CT/MRI结合立体定向技术辅助显微手术切除颅内小病灶

目的探讨CT/MRI结合立体定向技术辅助显微手术切除颅内小病灶的优越性。方法应用LEKSELL-G型头架,CT/MRI定位,对11例颅内小病灶显微手术切除,病变性质脑转移瘤1例,脑膜瘤3例,脑胶质瘤2例,海绵状血管瘤1例,脑囊虫病1例,炎性肉芽肿4例。结果所有病灶均获得全切除,无严重并发症和死亡病例。结论CT/MRI结合立体定向技术辅助的显微手术切除颅内小病灶,具有定位精确可靠,手术创伤小,术后并发症少,恢复快等优点。     

儿童脑内小肉芽肿继发癫痫的CT脑立体定向开放显微手术

目的 探讨儿童脑内小肉芽肿继发癫痫的CT脑立体定向开放显微手术治疗方法。方法 对31例儿童脑内小肉芽肿继发癫痫病变直径在0．4～2．5cm之间的患采用CT脑立体定向仪定位,显微镜下切除病灶。结果 31例均在显微镜下操作将病灶完整切除,无手术并发症及死亡。随访8个月～3年,经CT复查证实无复发,癫痫消失,脑电图正常。结论 儿童脑内小肉芽肿继发癫痫的CT脑立体定向显微手术切除脑内病灶,定位准确,安全有效,值得推广。     

立体定向开颅术中病灶边缘点的定位

目的：通过对脑深部病灶边缘点定位．在立体定向开颅手术中引导术，以期彻底切除病灶。方法：应用驹井式计算机体层摄影(CT)立体定向仪对11例脑深部病灶进行立体定向开颅手术，其中腔质瘤8例．转移瘤3例．直径25～45mm．影像学显示肿瘤边界不清。术前对病灶边缘点三维座标进行测量登记，术中通过导针引导切除病灶。结果：术后半月内增强CT或磁共振成像(MRI)扫描显示：9例病灶完全消失．2例肿瘤周边有少许残余。无手术死亡及昏迷等。结论：对于脑深部边缘不清的病灶，在立体定向开颅手术切除病灶时，对病灶边缘点定位．可较彻底切除病灶，减少手术病灶残留。     

影像导向立体定向开颅切除颅内小病灶病变

目的 探讨影像导向立体定向开颅切除颅内小病灶病变的手术方法和临床应用.方法 结合CT/MRI,在立体定向仪及手术计划系统指导下,对19例直径0.8～3.5cm的颅内病变进行显微手术切除.结果 所有病灶均定位精确,一次手术切除,无死亡病例.病变性质:胶质瘤9例,转移瘤3例,脑囊虫3例,脑脓肿2例,海绵状血管瘤2例.结论 影像导向立体定向开颅切除颅内小病灶病变是一种定位精确、侵袭性小、安全有效的手术方法.     

神经导航引导下直视手术治疗脑内小病灶

目的 探讨在神经导航辅助下微创手术治疗脑内小病灶的经验。方法 在神经导航系统辅助下显微外科手术治疗24例脑内小病灶。其中脑脓肿2例，脑囊虫5例，炎性肉芽肿2例，转移癌7例，海绵状血管瘤2例，星形细胞瘤2例，胶质细胞增生2例，中枢神经细胞瘤1例，生殖细胞瘤1例。结果 导航平均注册误差（2．3±0．45）mm。病灶全切16例，次全切3例，大部分切除2例，取病检3例。术后无死亡、无神经导航误差引起的并发症。全部病例恢复良好。结论 神经导航引导直视手术治疗脑内小病灶手术准确、安全，减少了术中的盲目性和并发症的发生。     

神经导航系统在脑深部病灶手术中的应用

目的评价神经导航系统在脑深部病灶手术中的应用。方法应用ASA—610V神经导航系统对51例脑深部病灶手术治疗，术前采用神经影像导航扫描，对病灶进行三维重建，制定手术治疗计划，术中根据手术计划选择手术方式以及手术切除范围，分析治疗效果。结果肿瘤及其周围结构定位准确。51例脑深部病灶．手术全切除42例(82．3％)，次全切除3例(5．9％)，大部分切除6例(11．8％)；术后症状改善或不变48例(94．1％)．症状加重或出现新症状3例(5．9％)，无死亡病例。结论应用神经导航系统可以精确定位脑深部病灶．设计最佳手术入路，有助于提高手术疗效，降低手术并发症。     

立体定向开颅术中病灶边缘点的定位

目的:通过对脑深部病灶边缘点定位,在立体定向开颅手术中引导术者,以期彻底切除病灶。方法:应用驹井式计算机体层摄影(CT)立体定向仪对11例脑深部病灶进行立体定向开颅手术,其中胶质瘤8例,转移瘤3例,直径25～45mm,影像学显示肿瘤边界不清。术前对病灶边缘点三维座标进行测量登记,术中通过导针引导切除病灶。结果:术后半月内增强CT或磁共振成像(MRI)扫描显示:9例病灶完全消失,2例肿瘤周边有少许残余。无手术死亡及昏迷等。结论:对于脑深部边缘不清的病灶,在立体定向开颅手术切除病灶时,对病灶边缘点定位,可较彻底切除病灶,减少手术病灶残留。     

神经导航在脑内小病灶手术中的应用(附25例报道)

目的 探讨神经导航辅助显微手术治疗脑内小病灶的应用价值.方法 用神经导航系统辅助显微外科手术切除25例脑内小病灶.术前将头颅CT或MRI连续薄层扫描所获取的影像资料输入神经导航系统进行三维重建并注册,制定手术计划.术中实时导航指导手术切除范围,分析治疗结果.结果 导航平均注册误差2.12±0.73mm,术中准确定位病灶.病灶全切23例,次全切2例.术后22例病人症状改善或无变化,3例原有神经症状加重或出现新的神经功能损害.结论 神经导航能准确引导切除脑内小病灶,减少手术创伤,提高手术效果,降低死亡率、病残率,在显微神经外科手术中具有重要的临床应用价值.     

导航系统在神经外科的应用

目的：探讨神经外科导航系统在显微神经外科手术中的作用。方法：应用德国BrainLAB公司生产的BrainSCAN神经外科导航系统，对68例颅内病变患者进行导航系统引导下的显微手术。并对其精确性进行分析。结果：本组68例导航手术中，胶质瘤32例，脑膜瘤9例，神经纤维瘤7例，垂体瘤6例，颅咽管瘤2例，局限性癫痫8例，脑转移瘤1例，脑脓肿2例，炎性肉芽肿1例，全切除42例（61.7%)，次全切除15例（22.1%)，大部切除11例（16.2%)，无手术死亡及严重并发症，导航系统的精度误差平均为2.7mm。结论：在显微手术中应用导航系统可以精确完成术前病灶定位。设计最佳手术入路，精确并快速寻找病灶，确定病灶切除范围，保护重要结构。提高手术的成功率，减少手术并发症。     

立体定向手术切除颅内小病灶(附46例临床分析)

目的 探讨CT或MRI导向的立体定向手术切除颅内小病灶的应用价值,总结手术治疗的经验.方法 采用Leksell-G型立体定向仪,在CT或MRI导向下对46例直径1.0～3.0cm的颅内小病灶定位,通过小骨窗开颅和显微外科技术去除病灶.结果 46例颅内小病灶均精确定位,在直视或显微镜下全切除.全组无手术严重并发症及相关死亡.31例有癫痫症状患者术后24例症状完全消失,7例发作次数显著减少.25例术前有神经功能障碍的患者,术后20例恢复正常,3例减轻,2例无改善.结论 CT或MRI导向下的立体定向手术为颅内小病灶的切除提供了一种简便、准确、安全、微侵袭且疗效较为满意的手术方法.     

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。