应用脑磁图合成孔径磁场测定技术进行运动功能区和致痫灶定位的研究

目的利用脑磁图（MEG）的合成孔径磁场测定（SAM）技术对中央沟附近病变进行运动功能区和致痫灶定位研究,评估SAM技术在脑功能区病变和癫痫手术中的应用价值,明确MEG的空间定位优势。方法对12例中央沟附近病变（其中6例合并癫痫）的患者术前进行Karnofsky生活状态评分（KPS）,采用SAM技术确定颅内病变、运动功能区和致痫灶的位置关系,指导手术方案的制定。术中通过诱发电位监测和皮质及深部脑电监测,术后通过随访复测KPS评分和癫痫发作情况,明确SAM技术定位的准确性。结果本研究的12例患者运动诱发磁源成像均定位于中央前回附近,6例合并癫痫的患者致痫灶定位结果均与术中脑电图监测一致,所有患者根据SAM定位结果确定手术方案和指导手术进行。8例患者KPS评分改善,运动功能有所恢复;所有患者均没有额外的功能损害发生。6例癫痫患者中有5例癫痫控制良好,1例患者癫痫控制不佳。结论SAM技术可以对功能区和致痫灶进行精确定位,同时可以明确颅内病灶与功能区和致痫灶的位置关系,指导手术治疗方案,控制癫痫,减少术后残疾的发生率。     

ECOG评估PET对致痫灶定位的准确性

目的 :用皮层脑电(Electroencephalography,ECOG)评估 PET对致痫灶定位诊断的准确性。方法 :36例经CT和MR检查除外脑部肿瘤及脑血管畸形的癫痫病人 ,经正电子发射断层扫描(Positronemissiontomography,PET)检查定位后 ,进行颅骨钻孔 ,放置条状电极片 ,然后进行ECOG描记 ,评估PET对致痫灶定位诊断的准确性。结果 :PET对致痫灶定位诊断的准确率为93 %。结论 :PET是目前准确率较高的无创性致痫灶定位诊断方法     

术中皮层脑电监测对难治性癫痫致痫灶定位的价值

目的:探讨癫痫手术中皮层脑电图监测指导切除致痫灶的应用价值.方法:2007年3月至2010年8月期间36例难治性癫痫患者经严格术前评估后,开颅手术治疗.术中在EcoG引导下精确定位致痫灶,确定手术范围,手术切除病灶及其周围的致痫灶.结果:术后随访后随访12～ 449个月.根据Engel疗效分级标准进行疗效评价,Ⅰ级22例,Ⅱ级8例,Ⅲ级4例,Ⅳ级2例,有效率94.4％,显效率83.3％.结论:术中应用EcoG监测能大大提高致痫灶空间定位的准确性,有效地指导癫痫手术.EcoG在不同病理类型的致痫灶中的诊断价值不尽相同,皮质发育不良的术中EcoG应用前景广阔.     

难治性癫痫的外科诊疗进展

癫痫是由各种原因引起的脑神经元高度同步化异常放电所致的临床综合征,其患病率为0.8%~1.2%。30%~40%的癫痫患者呈药物难治性(规律使用一线抗癫痫药物2年仍不能充分控制癫痫发作),其中10%~50%该类患者可以选择癫痫手术治疗。癫痫手术旨在通过切除致痫灶控制癫痫发作,同时通过保留重要的大脑功能区域以避免神经心理和功能出现障碍。本文就难治性癫痫外科手术过程中的术前评估、致痫灶定位、手术方式的选择及手术预后等几个方面综述如下。     

术中皮层脑电图监测在癫痫外科手术中的临床应用

目的 探讨皮层脑电图(ECoG)监测在癫痫外科手术中的作用.方法 2007年12月至2008年6月期间,30例难治性癫痫患者在经过详细的术前评估后,进行了手术治疗,术中通过ECoG进一步精确定位致痫灶.结果 对30例患者手术前后ECoG进行了比较.手术前ECoG在致痫灶表面及其周围,均记录到分散的或密集的棘波、尖波、多棘波或棘慢综合波;致痫灶切除后,癫痫波消失者20例,有10例致痫灶周围仍有残余棘波发放,加用皮层热灼后,6例癫痫波消失;4例仍可见有少量棘波发放.随访12～18个月,28例癫痫得到有效控制,癫痫控制有效率达93.33%.结论 应用术中ECoG监测下手术切除致痫灶是一种治疗难治性癫痫的有效方法.     

脑电监测中癫痫发作的护理

目的 :为癫痫患者提供在脑电监测癫痫发作过程的安全护理 ,保证脑电监测质量 ,确定致痫灶 ,为手术提供准确定位。方法 :脑电监测前对患者进行心理评估 ,对患者应用抗癫痫药物进行干预 ,做好脑电监测过程中癫痫发作时各种抢救工作及护理安全措施。结果 :4 8例癫痫患者脑电监测癫痫发作、美解眠诱发癫痫发作 ,抢救工作准备充分 ,护理措施得当 ,监测医生和护士密切配合 ,既描记到致痫灶波形 ,又安全度过癫痫发作过程 ,无一例意外发生。结论 :脑电监测癫痫波形是确定致痫灶一种主要检查项目 ,是为选择手术方式提供科学依据的一种主要手段。在脑电监测患者癫痫发作期间 ,监测医生与护士进行密切配合 ,做好各项抢救及护理措施准备 ,是患者平安度过脑电监测癫痫发作期的重要保证。     

基于立体定向脑电图的电刺激在难治性癫痫评估中的临床应用进展

临床上对于需手术治疗的难治性癫痫，术前精确定位致痫灶是提高临床手术治疗成功率的关键。目前尽管采用电刺激方式定位致痫灶已经在国内外多个医学中心广泛开展，但对于颅内立体定向脑电图（stereoelectroencephalography, SEEG）的术前植入评估及电刺激诱发脑电活动的解读仍不够完善和严谨，尤其是电极植入模式、刺激参数设计以及手术预后相关性等方面仍存在诸多局限性和未知领域。该文围绕基于SEEG的立体电刺激诱发脑电活动在评估难治性癫痫领域中的临床背景、应用现状、技术进展及发展趋势进行了综述，着重阐述了该技术在临床致痫灶定位和大脑皮质功能评价2个方面的应用现状，以及电刺激过程中的安全性及高频/低频两类常用电刺激模式的特点。     

18F-FDG PET显像与EEG在颞叶癫痫致痫灶定位价值上的对比研究

目的：通过对62例难治性癫痫患者进行前瞻性研究,对18F-FDG PET显像与EEG在颞叶癫痫致痫灶定位上的价值进行对比研究。方法：对62例临床确诊颞叶癫痫并接受手术治疗的患者进行前瞻性研究。所有患者均进行发作间期PET-CT脑显像检查和长程/视频EEG检查,细致分析图像,并将所得检查结果与术后病理进行比较,利用统计学方法对二者的诊断准确率进行对比分析。结果：18F-FDG PET显像准确定位42例癫痫患者病灶位置,头皮EEG准确定位致痫灶30例,准确率分别为67.7%及48.4%,二者比较有显著统计学差异（P<0.05）。18F-FDG PET显像结果表现较多样,影像分析应细致、审慎。结论：发作间期PET-CT脑显像检查定位颞叶癫痫致痫灶优于长程/视频EEG检查,但因其价格较昂贵,临床可首选EEG定位癫痫,EEG定位困难时选择PET显像可明显提高致痫灶定位准确性。     

三步法定位并多术式联用显微外科手术治疗难治性癫痫

目的探讨难治性癫痫致痫灶定位和手术治疗方法。方法对81例难治性癫痫患者综合运用临床症状学、神经电生理、高场强MRI、PET/CT、术前及术中皮层及深部电极等三步法定位致痫灶,单纯病灶切除、病灶切除加胼胝体切开、病灶切除加软膜下横切、病灶切除加单脑回灰白质联合切除等多术式联用切除致痫灶和/或阻断传导通路。结果三步法致痫灶定侧准确率100%。多术式联用治疗后,满意31例,显著改善17例,良好16例,效差14例,无改善3例,总有效率79.0%。结论三步法可以对致痫灶精确定位,多术式联合处理致痫灶或/和传导通路可以取得良好的疗效。     

视频脑电监测顽固性癫痫患者癫痫发作的临床观察和护理对策

目的探讨为顽固性癫痫患者提供视频脑电监测过程的安全护理,保证脑电监测质量,明确病灶准确部位,为手术提供指导依据。方法在视频脑电监测前评估患者的心理状态,抗癫痫药物的应用,做好监测过程中癫痫发作时各项抢救及护理安全措施。结果所有脑电监测检查过程中预防性措施准备充分,护理得当,既描记到致痫灶波形,准确定位病灶部位,又使患者安全平稳度过癫痫发作期。所有病人无一例意外发生。结论视频脑电监测描记癫痫波形是确定致痫灶的一种主要检查项目,为选择手术方式提供科学依据。在脑电监测患者癫痫发作期间,做好各项抢救及护理措施准备是患者能够平安度过癫痫发作期的重要保证。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。