单侧空间忽视患者的线等分试验

单侧空间忽视常发生于脑损伤后,尤以卒中后的发生率较高,其对认知、注意、知觉等研究均具有较大意义,但目前国内相关研究较少.文章以线等分为主题,对单侧空间忽视检查中的影响因素以及相关机制、脑区定位、外延性研究进行了综述.     

缺血性脑血管病患者Stroop测验病例对照研究

目的 通过Stroop测验探讨缺血性脑血管病患者自动性加工、控制性加工、选择性注意功能的情况.方法 在124例年龄在60～90岁的缺血性脑血管病患者和126例年龄、文化程度与之相匹配的健康者中进行Stroop测验.通过对比两组人群Stroop测验各项指标,探讨缺血性脑血管病患者Stroop测验各指标的特点及与健康人群的区别.结果 两组比较,Stroop测验中卡片1的耗时数及卡片2、卡片4、字词反映干扰量(SIE)的耗时数及错误数的差异有统计学意义(均P＜0.05).结论 缺血性脑血管病患者的字词自动性加工能力无明显损害,而控制性加工能力及选择性注意能力受损.     

普渡钉板测验在帕金森病患者中的应用价值

目的探讨普渡钉板测验(PPT)在帕金森病(PD)患者中的应用价值。方法选择PD患者47例为PD组,社区健康者58例为对照组,对照组又分为55～69岁组28例和≥70岁组30例。入选者均行PPT并分析其与PD运动症状的相关性和诊断PD的准确性。结果与对照组比较,PD组PPT得分显著下降(P<0.01);≥70岁组较55～69岁组PPT得分显著下降(P<0.01)。对照组PPT得分与年龄呈负相关(P<0.01);55～69岁组女性单手PPT成绩优于男性(P<0.05)。PD组PPT得分与年龄无相关性,与统一PD评定量表运动评分呈负相关(P<0.01);55～69岁组PPT诊断PD敏感性82%～89%,特异性75%～100%,具有较高的诊断价值。结论 PPT指标可反映PD运动功能及疾病严重程度,对<70岁老年人具有较高的诊断敏感性和特异性。     

Item bias in the CAGE screening test for alcohol use disorders

Objective

To explore potential item bias in the CAGE questions (mnemonic for cut-down, annoyed, guilty, and eyeopener) when used to screen for alcohol use disorders in primary care patients.

Design and setting

Cross-sectional study, conducted in a university-based, family practice clinic, with the presence of an alcohol use disorder determined by structured diagnostic interview using the Alcohol Use Disorder and Associated Disabilities Interview Schedule.

Patients

A probability sample of 1,333 adult primary care patients, with oversampling of female and minority (African-American and Mexican-American) patients.

Main results

Unadjusted analyses showed marked differences in the sensitivity and specificity of each CAGE question against a lifetime alcohol use disorder, across patient subgroups. Women, Mexican-American patients, and patients with annual incomes above $40,000 were consistently less likely to endorse each CAGE question “yes”, after adjusting for the presence of an alcohol use disorder and pattern of alcohol consumption. In results from logistic regression analyses predicting an alcohol use disorder, cut-down was the only question retained in models for each of the subgroups. The guilty question did not contribute to the prediction of an alcohol use disorder; annoyed and eye-opener were inconsistent predictors.

Conclusions

Despite its many advantages, the CAGE questionnaire is an inconsistent indicator of alcohol use disorders when used with male and female primary care patients of varying racial and ethnic backgrounds. Gender and cultural differences in the consequences of drinking and perceptions of problem alcohol use may explain these effects. These biases suggest the CAGE is a poor “rule-out” screening test. Brief and unbiased screens for alcohol use disorders in primary care patients are needed.     

Swallowing in neurological outpatients: Use of a timed test

Swallowing was studied prospectively in a consecutive group of 90 neurology outpatients under 70 years of age. No patient had been referred primarily because of dysphagia. Patients were classified into four groups: those with (1) neurological or (2) non-neurological diagnoses possibly relevant to disordered swallowing, (3) functional disorders, and (4) definite diagnoses not likely to be relevant. They were defined as having abnormal or probably abnormal swallowing if two or more of the following were present: a complaint of swallowing problem, abnormal symptoms or signs, a slow swallowing speed (<10 ml.s^-1). Nineteen patients among the four groups (21%) were found to have abnormal/probably abnormal swallowing. Swallowing speed was significantly slower in patients who perceived a swallowing problem or who had abnormal symptoms or signs compared with those who did not, providing further evidence for the validity of a timed test of swallowing capacity. The study also provides evidence of a significant incidence of disordered swallowing in outpatients who may not have complained spontaneously but who have diagnoses potentially relevant to swallowing.     

Oral function test for monitoring suction and swallowing in the neurologic patient

Disturbances in swallowing are common in neurologic disease but difficult to evaluate in the clinical setting. Fundamental variables such as bolus volume, swallow capacity (volume ingested over time), and the relation between ingestion and time for important events in oral and pharyngeal swallowing have not been sufficiently studied. We therefore employed a composite method for monitoring oral and pharyngeal swallowing function: the test of Repetitive Oral Suction Swallow (the ROSS test). The technical details are described as well as preliminary results from a pilot study of 20 healthy subjects and 5 patients with neurologic swallowing impairment. The correlation with respect to time sequences for major events in bolus ingestion and oral processing as monitored by the ROSS test and by videoradiography is explained. With this simple and rapid bedside test, the immediate and long-time result of therapeutic interventions in dysphagic patients may be monitored.     

Spect-neuropsychology correlations in very mild Alzheimer's disease and amnesic mild cognitive impairment

BackgroundThe purpose of this study was to explore the clinical and brain functional abnormalities in patients with mild Alzheimer’s Disease (AD) and patients with amnesic Mild Cognitive Impairment (aMCI).Methodswe used resting spect-neuropsychology correlations method.ResultsWe found that parieto-temporal associative cortex, mainly involving the inferior parietal lobule, posterior cingulate and middle temporal gyrus, is compromised early in AD. These results suggest that the dysfunction in these areas contributes to cognitive decline in the storage of verbal information, drawing abilities and non-verbal abstract reasoning in AD. The aMCI group showed hypoperfusion primarily involving the frontal areas bilaterally, and this correlated with the impairment in free delayed recall on a verbal memory task.ConclusionOur results underlie the clinical differences between AD and aMCI patients that might reflect the involvement of different degenerative mechanisms in these groups.     

Tick–tock–tick–tock: the impact of circadian rhythm disorders on cardiovascular health and wellness

Humans spend a third of their lives asleep. A well–balanced synchrony between sleep and wakefulness is needed to maintain a healthy lifestyle. Optimal sleep is based on an individual's inherent sleep requirement and circadian rhythm. If either one or both of these critical elements are disrupted, daytime dysfunction, non–restorative sleep, and/or reduced sense of well-being may result. While the medical community is more familiar with sleep disorders such as sleep apnea, insomnia, and narcolepsy, circadian rhythm sleep wake disorders (CRSWDs) are less known, despite these being common within the general population. CRSWDs are comprised of the following: shiftwork disorder, delayed sleep phase disorder, advanced sleep phase disorder, jet lag disorder, non–24–hour sleep–wake disorder, and irregular sleep–wake rhythm disorder. In general, a CRSWD results when there is misalignment between the sleep pattern and the desired sleep schedule, dictated by work, family, and social schedules. Subsequently, patients have difficulty falling asleep, maintaining sleep, and/or experience poor quality sleep predisposing them to insomnia or excessive sleepiness. In this article, we review the core concepts related to sleep, and sleep deprivation in the context of CRSWDs.     

Anthropometric nutritional assessment is of value in colorectal patients

Eighty patients undergoing elective major colorectal surgery were nutritionally assessed using simple anthropometric methods and serum albumin. Although most of the patients were not malnourished, these tests were able to detect a small group of high-risk patients. Thirty major complications were recorded. The incidence of complications was 72 per cent in patients with low body weight, 69 per cent with low forearm muscle circumference, 55 per cent with recent weight loss, and 57 per cent with serum albumin below 35 g/l. Anthropometric tests were better in predicting postoperative complications than serum albumin. Of those patients who developed complications, 60 per cent had low grip strength, 37 percent weight loss, 37 per cent high malnutrition score, 33 per cent low body weight, and 27 per cent had lower serum album. Anthropometric tests were more sensitive and more accurate than serum albumin. Anthropometry has the additional advantages of being simple, noninvasive, and independent of laboratory facilities; it also provides instant bedside assessment.     

Acute childhood hemiplegia

A 10-year-old child presented to the emergency department with a sudden onset of right hemiparesis and dysphasia. A thorough evaluation, including CT scan of the brain and cerebral angiography, resulted in a diagnosis of acute childhood hemiplegia. The diagnosis of acute childhood hemiplegia depends on characteristic cerebral angiographic findings. The treatment of this particular entity is supportive, often with incomplete recovery.     

序列位置效应联合延迟回忆识别不同认知障碍水平患者的研究

目的 探索序列位置效应联合延迟回忆在区分不同认知障碍水平人群的诊断价值.方法 共纳入310例受试,其中认知正常(NC)组128例,轻度认知功能障碍(MCI)组133例,轻度阿尔茨海默病(AD)组49例.3组性别、年龄、受教育程度无显著性差异.所有受试进行成套神经心理学测验,使用听觉词语学习测验量表华山版(AVLT-H)...     

联合反应：评估脑卒中偏瘫患者运动功能的可靠、便捷检查

目的探讨联合反应与Brunnstrom分期之间的相关程度,量化分析脑卒中偏瘫患者联合反应的神经肌肉控制和运动的协调模式。方法54名脑卒中患者通过联合反应诱发患侧下肢的运动,实时采集双下肢臀中肌和内收肌的表面肌电信号,计算肌点积分值的拮抗比。结果随着Brurmstrom等级的升高,联合反应的强度逐渐减弱。脑卒中患者中的交互抑制机制受到抑制,主动肌和拮抗肌之间存在共同激活。Brunnstrom Ⅲ期～Ⅳ期患侧的拮抗比小于健侧（P〈0．05）,Brunnstrom Ⅴ期-Ⅵ期时健患侧拮抗比无差异。结论联合反应与Brunnstrom分期之间存在较好的一致性。脑卒中后患侧肢体主动肌运动神经元兴奋降低而拮抗肌运动神经元过度兴奋,是自主运动功能受损的可能原因。联合反应的神经肌肉控制是病理性的,交互抑制机制受到抑制,主动肌和拮抗肌之间存在共同激活,是脑卒中患者运动控制障碍的主要原因。联合反应是评估脑卒中偏瘫患者运动功能的可靠、便捷工具。     

Sideroblastic anemias: Variations on imprecision in diagnostic criteria,proposal for an extended classification of sideroblastic anemias

Sideroblastic anemias are caused by a diversity of hereditary, congenital, or acquired disorders. Criteria used in describing sideroblastic anemias vary widely among standard medical textbooks and even so have been imprecisely applied in the literature. Recent discoveries concerning the basic pathophysiologic mechanisms involving the molecular biology of nuclear and mitochondrial DNA, erythroid ALA synthase (ALAS-2), and iron transport have made the classification of sideroblastic anemias very complex. We recommend a more precise evaluation and documentation of the components that characterize the sideroblastic abnormality and propose an extended classification of the sideroblastic anemias. Am. J. Hematol. 57:1–6, 1998. © 1998 Wiley-Liss, Inc.     

急性脑血管病的多系统并发症

分析１８５例急性脑血管病的严重并发症，以探讨多脏器系统衰竭（ＭＯＳＦ）的临床特点。结果显示４７例无脏器系统衰竭，４７例为单脏器系统衰竭（ＳＯＳＦ），９１例为ＭＯＳＬ即有１３８例出现单或多个脏器系统衰竭（ＯＳＦ）。５０％病例发生脑疝及合并ＯＳＦ，其中合并单脏器系统衰竭（ＳＯＳＦ）者３９例，ＭＯＳＦ者５３例；有２５％病例死于ＯＳＦ而非脑疝，其中３８例为ＭＯＳＦ，８例为ＳＯＳＦ。好发生衰竭的脏器系统依次为胃＞代谢＞肺＞心＞肾＞血液。梗塞组和出血组的第１个脏器系统发生衰竭的平均时间分别为２４小时和１２．５小时；第２个脏器系统平均时间分别为４天和２４小时。ＯＳＦ的发生与性别、原患病及脑干受损有关，但与病灶大小、数量及血肿破入脑室无关。因此，脑原性多脏器系统衰竭存在独特的临床特点及发病机制。     

Gastrointestinal motility and neurogastroenterology

Abstract

Nordic research on gastrointestinal motility has since 1965 made substantial contributions to our current understanding of gastrointestinal function. During the last decade, the term neurogastroenterology has widened the concept of motility research into the study of gastrointestinal sensory-motor function, including the complex central nervous system interaction. The discovery of a non-adrenergic non-cholinergic (NANC) innervation of the gut in the sixties was made by considerable contributions from the Nordic countries with the Martinson group in Sweden as central innovators. Important discoveries regarding the intramural nerve ganglia as mediators of the autonomic nervous input has also been produced from this research. In clinical motility research, the study of the migrating motor complex in the small bowel has revealed its ability to act as a retroperistaltic pump in the proximal duodenum (Sweden) and its important role for gut microbial homeostasis (Norway). Also in the development of methodology to study gut sensory-motor function, the Nordic countries has contributed. Examples are the physical characteristics of the esophageal manometry catheter (Denmark), the use of ultrasound for assessment of gastric function (Norway), a temporary electrical stimulation method in patients with severe nausea and vomiting (Sweden), a rectal barostat method for clinical evaluation of recto-anal function and a colonic transit time method utilizing radio-opaque markers (Sweden). In later years, the research collaborations have increasingly become worldwide in a manner making it less easy to define pure Nordic contributions.     

How we treat paroxysmal nocturnal hemoglobinuria: A consensus statement of the Canadian PNH Network and review of the national registry

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disease characterized by intravascular hemolysis, thrombophilia, and marrow failure. Its phenotype is due to absent or reduced expression of GPI‐linked complement regulators and subsequent sensitivity of hematopoietic cells to complement‐mediated damage and lysis. Introduction of the terminal complement inhibitor eculizumab drastically improved outcomes in PNH patients; however, despite this improvement, there remain several challenges faced by PNH patients and physicians who care for them. One of the most important is increasing awareness of the heterogeneity with which patients can present, which can lead to significant delays in recognition. Data from the Canadian PNH Registry are presented to demonstrate the variety of presenting symptoms. In Canada, geography precludes consolidation of care to just a few centers, so management is distributed across academic hospitals, linked together as the Canadian PNH Network. The Network over the last several years has developed educational programs and clinical checklists and has worked to standardize access to diagnostics across the country. Herein, we address some of the common diagnostic and therapeutic challenges faced by PNH physicians and give our recommendations. Gaps in knowledge are also addressed, and where appropriate, consensus opinion is provided.