阿尔茨海默病患者额叶执行功能及其与记忆的相关因素分析

目的：探讨阿尔茨海默病（AD）患额叶执行功能及其与记忆的关系。方法：采用威斯康星卡片分类测验（WCST）,韦氏记忆量表（WMS）,对31例AD患及36例正常对照组进行对照研究。结果：AD患的WCST和WMS成绩均比对照组差（P＜0．05）,以WCST的持续反应数,持续错误数与各项记忆测验粗分成绩进行Pearson相关分析,经历,1→100与持续反应数和持续错误数显相关（P＜0．05）,记图与持续反应数显相关（P＜0．05）,其它各项分测验与持续反应数和持续错误数都不相关（P＞0．05）。结论：AD患有明显的额叶执行功能障碍和记忆障碍,提示AD患的额叶执行功能障碍与长时记忆缺陷有关。     

计算机辅助认知训练对精神分裂症患者认知功能的康复效果

目的探讨计算机辅助认知训练对精神分裂症患者认知功能康复治疗效果。 方法研究组51例精神分裂症患者，通过计算机辅助认知作业训练治疗2个月，对照组53例精神分裂症患者采用常规工娱疗法治疗2个月。2组患者治疗前后分别进行阳性和阴性症状量表（PANSS）、连线测验A和B、韦氏成人记忆量表（WMS）和威斯康星卡片分类测验（WCST）等神经认知功能测验，并进行统计学分析比较。 结果①治疗后，研究组和对照组患者临床症状PANSS量表总评分［(59.82±8.41)、(59.45±9.05)分］及阴性症状量表的评分［(16.67±3.20)、(17.08±3.23)分］均较组内治疗前［PANSS总评分(70.23±7.62)、(68.32±10.14)分及阴性症状量表评分(21.46±3.26)、(20.82±4.21)分］明显下降，组内差异均有统计学意义（P<0.05）；研究组治疗后上述各项的减分程度略高于对照组，但组间差异无统计学意义（P&rt;0.05）。②治疗后，研究组连线测验A测验成绩［（44.14±17.51）分］和B测验成绩［（96.47±34.43）分］均较组内治疗前［（51.76±21.18）和（114.31±35.76）分］明显下降（P<0.01)；而对照组连线测验A测验成绩和B测验成绩治疗前后变化不大（P&rt;0.05）。③治疗后，研究组WMS再认和WMS再生两个分测验成绩［(8.21±3.96)、(10.24±3.52)分］较组内治疗前［(5.83±3.12)、(8.63±3.45)分］明显增加，差异有统计学意义（P<0.01）；对照组WMS再认和WMS再生两个分测验成绩治疗前后变化不大（P&rt;0.05）；研究组测验成绩提高明显好于对照组（P=0.01）。④治疗后，研究组WCST的总测验数、持续错误数、正确数和分类数成绩［(87.82±23.21)、(23.20±11.5)、(23.14±42.00)、(4.80±0.76)］较组内治疗前［(78.20±21.40)、(28.87±10.21)、(21.54±26.50)、(4.26±0.08)］明显提高（P<0.05）；对照组WCST测验总测验、持续错误数、正确数和分类数成绩治疗前后变化不大（P&rt;0.05）；研究组的测验成绩变化明显大于对照组（P<0.01）。 结论计算机辅助认知训练可以提高精神分裂症患者认知功能测验任务成绩，改善患者部分认知领域的功能。     

心理护理改善抑郁症患者认知功能的对照研究

目的:探讨心理护理改善抑郁症患者认知功能障碍的作用.方法:对27例符合CCMD-3抑郁症诊断标准的抑郁症患者于治疗前及治疗后6周末分别进行汉密尔顿抑郁量表(HAMD)评分和威斯康星卡片分类测验(WCST). 结果:治疗后HAMD评分低于治疗前,差异有统计学意义(P<0.05);且治疗后的总测验次数、持续错误数、随机错误数低于治疗前,差异亦有统计学意义(P<0.05).相关分析表明患者的抑郁严重程度与WCST的持续错误数呈正相关,与正确数呈负相关.结论:抑郁症患者存在认知功能障碍,心理护理不但有助于抑郁症患者病情的康复,而且有利于认知功能的改善.     

抑郁症患者认知功能障碍的比较研究

目的:探讨抑郁症患者认知功能损害特点。方法:对46例符合CCMD-3抑郁症诊断标准抑郁症患者和46名健康自愿者对照组进行威斯康星卡片测验(Wisconsincardsortingtest,WC-ST)、词汇流畅测验、联想学习、相似、领悟和数字广度测验,并对经过6周抗抑郁药治疗的46例抑郁症患者进行治疗前后比较。结果:抑郁症患者WCST的总测验次数82.19±21.55、持续错误数31.56±18.97、随机错误数25.53±11.31、词汇流畅测验41.68±5.96、联想学习19.78±6.21、相似9.68±3.15、领悟9.82±4.33和数字广度测验10.85±2.77,与正常人为53.66±5.87,16.89±12.54,9.48±15.53,56.27±13.34,28.56±5.60,13.91±2.75,13.91±2.75,14.73±2.38相比差异均有显著性意义(P<0.01),WCST的总测验次数、持续错误数、随机错误数与HAMD总分(r=0.35,0.33,0.31,P<0.05)及迟缓(r=0.45,0.41,0.41,P<0.01)、日夜变化(r=0.31,0.29,0.31,P<0.05)两因子分正相关。WCST与其他各项神经心理学测验无明显相关。46例抑郁症患者治疗后,WCST的上述各项指标与治疗前相比差异均有显著性意义(P<0.05)。治疗后WCST的总测验次数、持续错误数、随机错误数的减分率与HAMD的减分率正相关(P<0.05)。结论:抑郁症患者存在认知功能损害,其认知功能损害与病情严重程度和患者     

未经治疗的抑郁症患者注意力及执行功能研究

目的:检测未接受药物治疗的抑郁症患者注意力、执行功能状况及其与抑郁症状的关系。方法:抑郁症患者29例纳入抑郁组,健康体检者30例纳入对照组,2组分别进行计算机化的威斯康星卡片分类测验(WCST)和持续操作测验(CPT)检查,并用汉密尔顿抑郁量表(HAMD)对患者临床症状进行评估;比较2组执行功能的差别,并作相关分析。结果:抑郁组WCST的错误应答数、持续性错误数、完成第一分类所需应答数及CPT的遗漏性错误、反应时间标准误差、反应标准误差变异性、固着反应均高于对照组高(P0.05);抑郁组WCST的错误应答数与HAMD评分呈正相关(r=0.44,P0.05),CPT的替代性错误数与HAMD评分呈负相关(r=-0.41,P0.05);抑郁组WCST的正确应答数与CPT的反应标准误差的变异性呈负相关(r=-0.46,P0.05);抑郁组CPT的遗漏性错误与病程呈正相关(r=0.46,P0.05)。结论:未服药的抑郁症患者存在执行功能和注意功能的损害,且与患者抑郁症状相关。     

不同亚型轻度认知功能障碍听觉事件相关电位随访研究

目的探讨听觉事件相关电位在不同亚型轻度认知功能障碍(MCI)诊断及转归预测中的作用。 方法对37例遗忘型-单领域MCI（SD-MCI）患者、19例遗忘型-多领域MCI（MD-MCI）患者及50例健康老年对象（纳入对照组）进行神经心理学测试和听觉事件相关电位（AERPs）检测。对各组对象神经心理学测试评分及P50、N100、P200、N200及P300波潜伏期和波幅进行分析比较。并于随访2年后再次进行相同测试。 结果入选时与对照组比较,SD-MCI组逻辑记忆即刻回忆得分及逻辑记忆延迟回忆得分均显著低于对照组（P<0.05）;MD-MCI组韦氏逻辑记忆亚测验、Boston命名、连线试验和韦氏成人智力量表积木试验得分均较显著低于SD-MCI组（P<0.05）。与对照组比较,SD-MCI组P50波幅明显增高(P<0.05),P300潜伏期明显延长(P<0.05),波幅明显降低(P<0.05)。MD-MCI组与SD-MCI组比较,前者P50波幅明显增高(P<0.01),P300潜伏期明显延长(P<0.05),波幅显著降低(P<0.05)。2年后随访时发现,转化为阿尔茨海默病（AD）的患者其韦氏逻辑记忆亚测验、Boston命名、连线试验和韦氏成人智力量表积木试验得分均显著低于稳定型MCI患者（P<0.01）。与对照组比较,AD组患者P300潜伏期明显延长(P<0.05),波幅显著降低(P<0.05)。AD组与稳定型MCI患者比较,前者P50波幅明显降低(P<0.001),P300潜伏期明显延长(P<0.05),波幅显著降低(P<0.05)。通过比较AD组与稳定型MCI患者入选时AERPs结果发现,前者入选时P50波幅明显增大(P<0.05)。 结论AERPs的P50波幅和P300潜伏期、波幅可作为诊断不同亚型MCI的重要指标,P50波幅可作为预测不同亚型MCI转归的重要参考依据。     

精神分裂症患者认知功能障碍的对照研究

目的:探讨精神分裂症患者的认知功能障碍情况。方法:对64例精神分裂症患者及53例正常对照组采用Stroop测验、数字符号测验,韦氏成人智力表第三版(WAIS-Ⅲ)符号搜索,定步调连续加法测验,威斯康星卡片分类测验(WCST-64)进行测评,结果用SPSS 16.0进行分析。结果:精神分裂症患者组与正常对照组的Stroop单词、Stroop颜色、Stroop色词、精神分裂症、WAIS-Ⅲ符号搜索总分、定步调连续加法测验尝试数、定步调连续加法测验正确数、WCST完成测试数、WCST正确数、WCST持续错误数、WCST随机错误数、WCST完成分类数等指标比较差异均有统计学意义的差异。结论:精神分裂症患者存在注意、记忆、执行功能、信息加工、抽象能力、概念形成等多方面认知功能障碍的表现。     

脑性瘫痪儿童神经心理功能障碍的特征

目的:对脑瘫儿童的神经心理功能进行测量,分析脑瘫儿童神经心理功能的水平及障碍的特征。方法:采用临床神经心理测量工具如线段方向判断测验、划消测验、韦氏记忆量表、Corsi触摸测验、YWG阅读测查表、WCST、河内塔测验、REY复杂图形临摹等对67例脑瘫儿童的神经心理功能进行测量,并与正常儿童进行比较。结果:脑瘫儿童的线段方向判断任务成绩低于正常儿童,差异具有显著意义(P0.01);划消测验的完成时间与正常儿童差异显著(P0.01),而测验的错误数即漏划数上两者差异不显著(P0.05);记忆测验中,图形记忆、联想记忆任务成绩存在差异(分别为P0.01,P0.05),而经历与定向、视觉再认、顺背数及Corsi任务差异均不显著(P0.05);脑瘫儿童与正常儿童WCST完成分类数差异具有显著意义(P0.01),而持续性错误和总错误数差异不显著(P0.05);河内塔移动次数差异具有显著意义(P0.01),而错误数差异不显著(P0.05);REY复杂图形临摹成绩明显落后于正常儿童(P0.05)。结论:脑瘫儿童主要存在信息处理速度、空间记忆、概念形成、问题解决策略和思维灵活性及运用功能障碍。     

抑郁症患者认知功能障碍的比较研究

目的：探讨抑郁症患者认知功能损害特点。方法：对46例符合CCMD-3抑郁症诊断标准抑郁症患者和46名健康自愿者对照组进行威斯康星卡片测验(Wisconsin card sorting test．WC-ST)、词汇流畅测验、联想学习、相似、领悟和数字广度测验，并对经过6周抗抑郁药治疗的46例抑郁症患者进行治疗前后比较。结果：抑郁症患者WCST的总测验次数82．19&;#177;21．55、持续错误数31．56&;#177;18．97、随机错误数25．53&;#177;11．31、词汇流畅测验41．68&;#177;5．96、联想学习19．78&;#177;6．21、相似9．68&;#177;3．15、领悟9．82&;#177;4．33和数字广度测验10．85&;#177;2．77，与正常人为53．66&;#177;5．87，16．89&;#177;12．54，9．48&;#177;15．53．56．27&;#177;13．34．28．56&;#177;5．60．13．91&;#177;2．75．13．91&;#177;2．75，14．73&;#177;2．38相比差异均有显著性意义(P&;lt;0．01)。WCST的总测验次数、持续错误数、随机错误数与HAMD总分(r=0．35，0．33．0．31．P&;lt;0．05)及迟缓(r=0．45，0．41，0．41，P&;lt;0．01)、日夜变化(r=0．31．0．29，0．31，P&;lt;0．05)两因子分正相关。WCST与其他各项神经心理学测验无明显相关。46例抑郁症患者治疗后，WCST的上述各项指标与治疗前相比差异均有显著性意义(P&;lt;0．05)。治疗后WCST的总测验次数、持续错误数、随机错误数的减分率与HAMD的减分率正相关(P&;lt;0．05)。结论：抑郁症患者存在认知功能损害，其认知功能损害与病情严重程度和患者特质有关。     

阳性型与阴性型精神分裂症认知功能的研究

为比较阴性型及阳性型精神分裂症患者的认知功能,我们对阴性型组(19例)及阳性型组(25例)患者进行了简式韦氏成人智力测验(WAIS-RC)、记忆功能测验(WMS)及色、数、形判断能力测定。结果两组患者WAIS测验结果无显著差异;WMS测验阴性型组显著低于阳性型组,色、数、形判断能力测验阴性型组比阳性型组明显差,两组阴性症状评分与WMS中的再生、联想、记忆商数呈负相关,与辨色错误、辨形时间、辨形错误呈正相关。说明以阴性症状为主的精神分裂症患者比阳性症状为主者认知功能损害更明显,似可提示阴性症状为主者可能有额叶功能损害。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.