Alzheimer’s病的T淋巴细胞亚群和HLA-DR抗原测定

为了研究T淋巴细胞正群和HLA－DR变化与Alzheimer’s病（AD）病情的关系。采用荧光素标记的单抗直接标记，流式细胞仪对20例轻度AD痴呆和18例重度AD痴呆进行T淋巴细胞亚群和外局单核细胞HLA－DR抗原测定。结果发现：1．CD、CDT细胞在轻度AD组中均路下降，在重度AD组中均升高，但都无显著性差异（P＞0．05）；各组的CD／CD比值均在正常范围之内。2．HLA－DR抗原在轻、重度AD组中均升高，两组与对照组比较均有显著性差异（P＜0．05）。以上结果说明：T淋巴细胞亚群变化与AD病情的联系不明显，应慎重地对其细胞免疫功能进行评价；HLA－DR抗原变化与AD病情变化有一定的联系。     

惊恐障碍时淋巴细胞CCK－8浓度

惊恐障碍时淋巴细胞ＣＣＫ－８浓度［英］／ＢｒａｍｂｉｌｌａＦ…∥ＡｍＪＰｓｙｃｈｉａｔｒｙ．－１９９３，１５０（７）；１１１１～１１１３在外周注入缩胆囊素四肽（ＣＣＫ－４）会引起健康者及惊恐障碍患者惊恐发作。由于外周间隙缩胆囊素的分泌能反映中枢产生的...     

损毁中缝背核或注射对氯苯丙氨酸对小鼠踏转轮运动昼夜节律的影响

哺乳动物下丘脑视交叉上核（ＳＣＮ）在昼夜节律的发生和调节中起着非常重要的作用。它大量接受来自中缝背核（ＤＲ）神经元的神经支配。本实验结果表明，不论在正常光照条件下，或者在连续光照和连续黑暗条件下，损毁ＤＲ后，小鼠踏转轮运动的昼夜节律消失；注射５—ＨＴ台成抑制剂对氯苯百氨酸后，踏转轮运动的节律也消失，但在注射后第７天起开始恢复。结果提示，从ＤＲ到ＳＣＮ的５－ＨＴ能神经传递可能参与踏转轮活动的昼夜节律调节。     

自发性松果体区血肿2例报告

松果体区血肿较罕见、现将我院收治的经CT、手术及病理证实的松果体区血肿2例报告如下。例1男．29岁。无原因突发头痛、恶心、呕吐，伴行走不稳、视物不清9天入院、无高血压病史。检查：血压13／10kPa．神志清，反应迟钝，双眼底视乳头轻度水肿．双眼上视困难、水平性眼震，右眼外展轻度受限，直线行走不能，跟膝胫试验阳性，双侧巴氏证（－）。克氏证（±）。头颅CT：平扫见松果体区有一类圆形均匀高密度灶（59Hu），3cm×3cm大小、Ⅲ脑室局部轻度受压．Ⅲ脑室、双侧脑室轻度扩大；增强无强化。诊断为松果体区血肿．未排除肿瘤。于全麻…     

精神分裂症的中枢单胺递质代谢研究

目的：比较精神分裂症治疗前后中枢5－羟色胺（5－HT）,高香草酸（HVA）,4－羟基苯乙二醇（MHPG）,5－羟吲哚醋酸（5－HIAA）相互作用的差异。方法：应用高效液相色谱（HPLC）对40例首发后经8周治疗的精神分裂症患者脑脊液5－HT,HVA,MHPG,5－HIAA进行检测,并以比值作为相互作用的指标。结果：精神分裂症组HVA／MHPG,5－HTAA／5－HT比值较对照组明显降低。治疗后HVA／MHPG比值两组间差异消失,而HVA／5－HIAA组间差异仍有显著性。结论：以阳性症状为主的精神分裂症存在5－HIAA／5－HT的降低及多巴胺和去甲肾上腺素相互作用的异常。     

Alzheimer病的T淋巴细胞功能活性检测

目的　探讨外周Ｔ淋巴细胞功能活性与Ａｌｚｈｅｉｍ ｅｒ病（ＡＤ）病情的关系。方法　流式细胞仪测定Ｔ细胞亚群;ＭＴＴ法检测ＣｏｎＡ刺激ＡＤ外周淋巴细胞的增殖功能;ＥＬＩＳＡ法检测细胞因子及其受体表达。结果　（１）ＣＤ４＋ 、ＣＤ８＋ Ｔ细胞比例和ＣＤ４＋ ／ＣＤ８＋ 比值各组间无统计学差异。（２）淋巴细胞增值在轻、重ＡＤ组略下降,但刺激指数（ＳＩ）都大于２,与对照无明显差异。（３）ＩＬ－２的分泌在重度ＡＤ组和ｓＩＬ－２Ｒ表达在轻、重度ＡＤ组明显升高（Ｐ＜ ０．０５）,ＩＬ－２Ｒ的表达各组间差异无显著性。结论　Ｔ淋巴细胞亚群变化与ＡＤ病情的联系不明显,细胞因子分泌功能与ＡＤ进展有关。     

丘脑中央下核和顶盖前区前核分别参与介导强电针和弱电针的镇痛效应

在大鼠以强电刺激外周感受野诱发的脊髓背角ＷＤＲ和ＮＳ神经元的晚串放电（Ｃ－反应）作为伤害感受性反应,观察了双侧丘脑中央下核（Ｓｍ）或顶盖前区前核（ＡＰｔＮ）内微量注射局麻药利多卡因对不同强度电针引起的镇痛效应的影响。结果表明：双侧Ｓｍ局麻可明显减弱强电针对Ｃ－反应的抑制效应,但对弱电针的抑制效应无明显影响;双侧ＡＰｔＮ局麻可明显减弱弱电针对Ｃ－反应的抑制效应,但对强电针的抑制效应无明显影响。结果提示,不同强度的电针刺激可能由粗细不同的纤维传入,通过不同的中枢机制产生镇痛作用。Ｓｍ参与介导强电针兴奋细纤维产生的镇痛作用;ＡＰｔＮ则参与介导弱电针兴奋粗纤维产生的镇痛作用。     

白腰文鸟原纹状体栎核发声通路与SP—免疫组化的定位

目的：对白腰文鸟端脑原纹状体栎核（RA）的神经联系和SP－免疫阳性神经细胞或纤维在发声通路中的定位进行研究。方法：采用生物素结合的葡聚糖胺（BDA）双向示踪方法和P物质（substance P,SP)免疫组织化学技术。将BDA微量注入RA内，经ABC以应。结果：（1）RA接受发声控制的高位中枢HVC和新纹状体前部巨细胞核（MAN）外侧部的传入投射，由RA发出的神经纤维投射到中脑背内侧核（DM）和延髓舌下神经核气管鸣管部（nXⅡts)，由此组成发声控制通路。（2）SP－免疫阳性神经细胞大量分布在端脑的HVC，MAN，RA内，SP－免疫阳性神经纤维或末梢密集分布在发声运动中枢中脑的DM，延髓的nXⅡts，舌下神经，以及中脑背外侧核壳区（MLdshell)，中脑丘间核（ICo)和丘脑卵圆核壳（OV shell)内。结论：由于SP广泛分布在发声控制中枢内，提示SP可能在发声控制方面具有重要的生理功能。     

肝豆状核变性患者流体智力的神经心理学研究

目的：通过神经心理学测验评估肝豆状核变性（HLD）患者的流体智力变化特点，探讨HLD患者流体智力变化的发生机制。方法：选取102例HLD患者为研究对象，根据颅脑影像学有无异常分为CT／MRI阳性组（70例）和CT／MRI阴性组（32例X另选正常对照组30例。记录瑞文标准推理测验（R＇SPM）总分和分项结果。结果：3组间比较在R’SPM总分、知觉辨别、系列关系及抽象推理上差异有显著统计学意义（P〈0．01）；在R’SPM比较推理上差异有统计学意义（P〈0．05）。与对照组比较，CT／MRI阳性组在R’SPM总分、知觉辨别、系列关系及抽象推理上差异有显著统计学意义（P〈0．01），在R’SPM类同比较、比较推理上差异有统计学意义（P〈0．05）；与CT／MRI阴性组比较，CT／MRI阳性组在R’SPM系列关系上差异有显著统计学意义（P〈0．叭），在总分、知觉辨别、抽象推理上差异有统计学意义（P〈0．05）。CT／MRI阳性组R’SPM与病程呈负相关（P〈0．05，P〈0．01）。结论：CT／MRI异常HLD患者存在流体智力缺陷；基底神经节器质性破坏及大脑广泛性萎缩可能是HLD患者流体智力缺陷的重要机制之一。     

谷氨酸对丘脑束旁核痛兴奋神经元放电的影响

目的：观察脑室注射谷氨酸（Glu)对大鼠丘脑束旁核（PF）痛兴奋神经元（PEN）电变化的影响。方法：以电脉冲刺激右侧坐骨神经作为伤害性痛刺激，用玻璃微电极细胞外记录神经元放电的变化。结果：（1）伤害性刺激使大鼠丘脑PF的PEN诱发放电频率增加；（2）脑室注射Glu(1.5μg/10μl）加强PEN的电活动，使PEN放电频率的净增值增加，潜伏期缩短；（3）这种作用可被Glu的NMDA受体拮抗剂MK－801（0．17μg/0.5μl)所阻断。结论：Glu在中枢痛沉调制中可能起兴奋作用，而NMDA受体参与介导中枢伤害性信息的传递过程。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.