皮质下失语患者的口语表达障碍: 18例分析

目的 分析皮质下失语患者在口语表达中音位障碍和词汇障碍特点以及可能的病理机制,为言语康复训练提供依据. 方法 用汉语失语检查法( ABC法)对武汉大学人民医院神经内科收治的 18例左侧皮质下血管病变引起的丘脑性失语和基底核性失语患者进行检查.分析两类失语患者在复述中音位错误和视命名中词汇错误出现的次数,并进行比较. 结果 皮质下失语的音位错误中音素替代最多(各自出现 27次 /84.4%, 10次 /66.7%),环境错误最少各自 2次.在词汇错误中丘脑性失语最多的类型是语义上位关系词替代( 32次 /42.5%),基底核性失语是音位错语( 11次 /26.8%),丘脑性失语与基底核性失语相比差异有显著性意义(χ 2=18.828,P< 0.05). 结论 皮质下失语患者在口语表达中的不同特点,揭示皮质下结构参与了语音、词汇-语义的组织表达.     

脑梗死失语症76例相关因素分析

目的:研究脑梗死患者失语症临床特点及其相关因素。方法:用汉语失语症检查法检查76例脑梗死失语症患者失语的类型及特点。结果:病灶位于皮质25%,皮质下67%,皮质及皮质下8%。完全性失语10%,运动性失语57%,感觉性失语5%,不完全混合性失语8%,皮层下失语综合征7%。结论:研究脑梗死失语症,除考虑病灶因素外,还要注意分析梗死所致的临床特征及病理生理改变的影响。     

脑梗死失语症76例相关因素分析

目的：研究脑梗死患失语症临床特点及其相关因素。方法：用汉语失语症检查法检查76例脑梗死失语症患失语的类型及特点。结果：病灶位于皮质25％，皮质下67％，皮质及皮质下8％。完全性失语10％，运动性失语57％，感觉性失语5％,不完全混合性失语8％，皮层下失语综合征7％，结论：研究脑梗死失语症，除考虑病灶因素外，还要注意分析梗死所致的临床特征及病理生理改变的影响。     

皮质下失语患者的口语表达障碍：18例分析

目的：分析皮质下失语患者在口语表达中音位障碍和词汇障碍特点以及可能的病理机制，为言语康复训练提供依据。方法：用汉语失语检查法(ABG法)对武汉大学人民医院神经内科收治的18例左侧皮质下血管病变引起的丘脑性失语和基底核性失语患者进行检查。分析两类失语患者在复述中音位错误和视命名中词汇错误出现的次数，并进行比较。结果：皮质下失语的音位错误中音素替代最多(各自出现27次／84．4％，10次／66．7％)，环境错误最少各自2次。在词汇错误中丘脑性失语最多的类型是语义上位关系词替代(32次／42．5％)，基底核性失语是音位错语(11次／26．8％)，丘脑性失语与基底核性失语相比差异有显著性意义(r=18．828，P&;lt;0．05)。结论：皮质下失语患者在口语表达中的不同特点，揭示皮质下结构参与了语音、词汇-语义的组织表达。     

弥散张量成像对皮质下失语症发病机制的研究

目的应用弥散张量成像(DTI)和纤维束示踪技术(DT-FT),探讨正常人语言功能区纤维连接特点以及皮质下失语症可能的发病机制。方法 2016年6月至2017年5月,选择正常被试20例和经MRI证实病变位于皮质下结构并表现为失语的脑卒中患者3例,根据西部失语成套测验评定标准,运动性失语2例,传导性失语1例。采用DTI及DT-FT观察语言功能区、对侧镜像区的各向异性(FA)以及纤维束的数量、走形等。结果正常被试语言功能区神经纤维走行十分复杂,与其他部位皮质和皮质下结构发生广泛联系,个体间差异不大。3例失语症患者中,语言功能区或弓状纤维束FA较对侧镜像区降低,纤维束破坏、数量减少、变形或移位。结论语言功能相关结构十分复杂,除皮质外,多种白质纤维束、皮质下结构也参与其中。语言功能区纤维受损、变形或移位,可能是皮质下失语症的发病机制。     

皮质下失语的研究与进展

目的:皮质下失语一直是神经科医师争论的焦点。近年来,随着功能影像技术的飞速发展,人们对皮质下失语的病因、临床表现及发病机制都有了新的认识,但尚未达成共识。资料来源:应用计算机检索Medline1980-01/2005-04期间与皮质下失语相关文章,检索词“subcorticalaphasia”、“thalamicaphasia”、“gangliaaphasia”,并限定文章语言种类为English。资料选择:对资料进行初审,选取双盲随机对照的临床研究,筛除明显不随机或没有对照组的临床研究及重复性研究。资料提炼:共收集到88篇相关文献,排除的27篇中,有19篇为重复性研究,8篇为个案报道。纳入61篇,其中关于皮质下失语的病因及分类25篇、临床表现24篇、发病机制及预后22篇。资料综合:皮质下失语的病因有缺血病变、脑出血及其他3类。按部位不同包括内囊纹状体区(基底节)失语、丘脑失语、脑室旁白质失语及小脑失语4类,而临床表现也因部位的不同而有所差异。皮质下失语的机制为:皮质下损害的直接效应、语言的实质皮质结构断开、损害了公式化的皮质语言输出中的语言“释放”片断、、神经机能失联系、皮质功能障碍、皮质执行功能障碍综合症。但发病机制仍然存在很多的争议。结论:皮质下失语临床表现多样,发病机制复杂不祥,需要进一步研究。     

皮质下失语症的特点及其相关机制探讨

皮质下失语症是指病变部位局限于丘脑、基底核-内囊区、脑室周围白质的失语症。其可表现为具有特征性的皮质下失语综合征,主要包括丘脑性失语症和基底核性失语症。也可表现为其他各种类型的失语症。对其机制目前主要有3种解释:①神经功能联系不能理论:即皮质下病变阻断了皮质下与皮质的功能联系,使皮质区因传入减少而发生功能和代谢下降,导致失语。所伴随的皮质低灌注是低代谢的结果,而不是其原因。②皮质下结构参与语言活动,其损害直接导致失语。③皮质下损害导致皮质的血流低灌注(血肿影响、缺血半暗带),由此引起失语。目前最多达到共识的是对第一种解释。     

皮质下失语的研究与进展

目的：皮质下失语一直是神经科医师争论的焦点。近年来，随着功能影像技术的飞速发展，人们对皮质下失语的病因、临床表现及发病机制都有了新的认识，但尚未达成共识。 资料来源：应用计算机检索Medline1980-01／2005-04期间与皮质下失语相关文章，检索词“subcortic alaphasia”、“thalamic aphasia”、“ganglia aphasia”，并限定文章语言种类为English。 资料选择：对资料进行初审，选取双盲随机对照的临床研究，筛除明显不随机或没有对照组的临床研究及重复性研究。 资料提炼：共收集到88篇相关文献，排除的27篇中，有19篇为重复性研究，8篇为个案报道。纳入61篇，其中关于皮质下失语的病因及分类25篇、临床表现24篇、发病机制及预后22篇。 资料综合：皮质下失语的病因有缺血病变、脑出血及其他3类。按部位不同包括内囊纹状体区（基底节）失语、丘脑失语、脑室旁白质失语及小脑失语4类，而临床表现也因部位的不同而有所差异。皮质下失语的机制为：皮质下损害的直接效应、语言的实质皮质结构断开、损害了公式化的皮质语言输出中的语言“释放”片断、、神经机能失联系、皮质功能障碍、皮质执行功能障碍综合症。但发病机制仍然存在很多的争议。 结论：皮质下失语临床表现多样，发病机制复杂不祥，需要进一步研究。     

皮质下失语症的特点及其相关机制探讨

皮质下失语症是指病变部位局限于丘脑、基底核-内囊区、脑室周围白质的失语症。其可表现为具有特征性的皮质下失语综合征，主要包括丘脑性失语症和基底核性失语症。也可表现为其他各种类型的失语症。对其机制目前主要有3种解释：①神经功能联系不能理论：即皮质下病变阻断了皮质下与皮质的功能联系，使皮质区因传人减少而发生功能和代谢下降，导致失语。所伴随的皮质低灌注是低代谢的结果，而不是其原因。②皮质下结构参与语言活动，其损害直接导致失语。③皮质下损害导致皮质的血流低灌注(血肿影响、缺血半暗带)，由此引起失语。目前最多达到共识的是对第一种解释。     

失语症患者近期自然恢复的观察

对２３例急性脑血管病所致的失语患者进行连续８周的失语检查,结果：自然恢复是在中风后２周最快,６周后逐渐减慢。说和听较读和写恢复好。各类失语中皮质下失语、传导性失语、命名性失语、经皮质性失语及Ｂｒｏｃａ失语恢复较好;而Ｗｅｒｎｉｃｋｅ失语、经皮质混合性失语及完全性失语恢复较差;脑出血较脑梗塞恢复要好;皮质下病变较皮质性变变恢复要。提示：失语症是一随时间变化的动态状况。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.