高氟对中枢神经系统损伤机制的研究进展

近年来,高氟对中枢神经系统的损伤越来越引起广泛关注,但其作用机制还不完全清楚。该文探讨了氟对中枢神经系统损伤的可能机制,包括氟中毒对中枢神经系统造成氧化应激、炎性损伤,对神经递质分泌及其受体、脑内蛋白质组成及含量的影响,对信号传导通路的干扰等,为进一步开展氟对中枢神经系统损伤机制的研究提供依据。     

接触低浓度硫化氢对工人健康的影响

选取某公司577名接触硫化氢的作业工人(其中有114名工人参加1999年和2004年体检)作为接触组,以条件相当的不接触任何毒物的373名商贸职工作为对照组,分析硫化氢对作业工人健康状况的影响。结果显示,长期接触低浓度硫化氢对作业人群的影响主要表现为上呼吸道的刺激作用。     

Involvement of the central nervous system in vibration syndrome

In order to clarify the involvement of the central nervous system (CNS) in vibration syndrome (VS), patients with VS and age-matched controls were given a questionnaire and neurophysiological tests on auditory brainstem response (ABR), event-related potential (P300), short-latency somatosensory evoked potentials (SLSEP), and blink reflex (BR). Twenty-eight patients with a mean age of 56.3 (SD = 3.01, range 48–65) years from western Japan were examined. They had been on sick leave for an average of 6.13 (SD = 3.2, range 1–13) years at the time of the testing. Almost all were experiencing Raynaud's phenomenon in the winter of 1990–1991. They were not suffering from diseases or injuries which might have affected the CNS function. These patients were divided into two subgroups, one with more symptoms related to the CNS, especially memory and judgment (n = 13, group A), and the other with fewer symptoms (n = 15, group B). Normal controls with an average age of 55.8 (SD = 4.8, 48–65) years were people from the same area who met similar criteria. The ABR parameters of the patients were slightly, but not significantly, delayed compared with those of the controls. The SLSEP and BR parameters of the patients were not delayed. The latencies of P300 in group A were significantly delayed compared with those in the controls. The findings suggest that VS involves the cognitive and attention functions of the cerebral higher function, but not the conduction function in the auditory and somatosensory ascending tract and facial nerve reflex tract in the brainstem.     

接触低浓度硫化氢对听力的影响

本文对某化工厂有硫化氢密切接触史并连续工作八年以上的７７名工人进行了听力检查，同时与５０名非硫化氢接触人员进行了比较分析。结果表明：长期接触低浓度硫化氢对听力有一定的影响，且随接触硫化氢工龄的增加，对听力的损害逐渐加重     

Neurobehavioral evaluation for a community with chronic exposure to hydrogen sulfide gas

In May 2000, the Agency for Toxic Substances and Disease Registry of the US government conducted a health investigation in response to community concerns regarding ambient and indoor hydrogen sulfide (H(2)S), odor, and health symptoms in Dakota City, Nebraska. The objective was to determine whether adult residents in an area with repeated exposure to H(2)S showed poorer performance on neurobehavioral tests than unexposed residents. Study participants were required to meet age (#10878;16 years of age) and length of residency (2 years) eligibility requirements. A battery of computer-assisted standardized neurobehavioral tests was administered in English or Spanish. A questionnaire was used to collect information about participants, demographic and health status. Three hundred forty-five people agreed to participate. After the exclusion of 10 persons, analyses were conducted on 335 participants; 171 residents in the target area and 164 residents in the comparison area. The two groups were comparable in demographic characteristics and various health conditions. Overall, neurobehavioral test results for the target and comparison groups were similar. Residence in the H(2)S-exposed area was associated with marginally poorer performance on a test of memory, namely, match to sample score, and a test of grip strength. However, these differences were not significant. Deficits in overall neurobehavioral performance were not associated with exposure to H(2)S in this study.     

Season of birth and primary central nervous system tumors: a systematic review of the literature with critical appraisal of underlying mechanisms

PurposeSeason of birth has been considered a proxy of seasonally varying exposures around perinatal period, potentially implicated in the etiology of several health outcomes, including malignancies.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we have systematically reviewed published literature on the association of birth seasonality with risk of central nervous system tumors in children and adults.ResultsSeventeen eligible studies using various methodologies were identified, encompassing 20,523 cases. Eight of 10 studies in children versus four of eight in adults showed some statistically significant associations between birth seasonality and central nervous system tumor or tumor subtype occurrence, pointing to a clustering of births mostly in fall and winter months, albeit no consistent pattern was identified by histologic subtype. A plethora of perinatal factors might underlie or confound the associations, such as variations in birth weight, maternal diet during pregnancy, perinatal vitamin D levels, pesticides, infectious agents, immune system maturity, and epigenetic modifications.ConclusionsInherent methodological weaknesses of to-date published individual investigations, including mainly underpowered size to explore the hypothesis by histological subtype, call for more elegant concerted actions using primary data of large datasets taking also into account the interplay between the potential underlying etiologic factors.     

儿童急性白血病中枢神经系统浸润的防治进展

中枢神经系统白血病(CNSL)是儿童急性白血病(AL)复发的根源和治疗的难点,CNSL的预防和治疗已成为儿童AL治疗的关键之一。CNSL可发生在AL的任何时期,以急性淋巴细胞白血病(ALL)患者最多见。其高危发病因素有初发病时高白细胞、有明显的髓外浸润表现、T细胞型、成熟B细胞型、有t(4,11)或Ph+遗传学特征等。脑脊液涂片发现白血病细胞最具诊断意义。CNSL的治疗重点在于预防,主要的治疗方法有鞘注化疗、全身系统化疗、及头颅放疗。已有越来越多的学者认为,以有效、系统的个体化化疗及理想的鞘内治疗为基础,而不再强调放射治疗,不会影响AL患儿的长期生存率。     

Molecular mechanisms of cognitive impairment in iron deficiency: Alterations in brain-derived neurotrophic factor and Insulin-like growth factor expression and function in the central nervous system

Objective

The present review examines the relationship between iron deficiency and central nervous system (CNS) development and cognitive impairment, focusing on the cellular and molecular mechanisms related to the expression and function of growth factors, particularly the insulin-like growth factors I and II (IGF-I/II) and brain-derived neurotrophic factor (BDNF), in the CNS.

Methods

Nutritional deficiencies are important determinants in human cognitive impairment. Among these, iron deficiency has the highest prevalence worldwide. Although this ailment is known to induce psychomotor deficits during development, the precise molecular and cellular mechanisms underlying these alterations have not been properly elucidated. This review summarizes the available information on the effect of iron deficiency on the expression and function of growth factors in the CNS, with an emphasis on IGF-I/II and BDNF.

Results and discussion

Recent studies have shown that specific growth factors, such as IGF-I/II and BDNF, have an essential role in cognition, particularly in processes involving learning and memory, by the activation of intracellular-signaling pathways involved in cell proliferation, differentiation, and survival. It is known that nutritional deficiencies promote reductions in systemic and CNS concentrations of growth factors, and that altered expression of these molecules and their receptors in the CNS leads to psychomotor and developmental deficits. Iron deficiency may induce these deficits by decreasing the expression and function of IGF-I/II and BDNF in specific areas of the brain.     

中枢神经系统先天畸形危险因素的病例对照研究

目的 探讨与中枢神经系统(CNS)先天畸形发生有关的危险因素。方法 以医院为基础的1:2配比病例对照研究方法,对照匹配的条件为同性别、同一居住地区与出生日期相差6个月,采用单因素及多因素logistic回归分析方法对48个变量进行分析。结果 母亲孕期接触农药(OR=16.471)、母亲孕期感冒发烧(OR=12.621)、先天畸形家族史(OR=10.246)、母亲孕期多食腌菜或泡菜(OR=7.274)、父亲接触有害化学物(OR=5.616)、母亲孕期有负性生活事件(OR=3.730)与CNS先天畸形的发生有正相关,母亲孕期多食肉、蛋、豆、奶类食物(OR=0.229)与CNS先天畸形的发生有负相关。结论 CNS先天畸形是多因素疾病,母亲孕期接触农药、母亲孕期感冒发烧、先天畸形家族史、母亲孕期多食腌菜或泡菜、父亲接触有毒化学物、母亲孕期有负性生活事件是其危险因素,母亲孕期多食肉、蛋、豆、奶类食物是保护因素。     

血清降钙素原对中枢神经系统感染性疾病的诊断价值

目的探讨血清降钙素原(PCT)、C-反应蛋白(CRP)、外周血白细胞计数对中枢神经系统感染性疾病的诊断价值。方法采用半定量固相免疫测定法测定31例中枢神经系统感染性疾病患者(细菌性感染组18例,非细菌性感染组13例)血清PCT浓度,免疫散射速率比浊法测定CRP,常规方法检测外周血白细胞。结果血清PCT对中枢神经系统细菌感染诊断的敏感度为100.0%,特异度为76.9%,优于CRP(P=0.001),与白细胞计数阳性率比较,差异无统计学意义(P>0.05)。结论血清PCT测定是中枢神经系统细菌感染的有效指标。     

Translocation of particles deposited in the respiratory system: a systematic review and statistical analysis

Many epidemiological studies have demonstrated that ambient particulate matter poses consistent risks for respiratory and cardiovascular disorders. The translocation of inhaled particles is one hypothesis that could explain such systemic effects. The objectives of this study were to conduct a systematic review of previous reports on particle translocation from the respiratory system and to discuss factors important for translocation. A PubMed search was conducted in August 2011 for the period from 1967 with four main keyword domains (particle, translocation, detection site, and exposure route). The systematic review identified 61 original articles written in English that met the specified criteria (i.e., information on experiment and particle detection). Categorical regression analysis was performed with the site of particle detection as the objective variable, and particle size, particle material, animal species, and exposure route as the explanatory variables. All explanatory variables showed statistically significant effects. The effects for particle size and particle material were large, while the effects for animal species and exposure route were relatively small. There was a broad relationship between particle size and detection site: ≤50 nm for brain and remote organs; ≤1 μm for blood; and ≤10 μm for lung tissues. However, these results should be considered within the context of several limitations, such as deficiency of information.     

Occupational exposure to hydrogen sulfide in the sour gas industry: some unresolved issues

Occupational exposure to hydrogen sulfide (H₂S) and the medical management of H₂S-associated toxicity remains a problem in the sour gas industry and some other industrial settings. The acute effects of exposure to H₂S are well recognized, but accurate exposure-response data are limited to acutely lethal effects, even in animal studies. Odor followed by olfactory paralysis and kerato-conjunctivitis are the characteristic effects of H₂S at lower concentrations. H₂S-induced acute central toxicity leading to reversible unconsciousness is a knockdown; it is controversial whether repeated or prolonged knockdowns are associated with chronic neurologic sequelae but the evidence is suggestive. Knockdowns can be acutely fatal as a consequence of respiratory paralysis and cellular anoxia. Pulmonary edema is also a well-recognized acute effect of H₂S toxicity. Human studies of sublethal exposure with satisfactory exposure assessment are almost nonexistent. There are indications, poorly documented at present, of other chronic health problems associated with H₂S exposure, including neurotoxicity, cardiac arrhythmia, and chronic eye irritation but apparently not cancer. Rigorous and comprehensive studies in the sour gas industry are difficult, in part because of confounding exposures and uncertain end points.     

血清降钙素原对中枢神经系统感染性疾病的诊断价值

目的 探讨血清降钙索原（PCT）、C-反应蛋白（CRP）、外周血自细胞计数对中枢神经系统感染性疾病的诊断价值。方法 采用半定量固相免疫测定法测定31例中枢神经系统感染性疾病患者（细菌性感染组18例，非细菌性感染组13例）血清PCT浓度，免疫散射速率比浊法测定CRP，常规方法检测外周血自细胞。结果血清PCT对中枢神经系统细菌感染诊断的敏感度为100．0％，特异度为76．9％，优于CRP（P=0．001），与白细胞计数阳性率比较，差异无统计学意义（P〉0．05）。结论 血清PCT测定是中枢神经系统细菌感染的有效指标。     

原发性中枢神经系统淋巴瘤21例临床分析

目的 探讨原发性中枢神经系统淋巴瘤的治疗方法.方法 对近5年笔者所在医院经手术或立体定向活检病理证实的21例原发性中枢神经系统淋巴瘤患者,予大剂量甲氨蝶呤化疗5～8周期及阿糖胞苷＋地塞米松鞘内注射12～16次,后续放疗.结果 21例患者中位生存期（45.00±2.05）个月.预计5年生存率（29.2%±2.1%）.毒副作用以骨髓抑制（100%）及胃肠道反应（78%）多见,其次为肝肾功能损害、口腔炎及脱发等.毒副反应多数可耐受.结论 大剂量甲氨蝶呤化疗及阿糖胞苷＋地塞米松鞘内注射后续放疗治疗原发性中枢神经系统淋巴瘤效果满意.     

Influence of proxy respondents and mode of administration on health status assessment following central nervous system tumours in childhood

Central nervous system (CNS) tumours account for 20% of childhood cancers. Survivors often experience severe physical, neuropsychological and social sequelae of the disease and its treatment. Health status assessment in these individuals is an essential clinical outcome measure, yet little consensus exists regarding the optimum methodology. The influence of proxy respondents (parents, physiotherapists and doctors) and mode of administration (home and clinic) in which assessment is performed has been evaluated in a cohort of 37 survivors of childhood CNS tumours. A health-related quality of life (HRQOL) questionnaire, incorporating the Mark II and III Health Utilities Indices, was completed at home and in clinic by patients and parents. Doctors and physiotherapists completed this questionnaire plus Lansky Play-Performance and Karnofsky Performance scores. No significant differences between raters for single attribute scores occurred either at home or in clinic, although a wide range of agreement ( =0.05-1.00, percentage agreement 53-100%) between observers was revealed. Most agreement occurred between parents and patients: this was greatest on home completion (%kappa; =0.48-1.00, percentage agreement 53-100%). Doctors and physiotherapists agreed less on subjective attributes (emotion, cognition and pain). Better agreement between all observers was demonstrated if responses were classified as normal or abnormal. Inter-observer agreement was greater for the HRQOL questionnaire than for Karnofsky and Lansky scores. Home completion of questionnaires provides a reliable, acceptable and convenient method of assessing health status.     

手足口病患儿合并中枢神经系统损害临床特征分析

目的 分析手足口病伴发中枢神经损害患儿的临床特征,以期为该病的临床防治工作提供参考依据.方法 回顾性分析2008年3月-2012年8月医院收治的手足口病伴发中枢神经损害66例患儿临床资料,统计分析其相关的临床特征.结果 66例手足口病伴发中枢神经损害的患儿中男42例占63.6％,女24例,占36.4％,男性的发病例数显著高于女性(P＜0.05);居住在农村的患儿50例占75.8％,城市的16例占24.2％,两者之间差异有统计学意义(P＜0.05);伴发中枢神经损害的患儿年龄主要集中在＜3岁,占78.8％;中枢神经系统损害主要表现为精神萎靡、手足抖动和嗜睡或昏睡,分别占92.4％、63.6％和57.6％,其次为易惊、昏迷、烦躁不安、肢体无力、抽搐等,分别占25.8％、22.7％、21.2％、19.7％和18.2％.结论 手足口病患者伴发中枢神经损害主要集中在＜3岁的患儿,精神萎靡、手足抖动和嗜睡或昏睡是其早期最常见的神经系统损害症状,早期的诊断和积极的治疗是减低死亡率和致残率的关键.     

临床药师干预对中枢神经系统感染患者万古霉素用药效果的影响

目的探究临床药师干预中枢神经系统感染患者万古霉素用药的临床效果。方法选择金昌市中西医结合医院2016年10月-2019年10月收治的85例接受万古霉素治疗的中枢神经系统感染患者,依据患者用药期间是否有临床药师参与分为临床药师干预组(n=45)和对照组(n=40)。比较两组患者万古霉素用药情况及治疗效果,分析两组脑脊液炎症指标、肝功能指标以及肾功能指标水平变化差异。结果两组患者万古霉素用药时间和用药总量比较差异有统计学意义(P<0.05),临床药师干预组血药初始浓度稳定于治疗窗内患者比例(93.33%)显著高于对照组(70.00%),达到潜在中毒浓度患者比例(24.44%)显著低于对照组(47.50%)(P<0.05);临床药师干预组患者治疗总有效率(91.11%)显著高于对照组(67.50%)(P<0.05);两组患者治疗后脑脊液基质金属蛋白酶-9(MMP-9)、降钙素原(PCT)、白细胞介素(IL)-1β以及C-反应蛋白(CRP)等炎症指标水平均下降(P<0.05),且临床药师干预组患者上述指标降低幅度优于对照组(P<0.05);临床药师干预组患者肝功能指标碱性磷酸酶(ALP)、谷草转氨酶(AST)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、总胆红素(TBIL)水平显著低于对照组(P<0.05);临床药师干预组患者肾功能指标尿素氮、肌酐以及24 h尿蛋白水平显著低于对照组,白蛋白水平显著高于对照组(P<0.05)。结论临床药师参与中枢神经系统感染患者万古霉素用药干预可有效控制感染,提高万古霉素用药合理性,促进患者病情改善,减少药物所致不良反应以及肝肾毒副作用。     

血清降钙素原与C-反应蛋白水平评价美罗培南与头孢他啶对中枢神经系统感染疗效研究

目的探讨应用血清降钙素原(PCT)和C-反应蛋白(CRP)水平评价美罗培南和头孢他啶对中枢神经系统感染疗效,为合理应用抗菌药物提供依据。方法对医院2011年3月-2013年1月收治的90例中枢神经系统革兰阴性杆菌感染患者,采取两种不同的抗菌药物治疗,A组48例患者采用美罗培南治疗,B组42例患者采用头孢他啶治疗,对两组疗效进行分析,同时比较患者血清降钙素原和C-反应蛋白水平的变化,并与30名健康者为对照组进行比较。结果两种抗菌药物对中枢神经系统革兰阴性杆菌感染治疗,A组总有效率为95.84%、B组为80.95%,差异有统计学意义(P<0.05);同时两组患者发病后血清降钙素原和C-反应蛋白水平要显著高于对照组,而经过相同时间治疗后,A组两种指标要显著优于B组,差异有统计学意义(P<0.05);血清降钙素原和C-反应蛋白水平对中枢系统感染诊断具有较高的灵敏度、特异度和准确度。结论中枢神经系统感染患者降钙素原和C-反应蛋白水平可以作为中枢系统感染程度的指标,同时不同抗菌药物对中枢神经系统感染疗效不同而影响降钙素原和C-反应蛋白水平。