脑脊液寡克隆区带在多发性硬化和视神经脊髓炎中的应用

目的探讨脑脊液寡克隆区带在多发性硬化和视神经脊髓炎2组疾病中的应用价值。方法通过等电聚焦电泳加免疫固定染色的实验室方法检测多发性硬化和视神经脊髓炎2组患者的脑脊液寡克隆区带,比较2组疾病的脑脊液寡克隆区带特点。结果多发性硬化患者共120例,其中脑脊液寡克隆区带阳性39例,阳性率为32.5%;视神经脊髓炎患者共45例,其中脑脊液寡克隆区带阳性4例,阳性率为8.9%。多发性硬化组脑脊液寡克隆区带阳性率明显高于视神经脊髓炎组,差异有统计学意义(P=0.002)。结论本结果对2组疾病的鉴别诊断具有一定的指导意义,且支持多发性硬化和视神经脊髓炎发病机制不同的观点。     

恩施土家族地区人群β-羟化酶基因多态性和吸烟在帕金森病中交互作用研究

目的探讨恩施土家族人群β-羟化酶基因(DβH)5Taq I多态性与帕金森病(PD)关联性及其与吸烟交互作用。方法采用多聚酶链反应-限制性片段长度多态性(PCR-RFLP),分析121例PD患者和129例正常对照β-羟化酶基因5Taq I基因型;非条件Logistic分析各基因型与发病中易感性关系以及与吸烟的交互作用。结果携带C(CC/CT)基因个体患病风险较非C基因携带者(TT)风险明显增加(OR=1.47,95%CI:1.25,2.91,P=0.000;校正OR=1.57,95%CI:1.35,2.97,P=0.000);非条件Logistic分析表明认携带CC/CT基因型吸烟个体PD罹患风险是携带TT基因非吸烟个体的3.41(OR=3.41,95%CI:2.12,4.71,P=0.000)(RERI=1.03,95%CI:0.79,2.25;API=0.36,95%CI:0.19,0.52;S=1.31,95%CI:1.08,2.17)。结论β-羟化酶基因5Taq I多态性增加恩施土家族地区PD罹患风险,且与吸烟在PD发病中存在协同效应。     

中枢神经系统炎性脱髓鞘病的诱发电位应用进展

正中枢神经系统炎性脱髓鞘病是在炎症基础上,一类免疫分子介导的髓鞘脱失而轴索相对保留的神经系统疾病。临床常见的有多发性硬化和视神经脊髓炎或视神经脊髓炎谱系疾病等。多发性硬化(multiple sclerosis,MS)为中枢神经系统广泛的白质脱髓鞘,累及大脑半球、小脑、脑干、脊髓和视神经等,表现为时间和空间的多发性,病程呈缓解复发。视神经脊髓炎(neuromyelitis optica,NMO)或视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder,NMOSD)主要表     

视神经脊髓炎研究发展史

19世纪中叶对视神经脊髓炎的认识是双侧同时发病的视神经炎和脊髓炎,而后续研究则发现两侧视神经炎呈先后发病,一般相隔数周、数月甚至数年。自2004年水通道蛋白4抗体被发现以来,"视神经脊髓炎"的概念遇到挑战并被修改。因此,2007年提出"视神经脊髓炎谱系疾病"的概念,并由此产生一系列不同命名,包括视神经脊髓型多发性硬化、视神经脊髓炎谱系疾病、视神经脊髓炎疾病谱系、视神经脊髓炎谱系、视神经脊髓炎扩展谱系等。笔者拟通过对不同时期"视神经脊髓炎"概念的回顾,对19~21世纪有关视神经脊髓炎研究的历史沿革进行全面复习,前瞻未来研究方向。     

CD4~-CD8~-双阴性T淋巴细胞在视神经脊髓炎谱系疾病与多发性硬化中的表达差异

目的对比分析视神经脊髓炎谱系疾病(NMOSDs)与多发性硬化患者急性期外周血CD4~-CD8~-双阴性T细胞(DNT)表达差异。方法纳入2017年1月至2019年12月诊断明确的NMOSDs(53例)和多发性硬化(20例)患者,以及性别、年龄相匹配的正常对照者(27例),流式细胞术测定外周血DNT细胞数目。结果 3组受试者外周血DNT细胞数目差异具有统计学意义(F=4.362,P=0.015),其中NMOSDs组DNT细胞数目分别高于正常对照组(t=2.415,P=0.023)和多发性硬化组(t=2.415,P=0.018),而多发性硬化组与正常对照组DNT细胞数目差异无统计学意义(t=0.149,P=0.881)。结论NMOSDs急性期患者外周血DNT细胞数目高于多发性硬化患者和正常对照者,推测DNT细胞可能参与NMOSDs的发病机制。     

视神经脊髓炎谱系疾病神经眼科表现

视神经脊髓炎谱系疾病包括经典视神经脊髓炎、视神经脊髓型多发性硬化、视神经脊髓炎限定型,以及伴系统性自身免疫性疾病或视神经脊髓炎特征性影像学表现的孤立性视神经炎或脊髓炎。其特征性神经眼科表现包括双侧同时或相继发生的视神经炎、视盘水肿和盘周渗出,视功能恢复差,对糖皮质激素有较好的反应性和依赖性。这些临床特征与水通道蛋白4抗体检测和头部MRI检查相结合,可为视神经脊髓炎谱系疾病与多发性硬化的早期鉴别诊断提供帮助。视神经脊髓炎谱系疾病可能出现某些特征性眼球运动异常,尚待进一步研究。     

视神经脊髓炎谱系疾病患者步态分析及跌倒风险评价

目的比较视神经脊髓炎谱系疾病患者与正常对照者的步态、平衡功能和行走能力,评价视神经脊髓炎谱系疾病患者的跌倒风险。方法共12例视神经脊髓炎谱系疾病患者和9例性别、年龄相匹配的正常对照者,采用德国Reha Watch步态分析系统测定步态周期参数(包括步频、步时、步长、步速、步行各时相对称性),Berg平衡量表(BBS)评价平衡功能,起立-行走计时测验(TUGT)、站起测验和走直线步态测验(TGT)评价行走能力。结果与正常对照者相比,视神经脊髓炎谱系疾病患者步态周期中步频减慢(t=-5.354,P=0.000)、步时延长(t=4.045,P=0.005)、步长减小(t=-7.243,P=0.000)、步速减慢(t=-10.161,P=0.000)、支撑相对称性(t=-2.220,P=0.050)和单脚支撑对称性(t=-2.359,P=0.020)降低,以及TUGT测验计时增加(t=3.197,P=0.024),TGT测验步数减少(Z=-1.544,P=0.049)。BBS量表中静态平衡相关项目(包括无支持站立、无靠背坐位等)评分较高比例明显高于动态平衡相关项目(包括站立位从地面捡起物品等)。结论视神经脊髓炎谱系疾病患者步态周期参数异常,平衡功能下降,尤以动态平衡显著,存在跌倒风险,可以通过增强下肢肌力和平衡功能等予以改善。     

视神经脊髓炎谱系疾病全身表现分析及其机制探讨

目的研究视神经脊髓炎谱系疾病合并中枢神经系统以外受累脏器或组织的免疫学改变。方法回顾分析56例视神经脊髓炎谱系疾病患者(视神经脊髓炎33例、非视神经脊髓炎23例)临床资料,逐一记录是否合并其他自身免疫性疾病,并行血清免疫学检测。结果视神经脊髓炎患者伴桥本甲状腺炎2例,以及系统性红斑狼疮和干燥综合征、哮喘、甲状腺功能亢进、风湿性关节炎和虹膜睫状体炎各1例。血清免疫学指标异常检出率较高者分别为甲状腺功能异常(10/17例)、抗核抗体阳性(14/28例)和补体C3阳性(8/19例),2例于分娩后发病。结论视神经脊髓炎谱系疾病患者可合并多种自身免疫性疾病,同时存在多种自身抗体,可能与视神经脊髓炎谱系疾病的发病有关。此外,妊娠期或分娩可能加重患者病情。     

视神经脊髓炎水通道蛋白4抗体分布特征及其与脑脊液寡克隆区带间关系的临床研究

目的观察视神经脊髓炎患者水通道蛋白4(AQP4)抗体在血清和脑脊液的分布特征,探讨血清AQP4抗体与脑脊液寡克隆区带之间的关系。方法采用酶联免疫吸附试验和间接免疫荧光法检测视神经脊髓炎和多发性硬化患者血清和脑脊液AQP4抗体,动态定时散射比浊法检测白蛋白和IgG,等电聚焦电泳联合免疫固定法检测脑脊液寡克隆区带,免疫印迹法检测寡克隆区带阳性视神经脊髓炎患者脑脊液电泳条带中AQP4抗体。结果视神经脊髓炎组患者血清AQP4抗体滴度[8.94(5.41,11.93)ng/ml]与多发性硬化组[7.34(4.76,12.00)ng/ml]相近(Z=-0.510,P=0.610),脑脊液AQP4抗体滴度[0.45(0.42,0.47)ng/ml]高于多发性硬化组[0.41(0.40,0.41)ng/ml;Z=-2.359,P=0.018],而且血清水平高于脑脊液(Z=-3.702,P=0.000)。视神经脊髓炎组患者脑脊液AQP4抗体阳性检出率高于多发性硬化组(5/7对1/5),但差异未达到统计学意义(Fisher确切概率法:P=0.242);复发期血清AQP4抗体滴度[8.54(5.32,11.42)ng/ml]与缓解期[9.97(5.41,13.28)ng/ml]相近(Z=-0.347,P=0.728);寡克隆区带阳性检出率低于多发性硬化组(3/13对10/14)且差异有统计学意义(Fisher确切概率法:P=0.021)。未在寡克隆区带阳性视神经脊髓炎患者的IgG电泳条带中检出AQP4抗体。结论视神经脊髓炎患者血清AQP4抗体滴度高于脑脊液,行脑脊液AQP4抗体检测具有一定临床意义。视神经脊髓炎患者鞘内合成IgG能力低于多发性硬化患者,且无针对AQP4抗原的成分。     

帕金森病与脑肿瘤发病风险的Meta分析

目的探讨帕金森病与脑肿瘤发病风险的相关性。方法以帕金森病,肿瘤和癌症,以及PD,Parkinson's disease,tumor,cancer,neoplasm等中英文检索词,计算机检索1965年1月-2016年7月美国国立医学图书馆生物医学信息检索系统、Web of Science、荷兰医学文摘、Cochrane图书馆,以及中国知网中国知识基础设施工程、万方数据库、维普数据库等数据库收录的关于帕金森病与脑肿瘤发病风险的前瞻性队列研究或病例对照研究,同时辅助手工检索,采用Newcastle-Ottawa量表和Stata 12.1软件进行文献质量评价和Meta分析。结果共获得1832篇文献,经剔除重复和不符合纳入标准者,最终纳入11项临床研究共350 632例帕金森病患者。Meta分析显示:帕金森病患者脑肿瘤发病风险高于健康人群(OR=1.370,95%CI:1.120~1.690;P=0.003),剔除2篇低质量文献后结论仍一致(OR=1.360,95%CI:1.080~1.720;P=0.008);根据发病顺序和地域分层分析,仅帕金森病后脑肿瘤发病风险高于健康人群(OR=1.430,95%CI:1.120~1.830;P=0.004),欧洲(OR=1.420,95%CI:1.290~1.560;P=0.000)和亚洲的中国台湾地区(OR=2.590,95%CI:1.730~3.880;P=0.000)帕金森病患者脑肿瘤发病风险均高于健康人群。漏斗图以及Begg法(P=0.583)和Egger法(P=0.985)证实发表偏倚较小。结论帕金森病患者脑肿瘤发病风险增加。     

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.     

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.     

《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。     

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.     

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。     

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。     

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.     

他汀类药物的使用和颅内动脉瘤破裂相关性分析

目的 探讨他汀类药物对颅内动脉瘤破裂的影响。方法 2010年3月至2014年3月收治颅内囊状动脉瘤67例,其中破裂者32例,未破裂者35例。采用多变量Logistic回归评估他汀类药物的使用和颅内动脉瘤破裂的关系。结果 破裂组术前使用他汀类药物4例（12.5%,4/32）,未破裂组16例（45.7%,16/35）。破裂组服用他汀类药物的百分比显著低于未破裂组（P<0.01）。纠正潜在的混杂干扰后（or值: 0.30,95%可信空间:0.12~="" 0.64）显示,颅内动脉瘤破裂与他汀类药物的使用呈显著负相关,也与高血清总胆固醇浓度有关。结论 本结果提示他汀类药物对颅内动脉瘤破裂有一定的预防效果。