GCS和NIHSS对基底动脉尖综合征临床转归的预测

目的探讨格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)及美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS)对基底动脉尖综合征(top of the basilar syndrome,TOBS)转归的预测价值。方法从南京卒中注册系统中筛选出符合基底动脉尖综合征诊断的64例患者,根据卒中后30d改良Rankin量表评分(modified Rankin Scale,mRS)分为好转组(0~3分)和不良转归组(4~6分),对两组入院时GCS、NIHSS评分进行回顾性分析。结果不良转归组中GCS分值低于好转组(P0.01);NIHSS分值均高于好转组(P=0.011)。经Logistic回归校正年龄、性别及治疗方式3个因素后,GCS评分OR值0.301(95%CI0.167~0.542);NIHSS评分OR值1.436(95%CI1.147~1.796),二者均为独立预测因素。ROC曲线分析显示,以GCS分值10分作为预测TOBS预后的界点,其灵敏度87.9%,特异度83.9%;以NIHSS分值14分作为界点,灵敏度63.6%,特异度77.4%。结论GCS、NIHSS均是基底动脉尖综合征转归重要的预测指标;GCS≤10分、NIHSS≥14分对于基底动脉尖综合征患者不良转归均有重要的预测价值,GCS预测效价高于NIHSS。     

进展性缺血性脑卒中的相关因素及预后分析

目的探讨进展性缺血性脑卒中的相关因素及预后。方法我院诊治的60例进展性缺血性脑卒中患者,经抗血小板聚集、扩容等常规治疗后,根据MRS评分分为预后好组和预后差组。记录2组患者的性别、年龄、体温、血糖、NIHSS评分、头颅MRI影像学改变、医源性原因、脑动脉狭窄、应用低分子肝素钙等因素,使用单变量Logistic回归分析各因素与进展性缺血性脑卒中预后的相关性。结果 通过单变量Logistic回归分析,结果表明进展性缺血性脑卒中预后的显著性相关因素为体温、血糖、NIHSS评分、脑动脉狭窄、应用低分子肝素钙和头颅MRI影像学改变（P〈0.05）。结论 进展性缺血性脑卒中的预后与体温、血糖、NIHSS评分、脑动脉狭窄、应用低分子肝素钙和头颅MRI影像学改变密切相关。     

基底动脉急性闭塞患者支架再通预后与侧支代偿之间的关系

目的探讨急性基底动脉近端或中段闭塞行Solitaire~(TM)支架再通后3个月预后与术前侧支循环代偿之间的关系。方法对天坛医院2014-01—2014-12期间33例因基底动脉近端或中段急性闭塞行SolitaireTM支架机械再通患者的资料进行回顾性分析,根据再通术前脑血管造影(DSA)所示侧支循环代偿情况进行分级(Ⅰ-Ⅳ级),将患者侧支循环代偿程度分级,术前NIHSS评分,闭塞血管再通时间,有无高血压、糖尿病、高脂血症,是否合并基础狭窄、合并溶栓、合并支架植入等与SolitaireTM支架机械再通3个月预后情况〔分为预后良好(MRS评分0~2)和预后差(MRS评分3~6分)两组〕分别进行单因素分析,并将两组间比较P0.10的因素与3个月预后情况行多因素Logistics回归分析,筛选出影响3个月预后的独立风险因素。结果与SolitaireTM支架机械再通3个月预后差的基底动脉近端或中段急性闭塞患者比较,预后良好的患者侧支循环代偿程度较好(H=13.6,P=0.001)、再通术前NIHSS评分低(t=-3.315,P=0.004);其他相关因素两组间比较差异无统计学意义(均P0.05)。其中,血管代偿程度分级、术前NIHSS评分和合并高血压病(P=0.066)等三种因素P0.10,对这三种因素进行多因素Logistics回归分析显示,代偿程度分级(OR=7.536,P=0.017)和术前NIHSS评分(OR=1.150,P=0.039)是影响患者预后的独立风险因素。结论术前NIHSS评分、血管代偿程度分级是评估近端或中段急性基底动脉闭塞患者3个月预后的独立风险因素,而且术前血管代偿程度分级评价近端或中段急性基底动脉闭塞患者3个月预后的灵敏度更高。     

脑电图分级标准在急性大面积缺血性脑卒中患者预后评估中的临床研究

目的 探讨脑电图(electroencephalogram, EEG)分级标准在急性大面积缺血性脑卒中患者脑功能损伤评价及预后评估中的作用。方法 收集2016年7月-2020年7月首都医科大学附属复兴医院神经内科收治的发病5 d内的68例急性大面积缺血性脑卒中患者脑电图进行EEG分级判定,记录并使用格拉斯哥昏迷评分(glasgow coma scale, GCS)、美国国立卫生研究院卒中量表(NIH stroke scale, NIHSS)评分,随访至90 d进行格拉斯哥预后评分(glasgow outcome scale, GOS),并采用Logistic回归分析评估各项评分系统的预测价值。结果 本组患者的EEG分级标准与预后有显著相关性(P<0.01),EEG分级评分越高,患者的神经功能预后越差。Logistic回归分析显示EEG分级标准的转归良好及不良预测准确率、综合预测准确率最高。结论 脑电图分级标准在急性大面积缺血性脑卒中患者预后研究中能更客观地反映脑功能损伤的程度,可以作为发病早期预后评估的预测指标。     

基底动脉尖综合征的临床及影像学分析

目的探讨基底动脉尖综合征(TOBS)的临床特点及影像学特征。方法对20例TOBS患者的临床及影像资料进行回顾性分析。结果TOBS临床表现复杂多样,以不同程度的意识障碍、眼球运动障碍和瞳孔改变最常见,首发症状以眩晕和意识障碍多见。影像学重要特征是丘脑、小脑、中脑、枕叶、颞叶等梗死多见,双侧及幕上幕下同时受累。MRI较CT更敏感。结论基底动脉尖综合征有复杂多样的临床及影像学改变,治疗效果不佳,预后差。     

基底动脉尖综合征12例临床及影像学分析

目的:探讨基底动脉尖综合征的临床及影像学特征。方法:对12例基底动脉尖综合征患者的临床资料进行回顾性分析。结果:基底动脉尖综合征复杂多样,常见眩晕、意识障碍、肢体不全瘫痪及眼球运动障碍等。影像学特征常为双侧、幕上、幕下多发性病灶,多位于丘脑、中脑、小脑等。本病预后较差。结论:基底动脉尖综合征的诊断主要依据是临床及影像学表现,预后不佳。     

基底动脉尖综合征18例临床分析

目的 探讨基底动脉尖综合征的临床特点、影像学规律、治疗效果及预后等.方法 对18例基底动脉尖综合征患者的完整资料进行回顾性分析.结果 18例患者均急性起病,首发症状多样,以头晕、行走不稳多见,病情重,预后差,病死率高.MRI扫描显示脑干、大脑及小脑等多个部位出现长T1、长T2异常信号,MRA扫描显示基底动脉系统多个血管出现狭窄或闭塞.结论 基底动脉尖综合征是一种特殊类型的脑血管病,病情危重,预后差,应早期及时诊断治疗,提高病人的生存质量.     

NIHSS评分为0分的急性脑梗死患者的临床特点

目的探讨美国国立卫生研究院脑卒中量表（National Institutes of Health Stroke Scale Score,NIHSS）评分为0分而磁共振弥散加权像显示急性脑梗死病灶患者的临床特点。方法对经NIHSS评分为0分、磁共振弥散加权像显示急性脑梗死病灶的发病48h内住院患者的临床症状、体征、影像学特点进行分析。结果共纳入急性脑梗死患者35例,主要症状有头痛、眩晕、恶心呕吐、肢体麻木、肢体无力。磁共振弥散加权像上均显示急性前循环梗死2（）例（57．1％）,后循环梗死11例（31．4％）,前后循环脑梗死3例（8．6％o）。26例脑梗死患者显示单发梗死病灶（74．3％）,其中穿支动脉小梗死19例（54．3％）。结论青年型脑梗死以男性多见,高血压病在致病危险因素方面男女均占据主要地位,男性还应警惕嗜烟酒及糖尿病。在TOAST分型NIHSS评分为0分不代表无脑梗死发生,主要为单发穿支动脉小梗死病灶。NIHSS评分项目不能很好地评价后循环急性梗死所引起症状和体征。     

基底动脉尖综合征19例临床分析

目的探讨基底动脉尖综合征（TOBS）的病因、临床表现、影像学特点、治疗及预后。方法对我科近5a来收治的19例基底动脉尖患者进行回顾性分析。结果 TOBS的临床表现可同时有多部位梗死,头CT及MRI可见多个病灶,可同时分布在幕上和幕下,呈对称性或不对称性,MRA可显示多条血管狭窄或闭塞。19例患者中治愈6例,好转9例,植物生存1例,死亡3例。结论 TOBS临床表现复杂,MRI联合MRA检查对临床指导意义重大,病变累及的部位及血管越多,预后越差。     

急性基底动脉闭塞血管内治疗不良结局的影响因素分析

目的筛查急性基底动脉闭塞血管内支架取栓术后预后不良的危险因素,并评价4种影像学评分系统的预测价值。方法 2012年3月至2018年8月共57例急性基底动脉闭塞患者均行血管内支架取栓术,术前行DWI后循环Alberta脑卒中计划早期CT评分(pc-ASPECTS)、DWI脑干评分(BSS)、后循环CTA评分(pc-CTA)和基底动脉CTA评分(BATMAN),术后即刻采用脑梗死溶栓血流分级(TICI)评价血管再通,术后36 h内记录症状性颅内出血发生率,发病后3个月采用改良Rankin量表(mRS)评价预后。单因素和多因素Logistic回归分析筛查急性基底动脉闭塞血管内支架取栓术后预后不良的危险因素。绘制受试者工作特征曲线(ROC)并计算曲线下面积,评价DWI pc-ASPECTS、DWI BSS、pc-CTA和BATMAN评分的预测价值。结果57例患者中53例(92.98%)血管完全再通,2例(3.51%)部分再通,2例(3.51%)未再通;3例(5.26%)症状性颅内出血;22例(38.60%)预后良好、35例(61.40%)预后不良;14例(24.56%)死亡。Logistic回归分析,入院时高NIHSS评分(OR=0.879,95%CI:0.783～0.986;P=0.028)、高DWI BSS评分(OR=0.348,95%CI:0.177～0.683;P=0.002)和低BATMAN评分(OR=1.549,95%CI:1.019～2.353;P=0.040)是急性基底动脉闭塞血管内治疗后预后不良的危险因素。ROC曲线,DWI pc-ASPECTS、DWI BSS、pc-CTA和BATMAN评分曲线下面积分别为0.787(95%CI:0.658～0.884,P=0.000)、0.861(95%CI:0.744～0.938,P=0.000)、0.634(95%CI:0.496～0.757,P=0.091)和0.698(95%CI:0.562～0.813,P=0.012)。结论入院时高NIHSS评分、高DWI BSS评分和低BATMAN评分是急性基底动脉闭塞血管内治疗后预后不良的危险因素。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

Origins of the sympathetic innervation of the cervical end of the uterus in the rat

A retrograde neuronal tracer (Fast Blue) was injected in the cervical end of the uterine horn of virgin rats. The majority of the retrogradely labeled post-ganglionic sympathetic neurons were found in the sympathetic chain (74%). The superior mesenteric ganglia, inferior mesenteric ganglia and suprarenal ganglia accounted for 22, 3 and <1%, respectively. The distribution of neurons in the sympathetic chain labeled from the uterus resembles that described for other pelvic organs.     

Sexual pheromones and the evolution of the reward system of the brain: the chemosensory function of the amygdala

The amygdala of all tetrapod vertebrates receives direct projections from the main and accessory olfactory bulbs, and the strong similarities in the organization of these projections suggest that they have undergone a very conservative evolution. However, current ideas about the function of the amygdala do not pay sufficient attention to its chemosensory role, but only view it as the core of the emotional brain. In this study, we propose that both roles of the amygdala are intimately linked since the amygdala is actually involved in mediating emotional responses to chemical signals. The amygdala is the only structure in the brain receiving pheromonal information directly from the accessory olfactory bulbs and we have shown in mice that males emit sexual pheromones that are innately attractive for females. In fact, sexual pheromones can be used as unconditioned stimuli to induce a conditioned attraction to previously neutral odorants as well as a conditioned place preference. Therefore, sexual pheromones should be regarded as natural reinforcers. Behavioural and pharmacological studies (reviewed here) have shown that the females' innate preference for sexual pheromones is not affected by lesions of the dopaminergic cells of the ventral tegmental area, and that the systemic administration of dopamine antagonists do not alter neither the attraction nor the reinforcing effects of these pheromones. Anatomical studies have shown that the vomeronasal amygdala gives rise to important projections to the olfactory tubercle and the islands of Calleja, suggesting that these amygdalo-striatal pathways might be involved in the reinforcing value of sexual pheromones.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Topographical organization of the motoneuron pools that innervate the muscles of the pinna of the cat

The topographical organization of the 22 motoneuron pools that innervate the pinna muscles of the cat was examined by injecting the B-subunit of cholera toxin conjugated to horseradish peroxidase into individual muscles. All 22 pools are found in the facial nucleus, organized as rostro-caudally oriented columns, and arranged according to the action of the muscles they innervate. Pools innervating muscles that pull the pinna dorsally are located in the dorsal two thirds of the medio-dorsal subdivision, and those innervating muscles that pull the pinna ventrally are located in the ventral one half of the nucleus. Motoneurons innervating muscles that pull the pinna cranially are located laterally, those that pull the pinna caudally are located medio-ventrally, and those that change the shape of the pinna are located along the entire dorso-ventral extent in the center of the medio-dorsal subdivision. This topographical layout is consistent with the somatotopic organization of the entire facial nucleus as demonstrated in a variety of species. © 1995 Wiley-Liss, Inc.     

Histochemical methods for the further characterisation of the tumourettes of the posterior lobe of the pituitary

Summary The granular cell tumourettes of the posterior lobe of the pituitary possess neuraminic acid containing carbohydrate. After removal of neuraminic acid with neuraminidase and exposure to FITC (Fluorescein isothiocyanate) labelled peanut agglutinin (Arachis hypogaea) (PNA), intracellular receptor structures could be demonstrated. The significance of the findings is discussed.