抑郁症患者治疗前后性激素水平的变化及与临床特征的关系

目的　探讨抑郁症患者治疗前后性激素水平的变化及其与临床特征的关系。方法　用酶联免疫吸附法测定 30例抑郁症患者治疗前、后血清雌二醇、孕酮、睾酮水平 ,并与 30名正常对照比较 ,同时作相关分析。结果　男性和女性抑郁症患者血清雌二醇水平均显著低于正常对照 (t=- 4 2 4 5 ,P <0 0 1;t =- 4 342 ,P <0 0 1) ,雌二醇水平与HAMD分和HAMA分呈负相关 (r =- 0 5 0 4 ,P <0 0 1;r =- 0 389,P <0 0 5 )。男性患者的睾酮水平显著低于正常对照 (t=- 2 319,P <0 0 5 ) ,而女性患者的睾酮水平与正常对照无显著差异 (t=0 5 6 9,P >0 0 5 )。抑郁症患者的孕酮水平无显著变化 (P >0 0 5 )。帕罗西汀治疗后 ,雌二醇水平显著升高 (t =- 4 335 ,P <0 0 1;t =- 4 0 14 ,P <0 0 1) ,但仍低于正常对照 (t=- 2 4 99,P <0 0 5 ;t=- 2 4 4 6 ,P <0 0 5 ) ,男性患者的睾酮水平恢复正常 ,孕酮水平及女性患者的睾酮水平治疗前后无显著变化 (P >0 0 5 )。治疗有效者比疗效不佳者的雌二醇水平显著增高 (t=4 12 7,P <0 0 1)。结论　抑郁症患者存在性激素水平改变 ,治疗后性激素水平仍未完全恢复正常 ,患者病前雌二醇水平与HAMD和HAMA分呈负相关 ,与抗抑郁疗效呈正相关。     

重症肌无力患者甲状腺功能和甲状腺抗体情况的临床分析

目的　了解重症肌无力 ( MG)患者甲状腺功能及甲状腺抗体的情况。方法　回顾性分析了 2 67例临床确诊 MG患者的甲状腺素水平 ,对其中 2 64例患者检测了甲状腺球蛋白抗体 ( TGAb)和甲状腺过氧化物酶抗体( TPOAb)或甲状腺微粒体抗体 ( TMAb)。结果　 5 5例 ( 2 0 .6% )患者有甲状腺功能异常 ,48例 ( 1 8.2 % )至少有 1项上述抗体阳性。甲状腺功能异常的 MG患者中 , 、 、 型抗体阳性者较多 ( P <0 .0 1 )。甲状腺抗体阳性者较抗体阴性者 MG发病晚 ( P <0 .0 5 ) ;甲状腺抗体阴性 MG患者有甲状腺功能障碍者 MG发病早于功能正常组 ( P <0 .0 5 )。甲状腺功能异常、抗体阳性的 MG患者病程较抗体阴性者长 ( P <0 .0 5 ) ;甲状腺抗体阳性者伴发胸腺增生或胸腺瘤的几率明显增高 ( P <0 .0 5 )。结论　MG合并甲状腺功能异常并不少见 ,甲状腺抗体阳性、功能异常的 MG患者病程长 ,伴发胸腺增生或胸腺瘤的几率高 ,临床应予以重视。     

老年重症肌无力住院患者48例临床特点分析

目的分析老年重症肌无力(MG)住院患者的有关临床特点。方法回顾性分析近年来在我院住院诊治的48例老年MG患者的临床资料。结果老年MG患者占总住院MG病例数(175例)的比例为27.4%。男性多于女性,男∶女=2.7∶1。老年MG多在60~69岁之间发病,在其常见首发症状中,眼部症状最多,为34例(70.8%)、球麻痹其次,为8例(16.7%)、肢体肌无力5例(10.4%)、肌萎缩1例(2.1%)。老年MG患者中,全身型比例(70.8%)显著高于眼肌型(29.2%),较少合并自身免疫性疾病和发生危象,常合并胸腺病变(17例)及其他内外科疾病(36例),其中15例为胸腺瘤。伴胸腺病变的老年MG患者出现首发症状的年龄与无胸腺病变的老年MG患者比较差异无统计学意义;而伴胸腺病变的老年MG患者需住院治疗时的年龄显著小于无胸腺病变的老年MG患者,差异有统计学意义(P0.05)。结论老年MG具有其自身特点,男性多见,早期表现多为眼肌无力,全身型比例高于眼肌型,胸腺病变主要为胸腺瘤,危象发生率较低等临床特点。     

家族性重症肌无力临床特点及其与人类白细胞抗原DQA1基因多态性的相关性研究

目的探讨家族性重症肌无力(MG)的临床特点及其与人类白细胞抗原(HLA)DQA1基因多态性的相关性。方法对15例家族性、36例散发性MG患者的临床特点进行研究,并运用聚合酶链反应序列特异性引物(PCR SSP)对HLA DQA1基因多态性进行分型。结果与散发性MG相比,家族性MG患者发病年龄较早(两者分别为18 7、34 4岁,P=0 006),病情较轻,预后较好;与散发MG组及健康对照组比较,家族性MG患者的DQA1 0301基因频率增高(三者分别为40 0%、19 4%和20 2% ),差异有统计学意义(P<0 05),这种差异在眼肌型的患者中同样存在,但未发现患者性别与DQA1相关。结论家族性MG有其独特的临床特点,DQA1 0301是家族性尤其是眼肌型MG的易患基因,提示家族性MG与散发MG可能有着不同的免疫遗传机制。     

急性脑梗死患者血清性激素水平及凝血指标的观察

目的　探讨急性脑梗死 (ACI)患者血清性激素水平及凝血指标的变化。方法　应用酶联免疫吸附法、比色法、比浊法检测 116例老年ACI患者的血清雌二醇 (E2 )、睾酮 (Te)、E2 /Te、抗凝血酶 Ⅲ (AT Ⅲ )及纤维蛋白原 (FIB)的含量变化 ,并与 78例健康者作对照。结果　ACI组男性患者血清E2 、E2 /Te、FIB含量较对照组明显升高 (P <0 .0 1,P <0 .0 5 ,P <0 .0 5 ) ,而Te、AT Ⅲ含量较对照组降低 (均P <0 .0 5 ) ;ACI组女性患者血清E2 、Te、AT Ⅲ含量较对照组低 (P <0 .0 1,P <0 .0 5 ,P <0 .0 5 ) ,其中以E2 降低更为明显 ,而E2 /Te无显著性差异 (P >0 .0 5 )。FIB含量较对照组明显升高 (P <0 .0 5 )。结论　不同性别ACI患者存在不同性激素失衡 ,是ACI患者的危险因素之一     

老年起病型重症肌无力患者的临床特点

目的探讨老年起病型重症肌无力(MG)的临床特点。方法回顾性分析332例起病年龄≥65岁的MG患者的临床资料。结果该组MG患者男女比例为1.3∶1。全身型MG (GMG)和眼肌型MG(OMG)的比例为1.9∶1,OMG在男性多于女性而GMG在女性多于男性(P=0.033)。以OMG起病和以GMG起病的比例为1.5∶1,起病症状以眼睑下垂最多见占38.6%;在以OMG起病的患者中,女性患者转化为GMG的比率要明显高于男性患者(P=0.035)。病程中位数为3.7年,平均定量MG评分为7分。新斯的明试验阳性率为96.7%。低频重复频率电刺激波幅递减的总体发生率为48.2%,其中面神经的阳性率最高。MG合并胸腺异常的发生率为36.3%,以合并胸腺瘤者最多;胸腺瘤手术后病理分型以AB型最多,女性患者AB型胸腺瘤所占的比率要明显高于男性(P=0.048)。MG合并甲状腺功能异常的发生率为16%,以合并甲状腺功能亢进者最多。结论老年起病型MG患者GMG多于OMG、以OMG起病的女性患者转化为GMG的比率高于男性患者,胸腺瘤是最常见的胸腺异常且最常见的胸腺瘤病理分型为AB型。充分认识其临床特点有利于更好的治疗该类患者。     

重症肌无力合并甲状腺机能亢进的临床特点

目的　研究重症肌无力 (MG)合并甲状腺机能亢进 (甲亢 )的临床特点。方法　回顾性分析1983～ 2 0 0 2年我院神经科 2 831例MG中合并甲亢的 2 0 7例患者的临床资料。结果　MG合并甲亢的发病率为7 31% ,男女比例为 0 6 8∶1;<5 0岁发病 192例 (92 78% ) ,先有甲亢 114例 (5 5 0 7% ) ,MG眼肌型 134例(6 4 73% ) ,合并胸腺疾病 4 9例 (2 3 6 7% ) ,有明确诱因 2 7例 (13 0 4 % ) ;经肾上腺糖皮质激素及抗甲亢联合治疗 ,16 5例患者 (79 71% )的MG症状得到改善 ,6 1例 (36 97% )甲亢痊愈。结论　MG合并甲亢以女性较多 ,发病年龄集中在儿童及青壮年 ;MG以眼肌型多 ;甲亢多先于MG发生 ,肾上腺糖皮质激素与抗甲亢联合治疗效果较好。     

重症肌无力患者血清可溶性白细胞介素—2受体的研究

应用酶联免疫吸附法 ( ELISA)测定 4 7例重症肌无力 ( MG)患者和 2 2例健康对照者血清中可溶性白细胞介素 - 2受体 ( s IL- 2 R)水平 ,结果发现 MG患者血清 s IL- 2 R水平明显高于健康对照组 ( P<0 .0 0 5,P<0 .0 0 1) ,且各型之间亦具有显著性差异 ( P<0 .0 0 1)。病情越重 ,临床记分越高 ,s IL - 2 R水平越高 ;免疫抑制剂治疗后较治疗前明显下降 ,临床记分与 s IL - 2 R滴度呈正相关。认为对 MG患者血清 s IL -2 R的测定 ,有助于对该病进行动态观察 ,可作为判断病情的客观指标     

单中心超晚发型重症肌无力队列的临床特点及短期预后分析

目的 回顾性分析并总结单中心超晚发型重症肌无力(MG)的基线临床特点及短期预后情况。方法 纳入2019年1月1日至2021年8月1日复旦大学附属华山医院MG数据库中登记确诊的361例MG患者，收集MG患者的人口学(性别、年龄)资料、临床特点、合并慢性基础疾病、用药等基线资料及MG评分进行回顾性分析。MG相关评分包括MG日常生活质量量表(MG-ADL)，定量评分(MGFA-QMG)及MG生存质量(QoL-15)评分。根据发病年龄分为3组：早发型(18～49岁)组(172例)、晚发型(50～64岁)组(108例)及超晚发型(≥65岁)组(81例)。对超晚发型组的临床特点及短期预后进行统计学分析。结果 361例MG患者中，男女性别比为149∶212，平均年龄(49.89±15.7)岁。与早发型组比较，超晚发型组的基线临床特点：(1)两组均以女性为主，但超晚发型组中男性比例显著增高(P=0.000 1)；(2)合并甲状腺功能亢进患者比例显著降低(P=0.013)。与超晚发型组高龄匹配的临床基线特点包括：BMI增高(P=0.001 5)，高血压病(P<0.000 1)及糖尿病(P<0...     

以球麻痹起病的副肿瘤综合征

目的归纳总结以球麻痹起病的神经系统副肿瘤综合征(PNS)的临床特点及转归,为临床进一步认识PNS提供依据。方法回顾分析作者医院2010-2019年收治的以球麻痹起病的符合PNS诊断标准的患者,按照是否符合重症肌无力(MG)诊断标准,分为MG组及非MG组;比较两组间临床特征、实验室检查指标、治疗、预后的差别。结果收集随访PNS患者20例,其中MG组患者11例,平均发病年龄(39.0±14.0)岁,以女性为主〔8例(72.7%)〕;非MG组共9例,平均发病年龄为(60.0±15.0)岁,以男性为主〔8例(88.9%)〕;非MG组肿瘤标志物阳性率高于非MG组(18.1%比77.8%,P=0.031)。MG组均接受了外科干预治疗;两组中均有部分患者使用激素及(或)丙种球蛋白治疗,痊愈及好转患者比例差异无统计学意义(P>0.05)。MG组无死亡,非MG组死亡2例。结论在以球麻痹首发的PNS患者中,符合MG的患者女性多见,外科手术联合免疫抑制剂能显著改善患者预后,而不符合MG者以老年男性多见,肿瘤标志物阳性率更高,预后及死亡率更差。     

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.     

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.     

《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。     

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。