102例大型听神经瘤的手术治疗

目的：总结102例大型听神经瘤手术切除的体会，以提高此类肿瘤的手术治疗效果。方法：采用一侧枕下乙状窦后入路切除肿瘤，其中64例采用超声吸引和显微手术治疗。结果：94例（92．2％）肿瘤获全切除。面神经解剖保留87例（85．3％），根据House-Brackmann面神经功能分级标准，I－Ⅱ级47例（54．1％），Ⅲ-Ⅳ级35例（40．2％），Ⅴ-Ⅵ级5例（5．7％）。结论：采用显微手术技术，绝大多数听神经瘤均可在保留面神经解剖完整的前提下获得手术全切除。     

大型听神经瘤的显微外科治疗

目的探讨听神经瘤显微手术方法,提高肿瘤全切除率及面神经解剖和功能保留率。方法回顾我科2003-08～2009—08经枕下乙状窦后入路显微手术切除的41例大型听神经瘤患者的临床资料,结合文献进行总结探讨。2005—04—29后,对27例行术中面神经电生理监测。结果41例病例中镜下肿瘤全切除37例（92％）,次全切除4例（9．8％）。面神经解剖保留36例（87．8％）,5例（13．2％）未能解剖保留面神经。无手术死亡病例,随诊3个月～6年,术后病人均能恢复正常生活,遗留永久性面瘫5例。结论经枕下乙状窦后人路采用显微技术切除大型听神经瘤,能明显提高手术全切率及面神经保存率。     

听神经瘤的显微外科治疗和面神经功能保护的探讨

目的 探讨听神经瘤的显微外科手术技巧及保留面神经的技术。 方法 福建医科大学附属第一医院神经外科自2002年8月至2010年12月经枕下乙状窦后（骨瓣成型、锁孔）入路显微手术治疗听神经瘤患者168例,术中在面肌肌电图监测下采取囊内切除与囊壁切除交替进行、双向会合、锐性分离面神经等技术切除肿瘤,并回顾性分析显微手术的技巧和疗效。 结果 肿瘤全切149例(88.69％),部分切除19例(11.31％);面神经解剖学保留146例(86.9％);死亡2例(1.19％)。术后6个月按House Blackmann标准评估面神经功能：Ⅰ、Ⅱ级91例(54.16％),Ⅲ、Ⅳ级52例(30.95％),Ⅴ、Ⅵ级25例(14.89％)。 结论 经枕下乙状窦后（骨瓣成型、锁孔）入路显微手术治疗听神经瘤安全有效;利用术中面肌肌电图监测可以提高面神经解剖保留率;熟练掌握显微手术技巧是全切肿瘤、解剖保留面神经的关键。     

大型听神经瘤的显微外科手术切除

目的 总结64例大型听神经瘤显微外科手术的体会,探讨面、听神经功能保留的可能性和可行性。方法 59例采用单侧枕下入路,5例巨大型累及岩尖斜坡采用经岩入路,所有病例均采用显微外科技术行肿瘤切除术。结果 肿瘤全切除56例（88％）,次全切除7例,大部切除1例。面神经解剖保留57例（89％）,功能保留43例（67％）。术前尚有听力22例,术后听力保存6例（27％）手术,死亡1例（1．5％）。结论 大部分大型听神经瘤采用显微外科技术可行Ⅰ期全切除和面神经的保留,强调保护桥脑腹外侧静脉丛和小脑前下动脉的重要性。对大型听神经瘤亦应争取面神经和听力的保留。     

大型听神经瘤的显微手术治疗

目的 探讨显微手术切除大型听神经瘤的入路和方法。方法 经枕下入路显微手术切除大型听神经瘤226例,其中锁孔手术93例。结果 肿瘤全切除193例,次全切除33例。术后死亡1例。术后出现肿瘤部位血肿4例。术中面神经解剖保留205例。177例出院后随访2月~13年,面神经House-Brachmann分级Ⅰ~Ⅲ级143例,Ⅲ级以上34例。结论 枕下入路是显微手术切除大型听神经瘤的有效入路,并能较好地保留面神经功能;强调术中监测,仔细、耐心操作以便保留面神经的功能;当肿瘤与面神经或脑干粘连紧时勿强求肿瘤全切;锁孔手术完全可以达到切除大型听神经瘤要求,损伤小。     

大型听神经瘤的显微手术治疗与面神经保护

目的探讨大型听神经瘤的显微手术治疗及面神经的保护。方法54例大型听神经瘤（直径＞3cm）患者,均在面神经及脑干电生理监测下采用枕下乙状窦后入路显微手术切除,术中采用长＂S＂形或直形切口,开枕骨骨瓣直径约4cm,显露横窦和乙状窦,放出枕大池脑脊液,再行显微镜下分离及切除肿瘤,术后对其面神经功能进行随防。结果全切49例（91%）,近全切5例,面神经保留51例,保留率为94%,无死亡病例。结论显微手术与面神经的电生理监测是大型听神经瘤得以全切并保留面神经的关键,扎实的显微解剖知识、娴熟的显微手术技巧及完善的手术中监测是手术成功的保障。     

大型听神经瘤手术治疗策略

目的 总结211例大型听神经瘤手术治疗效果,探讨大型听神经瘤手术治疗策略。方法 211例大型听神经瘤采用枕下乙状窦后经内听道入路,在面神经监护下行显微手术切除肿瘤,术后随访时间3个月至5年。结果 肿瘤全切196例(93％);近全切除7例(3.3％);大部切除8例(4％)。面神经解剖保留192例(91％)。结论 大型听神经瘤手术治疗是首选的治疗方法,术中面神经监护对保留面神经完整性非常重要。     

听神经瘤手术内听道处理及面听神经保护

目的探讨听神经瘤手术内听道内肿瘤的处理方法,并对显微解剖保留面神经的手术经验和技巧进行讨论,以提高肿瘤的全切率和面神经的保留率。方法回顾性分析经枕下乙状窦后-内听道入路显微外科手术治疗的听神经瘤49例,术前行CT内耳道薄层扫描,术中行面神经功能和脑干听觉诱发电位监测。对听神经瘤内听道处理的手术技巧进行分析。结果术中面神经解剖保留43例,面神经解剖保留率为87.8%,出院时功能保留35例(H-B分级,Ⅰ~Ⅱ级)。解剖未能保留6例,其中2例行面神经端-端吻合。肿瘤全切45例,全切除率为91.8%;近全切除4例。术后无死亡病例。结论熟悉内听道内面听神经与肿瘤的病理解剖关系,熟练掌握显微手术技巧并结合术中监测,对肿瘤全切除和面听神经功能保护具有重要的意义。     

听神经瘤手术治疗的临床体会

目的 总结104例听神经瘤手术切除的体会，以提高此类手术的治疗效果。方法 经CT或MRI扫描检查确诊，应用显微外科技术，经枕下-乙状窦后入路行肿瘤切除术。结果 肿瘤全切89例（85．58％），次全切和大部切除15例（14．42％）；术后死亡2例（1．92％）。术中面神经解剖保留89例（85．58％），听神经解剖保留25例（24．04％），术后7例（6．73％）听力保存或有所改善。结论 肿瘤大小与肿瘤全切率及面、听神经保留率密切相关。合适的体位，正确的切除方法及较强的功能保护观念，是提高听神经瘤手术疗效的关键。     

听神经瘤显微手术治疗的体会

目的总结38例听神经瘤显微手术切除的体会及并发症的防治,以提高患者的疗效和术后生存质量。方法回顾性分析38例听神经瘤患者的临床资料。结果肿瘤全切32例(84.21%),次全切6例(15.79%),术后面神经保留33例(86.84%),听神经保留10例(26.32%),2例听力有所改善(5.26%),无死亡病例。结论听神经瘤大小与肿瘤全切除及面听神经保留等密切相关。熟练掌握显微解剖结构及娴熟细致的显微手术操作,积极预防术后并发症是提高听神经瘤手术效果的关键。     

Technical recommendations and interpretation guidelines for electroencephalography for premature and full-term newborns

Electroencephalography (EEG) of neonatal patients is amongst the most valuable diagnostic and prognostic tool. EEG recordings, acquired at the bedside of infants, evaluate brain function and the maturation of premature and extremely premature infants. Strict conditions of acquisition and interpretation must be respected to guarantee the quality of the EEG and ensure its safety for fragile children. This article provides guidance for EEG acquisition including: (1) the required equipment and devices, (2) the modalities of installation and asepsis precautions, and (3) the digital signal acquisition parameters to use during the recording. The fundamental role of a well-trained technician in supervising the EEG recording is emphasized. In parallel to the acquisition recommendations, we present a guideline for EEG interpretation and reporting. The successive steps of EEG interpretation, from reading the EEG to writing the report, are described. The complexity of the EEG signal in neonates makes artefact detection difficult. Thus, we provide an overview of certain characteristic artefacts and detail the methods for eliminating them.     

Social gating and pedagogy: Mechanisms for learning and implications for robotics

It seems self-evident that human responsiveness to social input enhances learning, yet the details of the social forces at play are only beginning to come into focus. Recent research on language and cognitive development in preschoolers and infants illuminates mechanisms such as social gating and natural pedagogy, and specific ways in which they benefit learning. We review such advances and consider implications of this research for designing robotic systems that can harness the power of social forces for learning.     

Pharmacotherapy for the soul and psychotherapy for the body

The "mind-body" dualism has shaped the development of psychiatry. At the very beginning psychiatry was related to the mind and the rest of the medicine to the body. The main reasons for such division were lack of biological evidence for psychiatric disorders and wrong beliefs about demonic origins of "lunacy". But although the development of science offered more than enough biological evidence to understand brain as an organ of origin for psychiatric disorders, the dualism of mind and body remained alive even in the modern classification systems. One of the consequences was another dualism that differ biological (e.g. pharmacotherapy) from psychological therapy (e.g. psychotherapy) as completely different approaches. The purpose of this article is to offer enough evidence to reframe the existing dualisms into a different paradigm. In every illness both mind and body can be affected to a different extent. Which part of an illness is body and which part is mind is often difficult to differentiate even when we compare a person with broken leg with a person with acute stress reaction. For that reason it might be an over-simplification to differentiate sharply between biological and psychological therapies. The evidence show that psychotherapy influences biology of the brain and that pharmacotherapy influences psychological, social and developmental dimensions of the diseased person as well as overall well-being and functionality. In the era where medicine discovered psychology and psychiatry discovered biology, the debates and divisions that steam out of past dualisms should end. Every practising physician regardless of the medical discipline uses in everyday practice both biological and psychological approaches to help the patient successfully.     

Astrocyte-neuron metabolic relationships: for better and for worse

In recent years, previously unsuspected roles of astrocytes have been revealed, largely owing to the development of new tools enabling their selective study in situ. These exciting findings add to the large body of evidence demonstrating that astrocytes play a central role in brain homeostasis, in particular via the numerous cooperative metabolic processes they establish with neurons, such as the supply of energy metabolites and neurotransmitter recycling functions. Furthermore, impairments in astrocytic function are increasingly being recognized as an important contributor to neuronal dysfunction and, in particular, neurodegenerative processes. In this review, we discuss recent evidence supporting important roles for astrocytes in neuropathological conditions such as neuroinflammation, amyotrophic lateral sclerosis and Alzheimer's disease. We also explore the potential for neuroprotective therapeutics based on the modulation of astrocytic functions.     

Subsystems of sensory attention for skilled reaching: vision for transport and pre-shaping and somatosensation for grasping, withdrawal and release

Skilled reaching is a forelimb movement in which a subject reaches for a piece of food that is placed in the mouth for eating. It is a natural movement used by many animal species and is a routine, daily activity for humans. Its prominent features include transport of the hand to a target, shaping the digits in preparation for grasping, grasping, and withdrawal of the hand to place the food in the mouth. Studies on normal human adults show that skilled reaching is mediated by at least two sensory attention processes. Hand transport to the target and hand shaping are temporally coupled with visual fixation on the target. Grasping, withdrawal, and placing the food into the mouth are associated with visual disengagement and somatosensory guidance. Studies on nonhuman animal species illustrate that shared visual and somatosensory attention likely evolved in the primate lineage. Studies on developing infants illustrate that shared attention requires both experience and maturation. Studies on subjects with Parkinson's disease and Huntington's disease illustrate that decomposition of shared attention also features compensatory visual guidance. The evolutionary, developmental, and neural control of skilled reaching suggests that associative learning processes are importantly related to normal adult attention sharing and so can be used in remediation. The economical use of sensory attention in the different phases of skilled reaching ensures efficiency in eating, reduces sensory interference between sensory reference frames, and provides efficient neural control of the advance and withdrawal components of skilled reaching movements.     

Guidelines for collecting and maintaining archives for genetic monitoring

Rapid advances in molecular genetic techniques and the statistical analysis of genetic data have revolutionized the way that populations of animals, plants and microorganisms can be monitored. Genetic monitoring is the practice of using molecular genetic markers to track changes in the abundance, diversity or distribution of populations, species or ecosystems over time, and to follow adaptive and non-adaptive genetic responses to changing external conditions. In recent years, genetic monitoring has become a valuable tool in conservation management of biological diversity and ecological analysis, helping to illuminate and define cryptic and poorly understood species and populations. Many of the detected biodiversity declines, changes in distribution and hybridization events have helped to drive changes in policy and management. Because a time series of samples is necessary to detect trends of change in genetic diversity and species composition, archiving is a critical component of genetic monitoring. Here we discuss the collection, development, maintenance, and use of archives for genetic monitoring. This includes an overview of the genetic markers that facilitate effective monitoring, describes how tissue and DNA can be stored, and provides guidelines for proper practice.