颞叶内侧癫癎发作期海马深部脑电图的特点

目的探讨颞叶内侧癫癎（medial temporal lobe epilepsy,MTLE）发作期海马深部脑电图的特点。方法回顾性分析记录双侧海马深部脑电图,行前颞叶切除术且长期预后良好的18例病人的临床资料,研究海马深部脑电图发作起源的波形特点和部位。结果发作期海马深部脑电图低幅快节律起源7例,棘（尖）波节律起源8例,高幅棘（尖）慢波起源占3例。起源点主要位于从海马头部向后3 cm之内的区域。结论低幅快节律、棘（尖）波节律是MTLE病人海马深部脑电图发作期的最主要两种波形。发作起源区主要位于海马前头部。     

癫(癎)发作同步记录脑电图非典型癫(癎)样病理波发放的临床意义

目的 观察癫(癎)发作时棘、尖样波群以外有别于背景波的θ、δ波在癫(癎)诊断中的价值,正确认识癫(癎)发作同步记录脑电图未见到尖、棘样典型病理波发放的临床意义.方法 对2000-01～2007-01我院收治的具有(癎)样发作患者203例的录像监测脑电图(video-EEG)进行回顾性分析.结果 脑电图正常16例(7.5%),临床发作与典型癫(癎)样病理波同步发放者157例(77.3%),临床发作与非典型癫(癎)样病理波同步发放者30例(15.2%),发作间歇期有癫(癎)样波发放者56例,发作间歇期可见不典型癫(癎)样波发放者36例.结论 正确识别棘、尖波群以外有别于背景波的癫(癎)样波的演变过程及规律,可提高癫(癎)的准确诊断率.     

脑电图与经颅多普勒在脑梗死后癫(癎)患者中的应用价值

目的探讨脑电图与经颅多普勒在脑梗死后癫癎中的应用价值。方法对48例脑梗死后癫癎患者行脑电图及经颅多普勒检查。结果48例患者中,脑电图异常44例,异常率91.7%,主要表现为慢波增多,出现棘波、尖波及棘慢波、尖慢波等;经颅多普勒异常42例,异常率85.7%,主要表现为频谱形态异常及血流增快及减慢等。结论脑电图是脑细胞功能的最直接反映,对预测癫癎发作及病情变化有重要价值。经颅多普勒可反映脑血管功能情况,出现脑供血不足、脑组织缺血缺氧时可致癫癎发作。     

动态脑电图对顽固性癫癎的术前定位应用

目的探讨术前动态脑电图(AEEG)对癫癎病人定位、定侧的应用价值。方法对45例顽因性癫痫手术病人的常规脑电图(REEC)、AEEG及皮质脑电网(ECoG)进行研究比较。结果癫癎病人AEEG与REEG的异常率比较(P=0．013)、癫癎病灶的术前定位准确率比较(P=0．015)、定侧准确率比较(P=0．003)均有统计学意义；AEEG与ECoG定位准确率比较(P=0．125)无统计学意义。结论癫癎外科术前AEEG定位准确率优于REEG，与ECoG比较也有一定优势。AEEG结合其他检查方法可以进一步提高癫痫病人术前定位、定侧的准确率。     

术中皮质电刺激联合皮质脑电图治疗功能区肿瘤继发性癫(癎)

目的 总结术中唤醒麻醉下,皮质电刺激(CS)联合皮质脑电图(ECoG)监测治疗功能区肿瘤继发癫(癎)的临床经验.方法 回顾性分析功能区28例胶质瘤及13例脑膜瘤继发癫(癎)病人的临床资料,采用唤醒麻醉下开颅,通过CS定位感觉、运动及语言区,ECoG定位致(癎)区,显微手术切除肿瘤及处理致(癎)灶.结果 术中CS定位功能区33例,阴性8例;ECoG发现致(癎)灶29例,无异常12例.胶质瘤全切21例,次全切7例;脑膜瘤全切12例,次全切1例.术后暂时性神经功能障碍加重或新发障碍25例,均于1个月内恢复.随访41例,时间6个月～5.5年.癫(癎)发作消失29例,明显减少12例.结论 唤醒麻醉下联合CS、ECoG治疗功能区肿瘤继发性癫(癎),能最大限度保护脑功能,安全处理致(癎)灶.     

抗癫癎药物性脑病

许多抗癫癎药物（AEDs）在治疗过程中均可诱发与治疗药物相关的脑病，此为中枢神经系统毒性作用，甚者可导致死亡。各种抗癫癎药物导致脑病的机制和临床表现各异，但其共同的特点表现为：（1）反应迟钝。（2）精神迟滞甚至恍惚。（3）意识障碍。（4）无诱发因素的癫癎发作显著增加。（5）脑电图背景活动变慢，棘波发放增多。     

靶控输注瑞芬太尼-丙泊酚麻醉在癫痫手术的应用效果及对皮质脑电监测的影响

目的比较不同麻醉方法在癫痫病灶切除术中的麻醉效果以及对术中皮质脑电监测(ECoG)的影响。方法 90例颞叶癫痫患者,随机分为3组,分别采用瑞芬太尼-丙泊酚靶控输注(TCI)全凭静脉麻醉(Ⅰ组)、全凭吸入七氟醚麻醉组(Ⅱ组)及静吸复合麻醉(Ⅲ组)。观察不同麻醉方法的麻醉效果,以及对皮质脑电(ECoG)监测定位的影响。结果 3组患者时点MAP、HR组间比较差异无统计学意义。组ⅠECoG可检测时间、自主呼吸恢复时间和术毕清醒时间均较组Ⅱ、组Ⅲ短,差异有统计学意义。组Ⅰ对ECoG影响不明显,而组ⅡECoG的棘波、α波、β波及δ波的每秒连续波形数多有明显减少,与组Ⅰ相比差异有统计学意义。与组Ⅰ相比,组Ⅲ患者ECoG的α波、β波的每秒连续波形数减少,差异有统计学意义。结论合适的靶浓度瑞芬太尼复合丙泊酚TCI是术中ECoG指导下癫痫病灶切除手术患者麻醉的良好选择。术中患者生命体征平稳,易于调控,不干扰ECoG的监测,术后清醒完全而迅速,对术后需要神经学检查的患者更有优势。     

口服胺对脑电图的作用

作者观察了①口服胳胺(tyramine)对癫癎病人脑电图的作用,偏头痛病人在摄入②巧克力和③β-苯乙胺(β-Phenylethlyamine)后的脑电图变化。研究设计用的是安慰剂双盲对照。 (1)共15例癫癎病人(8例原发性癫癎,6例颞叶癫癎和1例乍克森氏癫癎),在服盐酸胳胺125mg或安慰剂4～5小时后各记录脑电图一次,所得二份脑电图间有差异的共14例。在此14例中有11例服胳胺后的脑电图比对照更为异常(p<0.01),也就是说胳胺对这11例原先存在的脑电图异常有增强作用。这些作用在过度换气中和过度换气后更显著,以至局灶性尖波和非典型棘慢波综合发作以及阵发性慢活动变得更显著,特别在颞区。背景活动很少     

顽固性癫癎病人的术前综合评估(附40例报告)

目的探讨常规脑电图(REEG)、视频脑电图(VEEG)、MRI、SPECT检查对癫病人术前综合评估致灶定位的意义。方法对40例顽固性癫病人进行REEG、VEEG、MRI及SPECT检查,其中32例行手术治疗,术中行皮质电极(ECoG)和深部电极监测,同时对REEG、VEEG、MRI、SPECT定位致灶的情况进行对比研究。结果REEG异常40例,局灶棘波17例(42.5%);VEEG异常40例,局灶棘波35例(87.5%),两组局灶棘波检出率有显著性差异(P <0.01)。SPECT异常32例(80%),MRI异常31例(77.5%)。在32例手术病人中,VEEG与ECoG病灶一致者30例(93.7%),MRI与ECoG一致者27例(84.3%)。结论VEEG、MRI、EEG、SPECT检查结合临床表现,对顽固性癫病人术前致灶的定位和指导手术治疗有较大的应用价值。     

多处软膜下横纤维切断术联合其他术式治疗顽固性癫癎手术疗效分析

目的总结多处软膜下横纤维切断术(MST)联合其他术式治疗顽固性癫癎的手术经验.方法回顾性分析163例顽固性癫癎病人的临床资料.根据术前脑电图、单光子发射断层扫描(SPECT)、正电子发射断层扫描(PET)、CT及MRI检查,结合术中皮质电极脑电图探测结果,标出致癎灶地域图.在显微镜下先行脑结构性病灶切除.反复复查皮质脑电图,对周围和广泛性棘波发放区施行MST,直至皮质脑电图结果正常.结果术后疗效优(癫癎发作完全消失)52例(31.9%),良(偶有发作)83例(50.9%),中(发作频率减少50%)10例(6.1%),差15例(9.2%),无改善3例(1.9%);手术总有效率88.9%.结论采用MST联合其他术式治疗癫癎疗效较好,可提高病人的生活质量.     

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。     

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.     

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.     

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.     

《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。     

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。