抑郁障碍相关性失眠患者静息态脑默认网络磁共振研究

目的 分析静息状态下中青年抑郁障碍相关性失眠(DRI)患者的相关功能脑区的连接特点,在功能影像学的基础上探讨其发生的神经功能及生理学的机制.方法 对28例首发DRI的患者及25名健康志愿者,进行静息态的功能磁共振(fMRI)检查,采用种子相关分析方法,以大脑双侧后扣带回(PCC)为感兴趣区,进行脑功能连接数据分析,碍到具有差异性的功能连接的脑区.结果 与正常组比较,DRI患者左侧中央旁小叶,左侧楔前叶,双侧小脑后叶等脑区与后扣带回功能连接减低;双侧颞上回,右侧颞中、颞下回,右侧额中回等脑区与后扣带回功能连接增强.结论 DRI患者默认网络(DMN)与后扣带回功能连接出现异常;失眠维持及抑郁障碍的发生两者的神经机制存在互通性.     

阻塞性睡眠呼吸暂停综合征患者频率依赖的低频振幅的静息态功能磁共振研究

目的 探讨阻塞性睡眠呼吸暂停综合征(OSAS)患者静息态不同频段下低频振幅(ALFF)脑自发活动的特点.方法 40例OSAS患者及40名正常睡眠志愿者(GS)进行静息态下脑功能磁共振(fMRI)数据采集.计算两个频段slow-4 (0.027 ～0.073 Hz)和slow-5 (0.01 ～0.027 Hz) ALFF信号值.采用SPM8软件进行两因素水平方差分析比较组间及频段间主效应ALFF值的差异.采用两样本t检验分别比较组间两个频段ALFF值的差异,同时分析ALFF值差异脑区与临床量表的相关性.结果 与GS组相比,OSAS组双侧楔前叶、后扣带回、左侧颞中回、右侧角回及顶下小叶ALFF值显著减低(P＜0.05);而双侧颞下回、梭状回、左侧眶部额下回、颞上极及双侧辅助运动区ALFF值显著增高(P＜0.05).与slow-5频段相比,slow-4频段左侧颞上极ALFF值显著增高;而左侧眶部额下回,双侧额中回,直回ALFF值显著减低.OSAS患者组slow-4频段比slow-5频段显示更广泛ALFF差异脑区包括右侧角回、顶下小叶,双侧颞中回及额中回,左侧眶部额下回.结论 OSAS患者存在多个脑区神经元内在自发活动异常,部分脑区脑自发活动存在频率依赖性,slow-4频段对检测OSAS患者的脑自发活动更敏感.     

首发抑郁症患者静息态默认网络功能连接的MRI研究

目的 探讨抑郁症(major depressive disorder,MDD)患者的静息态默认网络(default mode network,DMN)功能连接变化。方法 对17例首次发作的MDD患者和30例年龄、性别和受教育程度相匹配的健康对照者进行静息态功能磁共振扫描。以后扣带回(posterior cingulate cortex,PCC)作为种子点,与全脑其他区域进行基于体素的时间序列相关分析,并对MDD患者功能连接异常改变与病程及严重程度之间进行相关性分析。结果 与健康对照组相比,MDD组PCC与左侧颞中回、右侧额上回功能连接减低,与右侧岛叶、右侧颞横回,双侧楔前叶、右侧楔叶、右侧舌回、左侧后扣带回,左侧额上及额中回功能连接增强。功能连接异常改变与MDD病程及严重程度之间差异无统计学意义(P 0. 05)。结论 MDD早期DMN功能连接异常,可能是MDD的病理生理学机制。     

肝性脊髓病患者自发脑活动局部一致性的变化

目的 探讨肝性脊髓病(HM)患者静息态下局部一致性(ReHo)的差异.方法 对22例HM患者及25例人口学特征匹配的健康对照组(HC)进行静息态功能磁共振成像(rs-fMRI)扫描,用处理软件获得ReHo数据,比较HM患者与正常人在静息状态下大脑ReHo的差异.结果 与HC相比,HM患者ReHo值降低的脑区有左侧颞中回、右侧梭状回、右侧楔前叶和左侧海马旁回,ReHo值升高的脑区有双侧扣带回、双侧中央旁小叶、双侧额中回、右侧中央前回、双侧岛叶、右侧额上回和左侧额下回.结论HM患者的若干脑区存在ReHo升高或降低,提示HM的病理生理机制并非只存在单一脑区的功能异常,而涉及多个大脑功能网络,是一种大脑功能失连接的表现.     

脑梗死运动性失语患者的静息态脑功能研究

目的：采用基于低频振幅（ALFF）和功能连接（FC）算法的静息态功能磁共振成像（RS-fMRI）技术,探讨脑梗死运动性失语症患者静息态下脑功能的变化及其意义。方法对脑梗死运动性失语症患者及志愿者行RS-fMRI扫描。采用双样本t检验对病例组和对照组的进行ALFF分析,并以左侧后扣带回为种子点比较两组脑FC的差异。结果与正常对照组相比,病例组ALFF明显降低的脑区有左侧小脑前叶、梭状回,左侧后扣带回,左侧额内侧回;ALFF明显增高的脑区有右侧后扣带回。病例组与对照组相比,FC下降的脑区主要位于左侧额内侧回、左侧颞中回、左侧丘脑、右侧额中下回、右侧中央前回、右侧中央后回、右侧颞中回、右侧枕中回、右侧海马旁回、两侧楔前叶、后扣带回、胼胝体压部;FC增高的脑区主要以左侧大脑半球、左侧小脑齿状核、左侧小脑、右侧眶回、直回、右侧小脑后叶、右侧脑干较为显著。结论结合ALFF和FC两种技术,能从脑局部功能与功能网络的变化两个方面对脑神经活动进行评价,有助于脑梗死运动性失语病理生理机制的探索。     

2型糖尿病患者左侧小脑Ⅵ区与全脑功能连接改变的fMRI研究

【摘要】目的：探讨2型糖尿病（T2DM）患者左侧小脑Ⅵ区与全脑功能连接的改变及其是否与视觉空间功能损伤有关。方法：纳入32例T2DM患者(T2DM组)及年龄、性别相匹配的30 例健康被试（HC组）行静息态fMRI检查及神经心理学量表测试,对比左侧小脑Ⅵ区与全脑功能连接以及神经心理学量表的组间差异,提取存在显著差异脑区的功能连接平均值与行为学评分行相关性分析。结果：相对于HC组,T2DM组患者左侧小脑Ⅵ区与右侧海马旁回/梭状回, 右侧颞中/上回, 双侧楔前叶/右侧中、后扣带,双侧额内侧回/右侧额中、上回,右侧角回/颞中回/枕中回/缘上回/顶下小叶的功能连接减低（单个体素P＜0.001,矫正后P＜0.05,GRF矫正）,未发现功能连接增高的脑区。T2DM组患者左侧小脑Ⅵ区和左侧楔前叶功能连接强度与连线测试A(TMT-A)评分呈负相关（r=-0.38,P=0.048）。结论：T2DM组患者左侧小脑Ⅵ区与全脑多个脑区存在异常功能连接,并与视觉空间损伤有关,为进一步了解T2DM视觉空间功能损伤的神经机制提供了新的见解。     

基于局部一致性分析方法研究原发性开角型青光眼患者脑区异常激活及认知改变

目的采用静息态功能磁共振成像(rs-fMRI)评价原发性开角型青光眼(POAG)患者脑部局部一致性(ReHo)和认知状态的改变。方法对22例POAG患者(POAG组)及25例健康志愿者(NC组)行MR扫描前均接受简易精神状态检查(MMSE)量表评估并记录得分,计算全脑ReHo值,并进行统计学分析。结果与NC组相比,POAG组右侧背侧前扣带回、双侧额内上回、双侧额内侧回以及右侧小脑前叶区域(P0.05)ReHo值明显升高;左侧距状沟、右侧距状沟/舌回、双侧中央前/后回、左侧小脑后叶、双侧楔前叶及左侧顶下叶(P0.05)Re Ho值明显减低。POAG组MMSE评分与额内侧回(r=0.451,P=0.016)的ReHo值存在明显正相关。结论 POAG患者在静息状态下视觉、眼压及认知处理等多个功能脑区存在局部一致性改变,为POAG的病理生理学研究提供了影像支持,并有可能为POAG的精准治疗揭示新的靶点。     

遗忘型轻度认知障碍杏仁核功能连接静息态纵向变化功能磁共振研究

目的：探讨静息状态下遗忘型轻度认知障碍（aMCI）杏仁核功能连接在随访（13．0±2．2）个月前后的纵向变化。方法：纳入经临床确诊的13例aMCI患者,于纳入研究时及随访时接受静息态功能 MRI扫描,使用SPM8软件分析,采用感兴趣区种子体素分析方法,比较杏仁核功能连接前后两次的差异,分析杏仁核功能连接强度变化与神经心理评估结果之间的关系。结果：与基线对比,aMCI 随访后蒙特利尔认知评估量表（MoCA）成绩下降,差异有统计学意义（P＜0．05）。同时与基线相比,aMCI随访后与左侧杏仁核功能连接明显降低的区域有双侧颞中回/枕中回、左侧额中回/前扣带回、左侧楔叶/后扣带回/楔前叶结合部,与右侧杏仁核功能连接明显降低的区域为左侧额中回/前扣带回,然而与右侧杏仁核功能连接明显增强的区域为左侧额上回/额中回。重要的是杏仁核与以上脑区间功能连接的改变与认知能力呈正相关。结论：在aMCI向阿尔茨海默病转化过程中,杏仁核与多个脑区之间出现功能连接异常,可能是评价aMCI 演变的一个潜在的生物学标志。     

HIV感染者认知功能正常时静息态脑功能连接的研究

【摘要】目的：探讨认知功能正常时HIV感染者与正常人的静息态脑功能连接情况。方法：按照入选标准搜集25例HIV感染者和27例健康志愿者作为正常对照组,比较蒙特利尔认知评估量表评分、年龄、性别、教育水平的差异。应用静息态脑功能技术以双侧大脑各区为种子点,分析两组各种子点与全脑功能连接的差异,体素P取0.005,团簇P取0.05。结果：HIV感染组与正常对照组各种子点均有统计学差异,经多重校正后有19个种子点8个脑区差异具有统计学意义。HIV感染组在以左侧额极内侧、双侧海马、双侧前扣带回、左侧顶叶、左侧丘脑、左侧梭状回的种子点与全脑的功能连接高于正常组;HIV感染组在以双侧视觉皮层枕叶、左侧岛叶区域的种子点与全脑的功能连接低于正常组;HIV感染组在以右侧运动皮层、左侧顶下叶的种子点与全脑的功能连接与正常组比较既有升高又有降低。结论：HIV感染者认知功能正常时的静息态脑功能连接与正常人有显著差异,提示HIV感染者在认知功能正常时脑功能连接可能已经出现异常,HIV病毒可能影响脑功能的连接。     

帕金森病静息态脑功能成像研究

目的研究静息态脑功能成像在帕金森病(parkinson's disease,PD)中的应用。方法帕金森病患者29例和健康对照组33例行磁共振检查,扫描序列包括常规MRI平扫及静息态fMRI成像,通过比较两组之间局部一致性和低频振幅的差异,寻找PD患者发生功能异常的脑区,探讨PD尤其是非运动症状的发生机制。结果 PD组ReHo减低的区域主要位于双侧额叶(包括前额叶、额上回、额中回)、胼胝体和扣带回、左中央前回、右侧角回、右侧颞极、丘脑和左侧脑干;PD组ReHo增高的区域主要位于双侧顶叶(包括中央前回和中央后回)左顶下小叶和右楔叶。PD组ALFF减低的区域主要位于左侧额叶、右侧颞叶、右侧中脑及大脑脚、右侧脑桥、右侧小脑、右侧丘脑、胼胝体、双侧顶上小叶;PD组ALFF增高的区域主要位于左侧中央前回和中央后回、左侧岛叶、左侧壳核和左侧丘脑。结论静息态fMRI的局部一致性(ReHo)和低频振幅(ALFF)的方法能够显示PD功能异常的脑区,有助于研究PD的发生机制。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.