强迫症患者听觉事件相关电位P300的研究

目的 探讨听觉事件相关电位（ERP） P300与强迫症患者各项指标的相关性.方法 将63例强迫症患者作为研究组,选取63名身心健康正常人为对照组,采用自制的一般状况调查表了解两组人员的基本情况,对两组人员分别进行事件相关电位P300的检测,对强迫症患者采用耶鲁布朗强迫症量表评估其病情.结果 研究组ERP各项指标中N2、P3潜伏期长于对照组（t分别为-1.568,-2.602;P＜0.05）,N1、P2、N2、P3波幅均小于对照组（t分别为2.505,2.646,3.029,4.904;P＜0.05）.强迫思维组N2、P3潜伏期长于强迫行为组（t分别为3.301,2.580;P＜0.05）,P3波幅低于强迫行为组（t=-5.240,P＜0.01）.经相关分析显示事件相关电位P300的P3波幅与强迫思维分及强迫行为分呈负相关（r分别为-0.384,-0.512;P＜0.05）,N2和P3潜伏期均与强迫思维分呈正相关（r分别为0.448,0.405;P＜0.05）.结论 听觉事件相关电位P300可以客观反映强迫症的认知功能.     

抑郁障碍的事件相关脑电位研究新进展

本文综述了抑郁障碍患者的事件相关电位各成分包括P300、关联性负变（CNV）、失匹配负波（MMN）和听觉门控诱发电位P50的特点以及最新的一些进展。     

精神分裂症干预前后事件相关电位（P300）分析

近年来精神分裂症患者的认知功能损害问题日益受到重视，成为精神分裂症患者康复中亟待解决的问题［1］，特别是缺乏一个客观稳定的评价指标。事件相关电位（ERP ）是一种长潜伏期脑诱发电位，是受试者在注意到某个个体并对其进行认知加工时出现的电位变化，过程涉及人的注意、记忆、学习、推理、思维判断、情绪等，其中P300是最早发现的事件相关电位的内源性成分，目前已被作为评价认知功能损害的一个客观电生理指标。为此我们借助这一技术，对精神分裂症患者干预前后的事件相关电位（P300）变化进行研究，现将结果报告如下。     

帕金森病患者的事件相关电位研究

为探讨帕金森病（PD）患者认识功能障碍的电生理改变，分别对32例PD非痴呆患者，30例PD痴呆患者及28例健康人的事件相关电位（ERP）进行了分析。结果显示PD痴呆患者N2，P3潜伏期明显延长（P＜0．05），P3。潜伏期与其简易精神状态量表评分存在显著位负相关（P＜0．05）．另外，0对PD痴呆患者ERP及CT的对比研究表明，PD痴呆患者ERP阳性检出率高于CT。认为ERP能客观地反映出PD痴呆患者认知功能的损害．     

事件相关电位研究新进展——失匹配负波

关于经典事件相关电位(cognitive evoked potential)的关联性负变(contingent negative variation, CNV)和P300已有介绍.现再介绍事件相关电位领域的一项新指标--失匹配负波(mismatch negativity, MMN).     

婴儿痉挛症的听觉事件相关电位的初步研究

本文首次采用听觉事件相关电位(ERP)技术,对23名婴儿痉挛症患儿和21名正常儿童进行了初步研究,证实患儿P300潜伏期与DQ的负相关性,从神经电生理角度论证了婴儿痉挛症发病的年龄依附性,以及其脑功能的迟滞和无序性。提出听觉ERP是一种有发展前途的技术,有希望用于婴儿痉挛症智能发育障碍程度的客观评价。     

事件相关电位和脑电图在痴呆早期诊断中的意义

目的 研究血管性痴呆（vascular dementia,VD）患者ERP和EEG的变化特征,并与神经心理学及痴呆程度进行相关性分析。方法 测定68例VD患者及37例健康志愿者的事件相关电位（ERP：N100,P300）、脑电图（EEG）,同时采用MMSE进行认知功能评定,并进行相关性分析。结果 68例VD组患者的P300潜伏期明显延长,波幅明显降低,与正常对照组比较有明显差异性（P〈0.01,P〈0.05）,N100潜伏期。波幅变化不是很大（P〉0.05）,脑电图异常率,VD组94%,正常对照组18%,2组比较有明显差异性（P〈0.01）。VD组患者ERP异常程度与EEG异常程度经相关性分析无相关性。VD组MMSE与正常对照组比较有明显差异（P〈0.05）,VD组MMSE评分与P300PL呈负相关（r=-0.57,P〈0.05）,与P300AMP呈正相关（r=0.37,P〉0.05）。结论 ERP与认知功能存在明显相关性,提示了ERP是反映其认知功能障碍程度的客观指标之一,可作为检测高危人群普查的手段之一,ERP在判断认知功能方面敏感于其他检查手段,客观性强。     

多发性硬化患者的抑郁情绪及其事件相关电位研究

目的探讨多发性硬化（MS）患者的抑郁情绪和事件相关电位（ERP）特征,为多发性硬化的病情判定寻找更多的依据。方法对63例多发性硬化患者和60例正常对照分别进行了抑郁量表（HAMD）评定和ERP测定,并将结果加以比较。结果MS组中ERP测定的异常率为85．7％（54／63）,ERP中N2、P3波潜伏期较对照组延长,P3波幅降低,差异具有统计学意义（P〈0．01）;HAMD评定中躯体化、体质量变化、认知障碍、昼夜变化、迟缓、睡眠及绝望感等因子分和总分值与对照组相比,差异具统计学意义（P〈0．01）。ERP成分中P3波潜伏期与HAMD评定中躯体化、体质量变化、认知障碍、昼夜变化、迟缓、睡眠及绝望感等因子分呈呈正相关（r＝0．32～0．48,P〈0．01）,而P3波幅与其呈负相关（r=-0．29～-0．42,P〈0．01）。结论MS患者的抑郁情绪及认知障碍明显,ERP测定可作为MS患者认知功能的判定指标应用于临床。     

立体定向手术对精神分裂症患者事件相关电位的影响

目的：探讨脑立体定向手术对军人慢性难治性精神分裂症患者3种事件相关电位的影响。方法：以40例难治性精神分裂症患者为手术组，43例条件相匹配的非手术患者为对照组。在脑立体定向手术治疗前、后，对两组患者分别进行事件相关电位N400（N400）、失配性负波（MMN）和关联性负变（CNV）检查，以阳性与阴性症状量表（PANSS）评定疗效。结果：与治疗前比较，手术组CNV潜伏期M1缩短，命令信号后负变化（PINV）出现率下降，N400潜伏期缩短（P均〈0．05），MMN各指标变化不明显；手术组PANSS总分及各因子（除阴性症状因子）分均明显下降（P〈0．05或P〈0．01）；对照组N400、MMN、CNV和PANSS各项指标变化不明显。治疗后两组比较差异有显著性（P〈0．05）。结论：立体定向手术改善了军人慢性难治性精神分裂症患者的认知功能和精神症状。     

汉、维吾尔族神经症患者视觉事件相关电位P300对比研究

目的：探讨汉族与维吾尔族神经症患者视觉事件相关电位P300的异同。方法：选97例神经症患者作为神经症组（汉族48例,维族49例）,99例健康者作为对照组（汉族45例,维族47例）,对所有入组者均进行视觉事件相关电位P300检测并比较。结果：两组中汉族和维吾尔族神经症患者的靶N2潜伏期、靶P3潜伏期及波幅、非靶P2波幅差异均无统计学意义（P均〉0.05）;与正常对照组比较,汉族与维吾尔族神经症患者的靶N2潜伏期均延长（P均〈0.05）,靶P3潜伏期均延长且波幅降低（P均〈0.05）,非靶P2波幅均降低（P〈0.05）。结论：汉族与维吾尔族神经症患者的视觉事件相关电位P300差异无统计学意义;神经症患者的视觉事件相关电位P300有多项指标变化。     

Environmental factors in the development and progression of late-onset Alzheimer＇s disease

Late-onset Alzheimer＇s disease （LOAD） is an age-related neurodegenerative disorder characterized by gradual loss of synapses and neurons, but its pathogenesis remains to be clarified. Neurons live in an environment constituted by neurons themselves and glial cells. In this review, we propose that the neuronal degeneration in the AD brain is partially caused by diverse environmental factors. We first discuss various environmental stresses and the corresponding responses at different levels. Then we propose some mechanisms underlying the specific pathological changes, in particular, hypothalamic-pituitary adrenal axis dysfunction at the systemic level; cerebrovascular dysfunction, metal toxicity, glial activation, and Aβ toxicity at the intercellular level; and kinase-phosphatase imbalance and epigenetic modification at the intracellular level. Finally, we discuss the possibility of developing new strategies for the prevention and treatment of LOAD from the perspective of environmental stress. We conclude that environmental factors play a significant role in the development of LOAD through multiple pathological mechanisms.     

Disrupted structural and functional brain connectomes in mild cognitive impairment and Alzheimer＇s disease

Alzheimer＇s disease （AD） is the most common type of dementia, comprising an estimated 60-80% of all dementia cases. It is clinically characterized by impairments of memory and other cognitive functions. Previous studies have demonstrated that these impairments are associated with abnormal structural and functional connections among brain regions, leading to a disconnection concept of AD. With the advent of a combination of non-invasive neuroimaging （structural magnetic resonance imaging （MRI）, diffusion MRI, and functional MRI） and neurophysiological techniques （electroencephalography and magnetoencephaJography） with graph theoretical analysis, recent studies have shown that patients with AD and mild cognitive impairment （MCI）, the prodromal stage of AD, exhibit disrupted topological organization in large-scale brain networks （i.e., connectomics） and that this disruption is significantly correlated with the decline of cognitive functions. In this review, we summarize the recent progress of brain connectomics in AD and MCI, focusing on the changes in the topological organization of large-scale structural and functional brain networks using graph theoretical approaches. Based on the two different perspectives of information segregation and integration, the literature reviewed here suggests that AD and MCI are associated with disrupted segregation and integration in brain networks. Thus, these connectomics studies open up a new window for understanding the pathophysiological mechanisms of AD and demonstrate the potential to uncover imaging biomarkers for clinical diagnosis and treatment evaluation for this disease.     

高血压脑出血的显微外科治疗进展

高血压脑出血（Hypertensive intrac-rebral hemorrhage,HICH）是具有高发病率、高病死率、高致残率的急性脑血管疾病,占所有脑卒中患者的10%-20%,早期病死率可高达49.4%。随着人口老龄化,其发病率逐年提高;而外科手术的干预,使其病死率有所下降,但致残率居高不下。如何提高手术疗效和患者生存质量,一直是神经外科医师努力的方向。微侵袭血肿清除术因其手术创伤小,恢复快,是目前国内治疗高血压脑出血的重要手段。     

Edema and neuronal apoptosis in the hippocampus and cortex of elderly rats following transient cerebral ischemia/reperfusion injury

BACKGROUND： Previous studies of cerebral ischemia have used young animals, with an ischemic time greater than 5 minutes （safe time limit）. Despite an increased understanding of neuronal apoptosis, it remains uncertain whether brief cerebral ischemic events of 5 minutes or less damage brain tissue in elderly rodents. OBJECTIVE： To investigate the effects of transient cerebral ischemia （5 minutes）/reperfusion injury on brain cortical and hippocampal edema, aquaporin-4 （AQP-4） expression, and neuronal apoptosis in aged rats, and to compare ischemic sensitivity between cortex and hippocampus. DESIGN, TIME AND SETTING： A randomized, controlled, animal experiment was performed at the Institute of Cerebrovascular Disease, Qingdao University Medical School from April 2008 to March 2009. MATERIALS： Rabbit anti-AQP-4 polyclonal antibody, TUNEL kit, and SABC immunohistochemistry kit were purchased from Wuhan Boster Bioengineering, China. METHODS： A total of 160 healthy, male, aged 19-21 months, Wistar rats were randomly assigned to 4 groups： sham-surgery, and ischemia 1-, 3-, and 5-minute groups, with 40 rats in each group. The global cerebral ischemia model was established using the Pusinelli four-vessel occlusion, and the three cerebral ischemia groups were subdivided into reperfusion 12-hour, 1-, 2-, 3-, and 7-day subgroups, with 8 rats in each subgroup. The sham-surgery group was subjected to exposure of the first cervical bilateral alar foramina and bilateral common carotid arteries. MAIN OUTCOME MEASURES： The dry-wet weight assay was used to measure brain water content and histopathology of the cortex and hippocampus was observed following hematoxylin-eosin staining. In addition, cortical and hippocampal AQP-4 expression was detected by streptavidin-biotin complex immunohistochemistry, and neuronal apoptosis was detected by the TUNEL method. RESULTS： There was no significant difference in brain water content or AQP-4 expression in the cortex and hippocampus between ischemia 1- and 3-minute groups and the sham-surgery group or brain water content or AQP-4 expression in the cortex between ischemia 5-minute group and sham-surgery group （P 〉 0.05）. However, brain water content and AQP-4 expression in the hippocampus after 5 minutes of cerebral ischemia were significantly increased compared with the sham-surgery group （P 〈 0.05 or P 〈 0.01）. Several TUNEL-positive cells were observed in the cortex and hippocampus of the sham-surgery group and ischemia 1-minute group, as well as in the cortex of the ischemia 3-minute group. In addition, the number of apoptotic neurons in the hippocampus of ischemia 3-minute group and in the cortex and hippocampus of ischemia 5-minute group was significantly increased （P 〈 0.05 or P 〈 0.01 ）. Neuronal apoptosis was increased after 12 hours of ischemia/reperfusion, and it reached a peak by 2 days （P 〈 0.01）. CONCLUSION： Transient cerebral ischemia （5 minutes） resulted in increased hippocampal edema, AQP-4 expression, and neuronal apoptosis. Moreover, cerebral ischemia had a greater effect on neuronal apoptosis than brain edema or AQP-4 expression, and the hippocampus was more sensitive than the cortex.     

雷公藤内酯对癫痫大鼠神经元P13K／Akt／mTOR蛋白的影响

目的通过检测癫痫大鼠海马神经元P13K、Akt和mTOR蛋白表达,探讨雷公藤内酯抑制癫痫大鼠神经元凋亡的分子机制。方法30只大鼠随机分为对照组、海人酸组、雷公藤内酯干预组,免疫组化法检测各组大鼠海马神经元P13K、Akt和mTOR蛋白的表达情况。结果海人酸组神经元胞体皱缩,形态不规则,数量减少,而雷公藤内酯干预组神经元的数量和形态与对照组相似,海人酸组海马神经元P13K、Akt、ITITOR蛋白表达与对照组比较均减少,而雷公藤内酯干预组海马神经元的P13K、Akt、mTOR蛋白表达均较海人酸组增加,差异均有统计学意义（P〈0．05）。结论雷公藤内酯可能通过上调P13K／Akt／mTOR信号通路蛋白表达对癫痫大鼠海马神经元发挥保护作用。     

神经内镜联合亚低温治疗高血压基底节区脑出血

目的 探讨神经内镜联合亚低温在治疗高血压基底节区脑出血中的临床应用价值.方法 回顾性分析我院神经内镜治疗高血压基底节区脑出血患者40例的临床资料,并对治疗结果进行分析.结果 神经内镜治疗组22例(甲组),神经内镜联合亚低温治疗组18例(乙组),术后3个月根据GCS评分,甲组恢复良好1例,中残4例,重残6例,植物生存6例,死亡5例;乙组恢复良好4例,中残8例,重残3例,植物生存1例,死亡2例,两组比较差异有统计学意义(P＜0.05).两组颅内压比较第1天两者差异不明显,但第2、3天亚低温组颅内压明显降低.结论 神经内镜是治疗高血压基底节区脑出血较为有效的手术方式,联合亚低温治疗能有效降低颅内压,改善术后神经功能恢复,具有较好的临床应用价值.     

1例痰瘀同治精神疾患临床心得

现代医学把精神分裂症分若干类：狂躁型、忧郁型、强迫型、青春型、痴呆型等,西医一直把治疗精神分裂症的重点放在大脑的治疗上。我的经验是：痰和瘀血是精神分裂症的非常重要的原因,特别是肝、心、头部及其经络的痰和瘀血是关键。笔者治愈1例报道如下。     

心理干预对恶性肿瘤患者疼痛及焦虑抑郁状态的影响

目的 心理干预对恶性肿瘤患者疼痛及焦虑抑郁状态的影响.方法 将85例伴有疼痛的恶性肿瘤患者随机分为对照组42例和观察组43例,对照组给予三阶梯止痛治疗,观察组在给予三阶梯治疗的基础上对患者进行心理干预,采用问卷调查方式进行焦虑自评量表(SAS),抑郁自评量表( SDS)的评定.结果 伴有疼痛的恶性肿瘤病人存在着相当严重程度的焦虑/抑郁情绪,观察组疼痛治疗效果及焦虑抑郁状态均好于对照组,两组差异有统计学意义(P＜0.05).结论 伴有疼痛的恶性肿瘤患者普遍存在抑郁焦虑的心理问题,并且随着癌痛程度加重而加重,心理干预不仅对改善疼痛有着重要的作用;而且能够改善恶性肿瘤患者焦虑抑郁的心理状态,提高患者生活质量.