体感皮层下行冲动与C类纤维传入在小脑皮层的相互影响

实验用猫,在氯醛糖麻醉和三碘季铵酚制动下进行。电刺激大脑皮层体感Ⅰ区(SⅠ)和隐神经C类纤维时,在小脑皮层分别出现两个诱发电位:峰潜伏期为9.9±1.6ms的SⅠ-CEP和潜伏期为140.6±10.8ms的(C-CEP)。当SⅠ-CEP在C-CEP前出现时,C-CEP受到明显抑制,并与两者出现的时间间隔有关和刺激SⅠ区的强度相关;当SⅠ-CEP与C-CEP同时出现时,两者复合易化;当SⅠ-CEP在C-CEP后出现时,SⅠ-CEP受到轻度抑制。结果表明:体感皮层下行冲动与隐神经C类纤维传入冲动在小脑皮层可以相互影响。一般是先出现的抑制后出现的,两者出现的时间间隔越短,抑制越强,两者同时出现则复合易化。体感皮层下行冲动对C-CEP的抑制比C类纤维传入冲动对SⅠ-CEP的抑制强,提示体感皮层可能参与调制小脑皮层对C类纤维传入的反应。     

经颅磁刺激运动诱发电位对脊髓亚急性联合变性的诊断意义

目的 探讨经颅磁刺激运动诱发电位(TMS-MEP)对脊髓亚急性联合变性(SCD)脊髓侧索早期病变的评价作用,初步分析其在SCD定位诊断中的应用.方法 选取天津市第三中心医院2010-2014年确诊的SCD患者20例为确诊组,并选取同期14例拟诊断为SCD的患者为拟诊组,健康人21例为对照组.入选患者及对照组均进行TMS-MEP检查,分别比较确诊组、拟诊组与对照组MEP皮层潜伏期和中枢传导时间(CMCT)的差异.结果 拟诊组14例患者中10例出现MEP异常,异常率为71.4％.确诊组中患者上肢MEP皮层潜伏期为(24.49±1.87)ms,CMCT为(12.08±1.43)ms;下肢MEP皮层潜伏期为(33.81±2.09)ms,CMCT为(19.88±1.89) ms,均较对照组明显延长(P＜0.05).拟诊组中患者上肢MEP皮层潜伏期为(24.05±1.94)ms,CMCT为(11.68±1.71)ms;下肢MEP皮层潜伏期为(33.00±2.52)ms,CMCT为(19.36±2.06)ms,也较对照组明显延长(P＜0.05).结论 TMS-MEP异常在SCD患者未出现脊髓侧索受累临床体征前即可出现,其可发现脊髓侧索亚临床病变,并提供SCD的早期锥体束损害证据.     

睡眠呼吸暂停综合征及鼾症患者事件相关电位的研究

目的　研究睡眠呼吸暂停及鼾症患者事件相关电位 (P3)的情况 ,探讨可能的机制。方法　入组受试者分为睡眠呼吸暂停患者组 2 1例、鼾症组 2 1例及正常对照组 2 1例 ,均进行睡眠多导仪、听觉诱发事件相关电位 (P3)、临床记忆量表检查及神经系统查体。结果采用GLM程序分析。结果　睡眠呼吸暂停患者组记忆商 (MQ) 90± 12 ,P3潜伏期Fz记录点 :36 3ms± 2 3ms ,Cz记录点 :36 9ms± 2 8ms;鼾症组MQ :10 1± 17,P3潜伏期 :Fz记录点 :337ms± 31ms ,Cz记录点 :340ms± 32ms ;正常对照组MQ :114± 12 ,P3潜伏期 :Fz记录点 :341ms± 2 9ms ,Cz记录点 338ms± 30ms。睡眠呼吸暂停患者组与鼾症组、正常对照组的P3潜伏期和记忆商比较差异有显著意义 (P <0 0 5 )。鼾症患者记忆商较正常对照组降低。结论　睡眠呼吸暂停患者有认知功能损害。鼾症患者记忆功能减退。夜间低氧血症可能起重要作用     

胫后神经刺激的体感诱发电位和身高的关系

对51例健康人进行胫后神经刺激的体感诱发电位检查.结果表明,身高与脊髓电位N_22及皮层电位P_40的峰潜伏期高度相关,说明身高为胫后神经体感诱发电位正常值非常重要的参数。     

抽动障碍各亚型事件相关电位N400的比较

目的:比较抽动障碍(TD)各亚型患者事件相关电位N400的变化,并探讨其意义。方法:用MEB-9104K诱发电位检测系统测定病例组(11例Tourette氏障碍、17例慢性运动TD、7例一过性TD)及对照组(20例正常儿童)N400,并比较其潜伏期及波幅。结果:病例组Tourette氏障碍潜伏期(648.04±150.19)ms,波幅(28.82±19.09)μV;慢性运动TD潜伏期(724.89±215.23)ms,波幅(23.90±9.97)μV;一过性TD潜伏期(760.67±233.20)ms,波幅(27.85±12.72)μV;对照组潜伏期(485.75±85.76)ms,波幅(22.35±19.76)μV。病例组各亚型N400潜伏期较对照组长(P<0.001),波幅比无统计学意义(P>0.05)。各亚型之间N400潜伏期及波幅比均无统计学意义(P>0.05)。结论:TD患者存在认知功能缺陷,各亚型之间认知功能无差别。     

糖尿病性轻度认知障碍患者体感诱发电位的特征和规律研究

目的 利用体感诱发电位（SEP）技术对认知功能状态进行客观评价。方法 对符合纳入标准的30例 健康受试者、30例无认知障碍及30例轻度认知障碍的糖尿病患者进行体感诱发电位检测，记录周围神经电位、脊髓电位、皮层电位峰潜伏期等相关数据，并进行比较。结果 3组受试者SEP周围神经诱发电位、皮层下电位峰潜伏期比较，差异无统计学意义（P?>0.05），轻度认知障碍组的皮层电位峰潜伏期、中枢传导时间与正常组和无认知障碍组比较，差异有统计学意义（P?<0.05）。无认知障碍组的中长潜伏期P60、N75峰潜伏期与正常组比较，差异有统计学意义（P?<0.05），而中枢传导时间比较，差异无统计学意义（P?>0.05）。结论 SEP皮层电位对认知功能的评价更具敏感性，优于量表评估，可用于评估糖尿病性轻度认知障碍的亚临床病变。 且胫后神经SEP皮层电位对糖尿病性轻度认知障碍的亚临床期及早期评价较正中神经SEP更有优势。     

大鼠皮层体感诱发电位刺激和记录技术改进

目的改进传统的大鼠大脑皮层体感诱发电位(SEP)刺激和记录技术。方法SD大鼠16只,体质量(225±25)g,随机分为传统SEP检测组(A组)、改进SEP检测组(B组),分别记录比较所得SEP波形。结果B组检测到稳定的标准SEP波形[P1波潜伏期(11.85±0.23)ms,N1波潜伏期(23.13±0.73)ms,P1-N1波幅(0.21±0.05)mV],各项指标与A组相比差别无统计学意义。结论改良SEP刺激和记录技术创伤小,更适合于慢性动物实验研究。     

正常人听觉P300的研究

目的 :观察正常人各年龄组听觉 P3 0 0 指标变化。方法 :采用 oddball刺激序列检测 P3 0 0 ,靶刺激叠加2 0 0～ 50 0次 ,分析时间 1 0 0 0 ms。结果 :全组 1 0 2例 ,P3 0 0 潜伏期 ( Cz点 ) :<40岁组为 ( 343.2± 1 5.2 ) ms,40～59岁组 ( 348.4± 1 6.8) ms,≥ 60岁组为 ( 373.8± 2 9.8) ms,全组为 ( 351 .4± 2 2 .1 ) ms。上述三年龄组 P3 0 0 波幅 ( Cz点 )分别为 ( 1 3.7± 7.1 )μV、( 1 4.2± 7.6)μV、( 1 1 .7± 6.3)μV,全组为 ( 1 3.5± 7.2 )μV。经相关分析发现 ,P3 0 0 潜伏期与年龄呈显著正相关 ( r=0 .452 ,P<0 .0 1 ) ,波幅与年龄呈负相关 ( r=- 0 .0 68,P>0 .0 5)。结论 :本组正常人 P3 0 0 潜伏期平均在 350 ms± ,波幅变异较大 ,平均 1 3.5μV,随年龄增长潜伏期延长 ,波幅下降。     

胫骨前肌的神经支配及其各肌肉单元间的功能联系

目的:以胫骨前肌为例,探讨支配各肌肉单元的初级神经分支的感觉成分在脊髓后角传入位点的空间排列关系;探讨相邻的肌肉单元间及其协同肌长伸肌间的功能联系。方法:分离胫骨前肌、长伸肌及其初级神经分支(TA1、TA2、EHL);打开椎管,暴露L4、L5背根,在其进入脊髓处按前后顺序平分为5份;应用电生理技术,于L4.1～L5.5背根各分支上记录各初级神经分支的传入电位。单脉冲刺激TA1,依次记录TA2及EHL上的反射性传出电位,并进行平均叠加处理。结果:①TA1的传入电位在L4.1～L5.2脊髓节段均有分布,其中在L4.2、L4.3的峰值最大,平均幅值分别为(97.5±3.7)μV、(50±2.2)μV;TA2在脊髓的传入分布同TA1有重叠,但峰值在L4.3、L4.4最大,平均幅值分别为(70±3.4)μV、(45±1.8)μV。EHL的传入性电位分布于L4.2～L5.3,峰值位于L4.4、L5.1,平均幅值均为(40±0.5)μV。统计表明,胫骨前肌各初级神经分支及长伸肌初级神经分支感觉成分在脊髓后角的传入位置有明确的顺序性,P<0.001;②刺激TA1,可在TA2记录到反射性传出电位,平均幅值(36.89±3.25)μV,潜伏期为(10.16±1.07)ms。当刺激幅度增至0.5V时,在EHL上也记录到反射性电位,平均幅值(29.03±2.24)μV,潜伏期为(13.75±1.16)ms。结论:支配骨骼肌的初级神经分支的传入传出系统在     

腹膜透析、血液透析对维持性透析患者事件相关电位P300的影响

目的对比腹膜透析(简称腹透)、血液透析(简称血透)对维持性透析患者事件相关电位P300(简称P300)的影响。方法选择72例须行维持性透析的终末期肾衰竭(ESRD)患者,腹透组30例,血透组42例,分别测定两组治疗开始前及治疗后1年P300的潜伏期、波幅。结果治疗前腹透组和血透组P300潜伏期和波幅分别为[(397.6±35.9)ms,(8.3±1.57)μV和(405.3±46.7)ms,(7.9±1.43)μV],差异无统计学意义(P>0.05),治疗1年后腹透组和血透组P300潜伏期和波幅分别为[(320.6±31.95)ms,(10.8±1.06)μV和(345.6±33.28)ms,(9.5±1.12)μV],差异有统计学意义(P<0.01)。结论不同透析方式对维持性透析患者P300的影响程度不同,腹透对改善长期维持性透析患者的认知功能可能较血透好。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.