影响人工耳蜗置入后听力改善的因素

目的：如何解释和预测人工耳蜗存在的较大个体差异,从而预测置入后康复效果,不仅倍受听力学者和临床医师的关心,也是置入者及其家属密切关注的问题。通过对接受人工耳蜗置入患者的临床资料及置入后康复情况进行分析与评估,探讨人工耳蜗置入后康复效果的可能影响因素。 方法：28例患者均来源于青岛大学医学院附属医院耳鼻咽喉科,于2002-06/2008-04成功行人工耳蜗置入。分别按年龄、置入后康复训练时间,是否佩戴助听器,术中神经反应遥测技术反应情况、置入前有无残余听力等分组,观察其听觉言语改善情况,对所获结果进行临床分析,观察各因素对听力言语改善情况的影响。 结果：人工耳蜗置入年龄越小听觉言语改善效果越好,残余听力的存在及置入前助听器佩戴对提高置入后听觉言语改善效果有帮助,术中神经反应遥测技术反应良好的患者置入后的听觉言语改善效果也较好,康复训练时间越长效果越好。 结论：人工耳蜗置入后听觉言语改善效果的影响因素包括置入年龄、残余听力、置入前助听器佩戴,术中神经反应遥测技术反应及置入后康复训练时间。     

耳蜗干细胞内耳移植对感音神经性耳聋大鼠听力恢复的实验研究

目的：探讨耳蜗干细胞内耳移植能否对感音神经性耳聋大鼠听力恢复产生影响。方法：从新生大鼠耳蜗分离的组织,经原代和传代培养,鉴定后移植入感音神经性耳聋模型大鼠内耳,将感音神经性耳聋大鼠模型分为两组：耳蜗干细胞移植组;PBS移植对照组;术后分别于1个月、18个月和24个月采用听觉脑干诱发电位方法检测模型大鼠的听力恢复情况,处死大鼠,通过免疫荧光染色方法,观察移植的耳蜗干细胞在内耳存活、分化和迁移情况。结果：分离新生大鼠耳蜗组织,细胞培养后,可获得大量Nestin阳性耳蜗干细胞。制作感音神经性耳聋模型,将耳蜗干细胞移植入感音神经性耳聋模型大鼠内耳,免疫荧光检测发现在耳蜗干细胞移植组移植针道两侧可见移植的Nestin阳性细胞和Myosin ⅦA阳性细胞。对照组呈较弱的荧光反应。听觉脑干诱发电位结果显示耳蜗干细胞移植组的感音神经性耳聋模型大鼠听力恢复情况较好,对照组无明显改善。结论：耳蜗干细胞移植入内耳可存活、迁移和分化为内耳毛细胞,可促进感音神经性耳聋模型大鼠的听力恢复。     

人工全髋关节置换患者术前疾病不确定感与焦虑水平的关系

目的 探讨人工全髋关节置换患者术前疾病不确定感与其焦虑水平的关系.方法 选定本院2018年11月～2019年11月住院治疗的200例人工全髋关节置换术患者,采用疾病不确定感量表(MUIS)评估患者术前疾病不确定感,采用焦虑自评量表(SAS)评估焦虑水平,通过比较不同疾病MUIS组的SAS评分和不同焦虑水平组的MUIS评分以及Spearman相关性分析来探讨MUIS量表各维度与焦虑情绪的相关性.结果 200例患者MUIS评分71.5～139.4分,平均(105.26±4.64)分.其中21例是高水平不确定感,占10.50％,MUIS评分(60.25±4.14)分;118例是中水平不确定感,占59.00％,MUIS评分(92.52±10.44)分;61例是低水平不确定感,占30.50％,MUIS评分(138.26±6.44)分.200例患者中46例轻度焦虑,占23.00％;101例中度焦虑,占50.50％;53例重度焦虑,占26.50％.重度焦虑组MUIS评分高于中度焦虑组,中度焦虑组MUIS评分高于轻度焦虑组(P＜0.05).MUIS量表不可预测性、信息缺乏、不确定性、复杂性与焦虑水平均为正相关(P＜0.05).结论 人工全髋关节置换术患者的术前不确定感和焦虑水平均处于中等水平,不确定感和患者的焦虑水平呈正相关,临床应及早予以处理,尽可能减轻患者不确定感、焦虑水平.     

足月新生儿缺氧缺血性脑病患儿与正常儿颅脑CT对比

目的比较足月新生儿缺氧缺血性脑病患儿与正常儿颅脑CT表现。方法抽取我院2013-01—2015-01确诊的50例足月新生儿缺氧缺血性脑病患儿为研究组,选择同期50例正常儿为对照组,均行CT扫描,比较2组CT扫描结果。结果研究组脑白质及脑灰质CT值分别为(25.6±3.4)HU、(26.0±3.8)HU,均显著低于对照组的(30.5±3.3)HU、(30.8±3.7)HU,差异有统计学意义(P0.01)。重度HIE患儿基底节、脑白质及脑灰质CT值分别均明显低于轻度、中度组,差异有统计学意义(P0.05)。结论 CT能正确显示足月新生儿缺氧缺血性脑病病变位置及其密度,对疾病严重程度判断、预后评估有重要意义。     

婴儿流感嗜血杆菌性脑膜炎后听力丧失

儿童最易患脑膜炎。据报道儿童患细菌性脑膜炎后,10%以上遗留单侧或双侧感音性聋。但儿童的听力丧失最难判断。由于计算机技术的进展,现在临床已应用脑干听觉诱发反应(ABER)检查,可以客观地、可靠地测定不合作的婴幼儿的周围和脑干听觉机能传导路的完整性。作者用ABER 测定了34例(男20例,女14例,8周——24个月)。最常见的流感嗜血杆菌性脑膜炎患儿     

NOS及NO在分泌性中耳炎引起的感音神经性聋中的作用

目的研究NO及NOS在分泌性中耳炎导致的感音神经性聋中所起的作用或影响。方法选取58例分泌性中耳炎患者,其中29例为单纯性分泌性中耳炎患者(A组),29例为分泌性中耳炎所致的感音神经性聋患者(B组),分别抽取A、B 2组的中耳积液,试剂盒检测NO的含量及NOS的活性,探讨NO及NOS在分泌性中耳炎导致感音神经性聋中所起的作用。结果 A组中耳积液中NO含量为(138.71±40.98)μmol/L,NOS的活性为(74.28±27.00)U,B组耳积液中NO含量为(176.18±42.68)μmol/L,NOS的活性为(98.78±30.02)U,B组NO含量大于A组,差异有统计学意义(P0.01);NOS活性比较,B组A组,差异有统计学意义(P0.05);结论 NO及NOS在分泌性中耳炎引起的感音神经性聋中发挥着重要作用,可能参与感音神经性聋的炎症病理发病过程。     

轻度感音神经性耳聋对婴幼儿言语能力发育的影响

目的比较轻度感音神经性耳聋婴幼儿与正常婴幼儿言语发育情况,了解轻度感音神经性耳聋对婴幼儿言语能力发育的影响。方法出生时听力筛查未通过、3月龄经听力学评估确诊为轻度感音神经性听力障碍婴幼儿32例;听力正常婴幼儿35例为对照组。采用《婴幼儿听觉及言语发育观察表》及Gesell发育量表进行言语能力测试,并将2组结果进行统计学分析。结果 18月龄时聋儿组的言语发育水平低于正常对照组,该组言语发育商(developmental quotient,DQ)较低,与对照组相比差异有统计学意义(P0.05)。结论轻度感音神经性耳聋对婴幼儿言语能力发育有影响,应加强听力随访工作,早期配合干预治疗。     

斯德奇-韦伯综合征伴局灶皮质发育不良Ⅱ A型一例临床及病理分析

目的 总结1例经病理确诊的斯德奇-韦伯综合征患者的临床、影像学特征及病理表现.方法 回顾性分析1例斯德奇-韦伯综合征患者的临床、影像学及病理资料,对切除标本行HE及免疫组织化学染色观察.结果 CT显示左侧额叶条索状钙化;MRI示左侧额叶萎缩,可见低信号沿脑回分布.病理学特点为软脑膜的血管瘤病,病变皮质下沿脑回呈带状分布的钙化灶,同时周围皮质排列构筑紊乱,局部见形态异常神经元散在分布,免疫组织化学显示形态异常神经元(神经元特异核抗原、微管相关蛋白2、神经纤维细丝蛋白、SMI32R阳性,符合局灶皮质发育不良ⅡA型的组织学改变.诊断为斯德奇-韦伯综合征伴有局灶皮质发育不良ⅡA型.结论 斯德奇-韦伯综合征可以伴有局灶皮质发育不良,局灶皮质发育不良是部分斯德奇-韦伯综合征的癫痫起源灶.术前诊断为斯德奇-韦伯综合征的患者需仔细评价其临床资料及影像学、脑电图资料,以确定癫痫的起源,从而完整切除癫痫灶,并在术后进行规范的病理分析,明确是否伴有局灶皮质发育不良.     

癫痫患儿大脑半球切除术的护理体会

我科自1963年起应用大脑半球切除治疗伴有偏瘫的顽固性癫痫7例,年龄7～12岁。男性5例,女性2例。行右侧大脑半球切除2例,左侧大脑半球切除5例,均获满意疗效。现结合我们的护理体会,浅谈术前后护理。一、术前护理 1.婴儿性偏瘫患儿伴癫痫,此癫痫发作,用药难以控制。常伴有智力低下,性格暴躁,行为异常,很难管理。我们应主动向家属介绍,大脑半球切除术对控制癫痫发作优缺点,以取得家属理解,主动配合治疗及以后的康复问题。 2.协助做好术前有关检查,如EEG、CT、智力测验、言语、记忆以及Wada氏试验,测定言语功能半球的位置在何侧半球,以便术后对比。     

应用DTI评价颈总动脉交感神经网剥脱术治疗成人脑性瘫痪分析

目的探究磁共振扩散张量成像(DTI)技术对行颈总动脉交感神经网剥脱术治疗后的成人脑性瘫痪患者脑白质恢复情况的评估价值。方法选取2016年10月至2018年10月在本院行颈总动脉交感神经网剥脱术治疗的80例单侧痉挛型脑瘫患者为研究对象,评估患者术前和术后6个月粗大运动功能分级系统(gross motor function classification system,GMFCS)分级情况、DTI内囊后肢和大脑脚的各向异性分数(fractional anisotropy,FA)及其相关性。结果 (1)与术前相比,患者在行颈总动脉交感神经网切除术6个月后,粗大运动功能评分提高,分级情况有所改善,差异有统计学意义(P=0.005);(2)患者术后6个月术侧内囊后肢FA值为(0.478±0.081),显著高于术前(0.426±0.069),差异有统计学意义(P0.001);术后6个月术侧大脑脚FA值为(0.443±0.079),显著高于术前(0.361±0.081),差异具有统计学意义(P0.001);(3)术后6个月患者GMFCS分级与内囊后肢FA值呈负相关(r=-0.620,P0.01),与大脑脚FA值也呈负相关(r=--0.719,P0.01)。结论 DTI技术对评估行颈总动脉交感神经网剥脱术治疗的成人脑瘫患者术后脑白质恢复情况具有重要价值,值得临床推广应用。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.