调查第1年重症抑郁发生率为2.77%、亚临床抑郁发作2.82%、轻度抑郁发作3.99%、恶劣心境7.18%;与第3年比较均差异无统计学意义(P0.05)。调查第1年代谢综合征患病率为56.25%、其中高血压为50.41%、糖尿病14.38%及高脂血症8.34%,与第3年比较均差异无统计学意义(P0.05);代谢综合征与抑郁障碍共病率为23.72%,糖尿病与抑郁障碍共病率最高(52.32%),同时患有3种代谢性疾病者其与抑郁障碍的共病率为70.49%,明显高于患有2种、1种及无代谢性疾病者(P0.05)。结论:3年内老年人MS与抑郁障碍的发生发展趋势相对平稳。     

Anatomical basis for the lateral approach to the fourth ventricle

Abstract

This study focused on the posterior inferior cerebellar artery bifurcation and branching patterns in the fissures around the fourth ventricle. The vertebral arteries in 25 unfixed human cerebellum were cannulated and injected with polyester colored resin. The suboccipital surface of the cerebellum was exposed and the cisterna magna main landmarks localized. The average distance was 12.6 mm between the tonsillovermlan notches and 21.8 mm between the inferior tips of the tonsils. The mean vertical distance between these horizontal planes was 14.5 mm. The posterior inferior cerebellar artery was found in the cerebellomedullary fissure in 42 of 50 cerebellar hemispheres, in seven cases the artery was absent and in one it was hypoplastic. The mean outer diameter was 1.8 mm and the average length was 27.9 mm. The posterior inferior cerebellar artery presented four bifurcation point patterns: superomedial, superolateral, inferomedial, and inferolateral. These patterns were characterized into subtypes based on the courses of the vermian and tonsillohemispheric branches. The perforating and choroidal branches originating in these segments were also studied. The mean number of perforating branches per hemisphere was 5.1. The range of the length was 2-10 mm and the range of the outer diameter was 0.1-0.3 mm. An average of 4.6 choroidal arteries originated from the tonsillomedullary and telovelotonsillar segments, a mean of 4 arose from both vermian and tonsillohemispheric branches. This information will facilitate surgical planning in approaching the fourth ventricle as well as the interpretation of cerebellar infarcts in the posterior inferior cerebellar artery area. [Neurol Res 1999; 21: 444–456]     

Delayed potassium current and non-specific outward current in pyramidal neurones acutely dissociated from rat hippocampus

The electrical property of delayed K+ currents (IKD) was studied in pyramidal neurones freshly isolated from the rat hippocampal CA1 region. The IKD was separated pharmacologically from other membrane currents. Activation and inactivation processes of the IKD were highly voltage-dependent in the potential range between -30 and +20 mV. The steady-state inactivation of IKD was observed at -100 mV or more positive potentials. The potential for half steady-state inactivation was -65 mV. The IKD was fully inactivated around -20 mV. Reactivation of IKD consisted of two exponential components. After pharmacological suppression of IKD, the small amount of residual voltage-dependent outward current (one-fifteenth to one-twentieth of IKD amplitude) was observed. The current kinetics was similar to that of IKD and greatly reduced by substitution of internal K+ with N-methyl-D-glucamine+. It was concluded that the properties of IKD was basically similar to those of IKD in other excitable tissues and that the residual current might be non-specific outward current.     

微侵袭手术治疗侧屈型痉挛性斜颈81例

目的研究侧屈型痉挛性斜颈(LFST)微侵袭手术治疗效果。方法将LFST相关的痉挛肌肉分成主要责任肌和次要责任肌,并明确每一肌肉的支配神经。对LFST临床分型,按不同分型制定个体手术方案。采用下列术式组合治疗。术式1:屈向侧颈痉挛肌肉选择性切除术。术式2:屈向侧颈神经1～6后支选择性切断术。术式3:屈向侧副神经切断术(或附加胸锁乳突肌、斜角肌切除术)。三种术式组合称"三联术",术式1和术式3组合称"二联术"。结果术后6～12个月评定疗效,全组81例痊愈69例(85.2%),显效8例(9.9%),进步4例(4.9%),无死亡和严重并发症。35例采用二联术治疗的患者中,痊愈27例,显效5例,进步3例,优良率91.4%(32/35);46例采用三联术治疗患者中,痊愈42例,显效3例,进步1例,优良率97.8%(45/46)。结论采用颈部痉挛肌肉选择性切除和相关神经选择性切断术治疗LFST,手术安全创伤小,效果满意。     

中国农村黑龙江省东宁县癫痫的流行病学研究

目的：提供客观、可信的中国农村人群癫痫的流行病学资料。方法：应用世界卫生组织建议的癫痫流行病学调查表，采用随机整群抽样方法，对东宁县内4镇6乡全体居民进行面对面的流行病学普查，应查人口10823人，实查人口10151人，见面率93．8％。结果：癫痫的患病率为7．98／1000；癫痫的年发病率为29．55／10万；超过50％的患者首次发病年龄在20岁之内；特发性癫痫占79．01％，中枢神经系统感染性疾病是症状性癫痫的主因；最常见的发作类型为全身强直－阵挛发作。结论：东北农村癫痫的患病率与发达国家情况相似。     

The somatosensory blink reflex in upper and lower brainstem lesions

The brainstem pathways that mediate the somatosensory blink reflex (SBR) are not completely understood. We hypothesized that the circuits of the SBR might be affected separately from those of the trigeminal blink reflex (TBR). We examined 7 patients with mesencephalic lesions and 8 patients with medullary lesions. The SBR was elicited by median nerve stimulation. The TBR was elicited by supraorbital nerve stimulation. In patients with upper brainstem lesions, the TBR was normal, whereas the SBR was generally abnormal. The SBR was either absent or small and was significantly delayed with respect to control subjects. The opposite was the rule in patients with lower brainstem lesions who had delayed or absent TBR and no abnormal findings in the SBR. The SBR is mediated through circuits in the upper brainstem. Study of the SBR can be helpful in the neurophysiological assessment of patients with mesencephalic lesions.