迁延性脑脊液鼻漏伴颅内感染的诊治

目的探讨迁延性脑脊液鼻漏伴颅内感染的诊断和治疗方法。方法2008年2月～2010年1月收治迁延性脑脊液鼻漏伴颅内感染患者6例,高分辨率CT和CT脑池造影检查明确漏口位置,采用经蝶手术修补漏口,持续腰大池引流并鞘内注射头孢曲松钠＋万古霉素治疗。结果6例患者均治愈,随访6个月,无脑脊液鼻漏或颅内感染复发。结论采用高分辨率CT和CT脑池造影检查明确漏121位置,经蝶手术修补漏121,持续腰大池引流并鞘内注射头孢曲松钠＋万古霉素是治疗迁延性脑脊液鼻漏伴颅内感染的有效方法。     

万古霉素鞘内注射联合腰大池持续引流治疗颅脑术后颅内感染80例临床分析

目的探讨万古霉素鞘内注射联合腰大池持续引流治疗颅脑术后颅内感染的临床效果。方法选择我院收治的80例颅脑术后颅内感染患者为研究对象,随机分为对照组和观察组,对照组采用万古霉素鞘内注射治疗,观察组在对照组的基础上加用腰大池持续引流治疗。比较2组的治疗效果,治疗前后脑脊液常规检查改善情况及治疗过程中不良反应发生情况。结果观察组总有效率为92%,显著高于对照组的73.3%,差异有统计学意义(P0.05)。治疗后脑脊液白细胞计数、蛋白质显著低于治疗前,葡萄糖显著高于治疗前,观察组改善效果更显著。结论万古霉素鞘内注射联合腰大池持续引流治疗颅脑术后颅内感染,可显著改善感染症状,对患者损伤小,为理想的治疗方法,值得临床推广应用。     

腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的临床疗效分析

目的探讨腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的疗效和安全性。方法回顾性分析2018年4月—2019年12月本院神经外科收治的26例泛耐药鲍曼不动杆菌颅内感染患者的临床资料,所有患者均接受腰大池引流及鞘内注射抗生素,观察并记录患者感染指标(体温、颈项强直征、血常规、脑脊液常规及生化、脑脊液细菌培养)变化情况,记录治疗方法并对治疗效果进行分析。结果 24例患者行单纯性腰大池引流,2例患者因腰大池引流管堵塞,重置腰大池引流管并联合侧脑室引流。23例患者在治疗10～34 d内治愈,治愈率为88.46%; 3例患者死亡,死亡率11.54%,死亡时间分别为感染确认后第4天、第7天、第12天。结论对泛耐药鲍曼不动杆菌颅内感染患者应用腰大池引流加鞘内注射治疗是安全有效的,值得临床推广。如发生因脑脊液蛋白含量高导致腰大池引流管堵塞,可联合侧脑室引流并行腰大池-侧脑室方向替加环素溶液持续冲洗。     

腰大池引流治疗术后颅内感染及脑脊液漏

目的探讨持续腰大池引流治疗术后颅内感染及脑脊液漏的疗效。方法回顾性分析2004年2月至2007年10月经持续腰大池脑脊液引流治疗的39例术后颅内感染及脑脊液漏患者的临床资料。这39例患者中，单纯脑脊液切口漏11例，脑脊液鼻漏9例，单纯颅内感染8例，脑脊液切口漏合并颅内感染11例。结果27例行腰大池持续外引流，12例经腰大池外引流并辅以鞘内注入敏感抗生素治疗，均取得满意疗效，无加重及脑疝等严重并发症发生，所有患者均痊愈出院。结论应用持续腰大池引流脑脊液加鞘内注药，配合全身应用敏感抗生素是治疗术后脑脊液漏及颅内感染一种安全、有效的方法。     

鞘内注射万古霉素治疗重型颅脑外伤开颅术后MRSA颅内感染的临床研究

目的探讨鞘内注射万古霉素治疗重型颅脑外伤开颅术后耐甲氧西林金黄色葡萄球菌（MRSA）颅内感染的临床效果及并发症。 方法回顾性分析济宁市第一人民医院重症医学科自2016年7月至2019年5月收治的27例重型颅脑外伤开颅术后MRSA颅内感染患者的病例资料，评价鞘内注射万古霉素的临床效果，并统计并发症。 结果大多数患者的临床表现较治疗前均有显著改善，其中痊愈11例，显效8例，进步6例，无效2例（1例因多脏器功能衰竭，1例因重症肺炎并急性呼吸窘迫综合征）。临床总有效率为92.59%，病死率为7.41%，细菌清除率为100%。所有患者治疗期间均未出现明显并发症。 结论腰大池通畅引流联合鞘内注射万古霉素能有效控制MRSA颅内感染，且无明显并发症。     

腰大池置管引流术治疗颅脑手术后颅内感染28例临床分析

目的探讨腰大池置管引流术治疗颅脑手术后颅内感染的临床疗效。方法对28例颅脑手术后颅内感染患者采用腰大池置管持续引流,鞘内注入万古霉素,观察其效果。结果本组28例,治愈14例,好转6例,无效8例,有效率71.4%;脑脊液白细胞数明显下降,糖及氯化物明显升高,颅内压明显下降,治疗过程中未出现鞘内注药的不良反应。结论该方法能有效提高颅脑手术后颅内感染的治愈率,降低病死率。     

持续腰大池外引流加鞘内注射治疗颅内感染37例临床分析

目的探讨开颅术后颅内感染的诊断和治疗。方法对我科2007-01—2011-10收治的37例因颅脑损伤与脑出血行开颅手术后并发颅内感染的患者,进行腰大池持续引流、鞘内给药、全身应用敏感抗生素等抗感染治疗。结果本组36例治愈出院,1例并发多器管功能衰竭放弃治疗。治愈的36例患者均获得随访,均未见复发及并发症发生。结论腰大池置管引流,鞘内注射结合全身应用抗生素治疗颅内感染是一种安全、有效的治疗方法。     

腰大池引流与万古霉素鞘内疗法在颅脑外伤术后颅内感染治疗中的应用

目的探讨腰大池引流与鞘内注射万古霉素治疗颅脑外伤术后发生颅内感染的效果,给临床治疗提供理论参考。方法选取2013-06—2015-06在我院接受治疗的70例经颅脑外伤术后出现颅内感染的患者为研究对象,随机分成2组各35例,2组患者均鞘内注射万古霉素,观察组在鞘内注射万古霉素的同时应用腰大池引流,比较2组治疗效果。结果治疗前2组脑脊液白细胞计数、蛋白质浓度和葡萄糖浓度比较,差异无统计学意义(P0.05)。治疗后对照组白细胞计数、蛋白质浓度和葡萄糖浓度分别为(14.59±3.42)×106 L-1、(0.95±0.69)g/L、(3.12±0.51)mmol/L,观察组分别为(5.89±1.56)×106 L-1、(0.46±0.22)g/L、(4.64±0.61)mmol/L,治疗后2组各项指标比较差异均有统计学意义(P0.05);2组颅内感染的病原菌种类一致,各病原菌所占比例差异无统计学意义(P0.05);观察组总有效率较对照组高,差异有统计学意义(P0.05)。结论万古霉素鞘内注射联合应用腰大池引流能显著提高治疗颅脑外伤手术后颅内感染的治疗效果,有效改善脑脊液各项指标,值得临床推广。     

多途径联合用药治疗广泛耐药鲍曼不动杆菌颅内感染1例报告并文献复习

目的探讨广泛耐药鲍曼不动杆菌颅内感染的早期诊断及治疗方案。方法分析1例颅脑外伤术后广泛耐药鲍曼不动杆菌颅内感染患者的临床资料;并结合文献复习,分析广泛耐药鲍曼不动杆菌颅内感染的治疗方案。结果本例患者住院过程中,采用二代测序技术及降钙素原检测脑脊液辅助诊断;抗生素使用方案为亚胺培南+替加环素+多粘菌素B静脉注射,以及联合腰大池引流庆大霉素冲洗和多粘菌素B+替加环素鞘内注射。治疗2周后患者颅内感染好转,脑脊液细菌培养阴性。结论对于广泛耐药鲍曼不动杆菌颅内感染,替加环素+多粘菌素B静脉用药,联合腰大池引流庆大霉素冲洗和多粘菌素B+替加环素鞘内注射有较好的治疗效果。     

脑脊液置换联合万古霉素与地塞米松鞘内注射治疗术后颅内感染的临床研究

目的探讨脑脊液置换联合万古霉素与地塞米松鞘内注射治疗术后颅内感染的疗效。方法2002~2012年收治67例术后颅内感染患者,均给与脑脊液置换治疗;在此基础上,25例给予静脉滴注头孢曲松治疗（对照组）,42例给予鞘内注射万古霉素和地塞米松治疗（治疗组）。结果治疗组14 d治愈率（64.3%,27/42）、20 d治愈率（83.3%,33/42）和总治愈率（100%）均明显高于对照组[（分别为20.0%,5/25;56.5%（13/25）;84.0%（21/25）;P〈0.05）。治疗组平均治愈时间[（13.21±4.52）d]较对照组[（22.51±5.74）d]显著缩短（P〈0.05）。两组脑萎缩、脑积水、神经根刺激症状等并发症发生率无统计学差异（P〉0.05）。结论脑脊液置换联合万古霉素和地塞米松联合鞘内注射治疗术后颅内感染疗效显著,实用安全。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。