神经假体移植与神经源性膀胱

背景：脊髓损伤后由于神经传导通路中断,膀胱失去正常调控,经常出现尿潴留及肾损害,其膀胱功能重建一直是神经泌尿外科学研究的难点之一,神经假体移植被认为是重建其功能的有效手段。 目的：探讨近年来应用神经假体移植治疗脊髓损伤后神经源性膀胱的最新进展。 方法：应用计算机检索CNKI和springer数据库中1988-01/2009-12关于神经假体移植治疗神经源性膀胱的文章,在标题和摘要中以“神经假体,移植,治疗,神经源性膀胱,电刺激”或“Neuroprostheses, Implantion, Treat, Neurogenic bladder, Electrical stimulation”为检索词进行检索。选择文章内容与神经假体移植治疗神经源性膀胱相关并发表在权威杂志上。根据纳入标准选择44篇文章进行综述。 结果与结论：目前脊髓再生研究尚无重大进展的情况下,神经假体移植技术逐渐成为重建脊髓损伤后神经功能的主要手段。当前临床上治疗神经源性膀胱的神经假体有2种：一是Finetech-Brindley 膀胱系统,另一种是InterStim-Therapy膀胱系统。近年来4种新技术的开展将对神经假体治疗神经源性膀胱带来革命性变化：①阳极阻滞技术。②条件性电刺激。③注射型神经假体。④刺激阴部神经分支。     

小脑靶向神经刺激促进吞咽恢复机制的研究进展

大脑的经颅磁刺激和电刺激是目前具有一定应用前景的技术,逐渐在基础研究和临床实 践中得到应用。这种无创的、非侵入性的靶向神经刺激,通过调节神经兴奋性和可塑性来改善或恢复 大脑功能。由于小脑在运动协调、联想和情感等方面与大脑存在神经解剖和功能联系,因此以小脑为 靶点的神经刺激可以更好地了解生理及病理状态下,小脑与大脑吞咽运动区之间的联系,更好地研究 小脑对吞咽皮质区域兴奋性的调节作用,以及对吞咽功能的影响,为神经源性吞咽障碍提供一种潜在 的治疗方法。     

导尿管球囊扩张术治疗神经源性环咽肌失弛缓症的疗效观察

目的探讨导尿管球囊扩张术治疗神经源性环咽肌失弛缓症的临床效果。方法择取我科收治的神经源性环咽肌失弛缓症患者44例,随机分为实验组与对照组各22例。对照组给予常规康复治疗,实验组在此基础上给予导尿管球囊扩张术治疗,对比2组吞咽障碍评分及吞咽功能的改善情况。结果 2组治疗前吞咽障碍评分无明显差异,治疗后实验组吞咽障碍评分显著高于对照组,各项功能改善情况均显著优于对照组,差异有统计学意义(P0.05)。结论导尿管球囊扩张术可有效改善神经源性环咽肌失弛缓症患者的症状,促进患者早日康复。     

缺血性脑卒中后神经源性吞咽障碍的影响因素分析

目的 探讨缺血性脑卒中后神经源性吞咽障碍的影响因素.方法 选取我院收治的缺血性脑卒中患者611例,对其临床资料进行回顾分析,总结脑卒中后发生神经源性吞咽障碍的高危因素.结果 611例缺血性脑卒中患者共发生神经源性吞咽障碍81例,发生率13.26%.女性患者,年龄＞50岁,复发,梗死部位位于颞叶、顶叶或脑干,合并高血压、肺炎、血脂异常、颈椎病及颈内动脉粥样硬化均为缺血性脑卒中患者发生吞咽障碍的独立危险因素（P＜0.05）.结论 缺血性脑卒中后发生神经源性吞咽困难受多因素影响,在临床工作中应对高危患者积极预防.     

无创性神经刺激技术治疗脑卒中后吞咽障碍的临床研究进展

正吞咽障碍是脑卒中的常见并发症之一,其发生率高达37%~78%。脑卒中后吞咽障碍患者常并发吸入性肺炎、营养不良和脱水等,导致患者的病死率显著增高~([1-2])。有研究表明,吞咽障碍是脑卒中患者死亡的独立危险因素之一~([3])。越来越多的研究报道,药物在促进受损的吞咽皮质功能恢复方面的作用甚小~([4-5])。因此,探索对脑卒中后吞咽障碍患者的非药物治疗尤为重要。目前,神经刺激技术     

神经调控治疗难治性癫痫

癫痫是最常见的慢性神经系统疾病之一,超过50％的难治性癫痫患者,由于致痫灶散在或不能精确定位,或癫痫灶位于功能区等原因,不适合接受切除性手术治疗,成为神经调控技术服务的对象[1].神经调控技术指在神经科学层面,用电或化学的方式,通过改变神经系统功能或状态而获得治疗效果的治疗模式.目前在治疗癫痫方面,神经调控治疗主要是依靠电刺激的方式实现:通过电刺激改变癫痫样放电区域的神经电活动,或者通过对癫痫相关的神经网络中重要节点进行电刺激,刺激再通过神经网络扩大传导,引起相应区域电活动的改变,从而抑制癫痫发作[2].根据治疗的目标区域可分为周围神经刺激与中枢神经刺激两种模式.     

经颅直流电刺激在卒中后吞咽障碍康复治疗中的应用研究进展

卒中后吞咽障碍可能是由吞咽皮质中枢、皮质下行纤维、延髓吞咽中枢及锥体外系损伤 所致,目前尚无特异性治疗方法,临床干预以直接训练和间接训练等康复治疗为主。经颅直流电刺激 （transcranial direct current stimulation,tDCS）是通过直流电刺激来改变神经可塑性和皮质兴奋性,以 改善各种神经、精神疾病的神经刺激治疗手段。近年来,研究者逐渐重视tDCS对大脑活动的调节作 用和生理效应,并对tDCS刺激神经网络的作用机制展开探索。本研究从tDCS的神经作用机制、刺激 参数以及刺激后效应等方面阐述tDCS的研究进展,以期为卒中后吞咽障碍患者寻找有效的康复方式, 并为未来的研究提供依据。     

神经肌肉电刺激对卒中性吞咽障碍疗效的研究

目的探讨神经肌肉电刺激对卒中性吞咽障碍患者的疗效。方法将200例吞咽功能评级5级及以下的脑卒中患者分为对照组67例和研究组133例,均给予常规药物治疗配合吞咽功能训练,研究组加用Vitalstim电刺激治疗仪。2个疗程后进行吞咽评级比较。结果研究组吞咽评级结果明显优于对照组,差异有统计学意义（P〈0.01）;加用神经肌肉电刺激治疗后,单侧大脑卒中组疗效优于双侧大脑卒中组;缺血性脑卒中组疗效优于出血性脑卒中组。结论神经肌肉电刺激疗法可明显提高卒中性吞咽障碍患者的吞咽功能,临床效果优于常规治疗。     

神经肌肉电刺激联合口腔感觉训练对重症病毒性脑炎合并吞咽障碍患儿的康复效果

目的 探讨神经肌肉电刺激（NMES）联合口腔感觉训练对重症病毒性脑炎（SVE）合并吞咽障碍患儿的康复效果、吞咽功能、神经功能、营养状况的影响。方法 选择河北省儿童医院2021-01—2023-03收治的SVE合并吞咽障碍患儿108例。随机数字表法分为口腔感觉训练组和NMES联合组各54例。2组患者均进行抗病毒、降颅内压、去高热、控制惊厥、保护脑神经等对症支持治疗。口腔感觉训练组给予口腔感觉运动训练,NMES联合组在口腔感觉训练基础上进行NMES康复治疗。比较2组患者康复效果、吞咽功能[吞咽障碍调查量表（DDS）]、神经功能指标[血清脑源性的神经营养因子（BDNF）、神经元特异性的烯醇化酶（NSE）水平]、营养状况[主观的综合性营养评分量表（SGA）]、生活质量[吞咽障碍特异性生存质量量表（SWAL-QOL）]。结果 康复治疗4周后,NMES联合组康复总有效率为92.59%,高于口腔感觉训练组的72.22%(P<0.05);NMES联合组口腔期、咽期、食管期DDS评分、SGA评分、SWAL-QOL评分、血清BDNF水平明显高于口腔感觉训练组,血清NSE水平低于口腔感觉训练组（P&l...     

神经刺激治疗癫(癎)的临床应用

癫痫是多种病因导致的具有发作性症状的脑病,是常见的神经系统疾病,我国的患病率大约为7％,因此,估计全国应有900万的癫痫病人。癫痫的治疗包括了药物、手术及心理等综合治疗。对于那些药物及外科手术难以控制的顽固性癫痫患者,神经刺激是一项很有发展前景的治疗技术。在过去的30年中,通过电刺激神经系统的不同部位,来控制癫癎的发作,已经在临床被应用,并取得了不同程度的临床效果。神经刺激治疗癫癎的方法很多,其中主要包括迷走神经刺激和脑深部核团刺激等。[第一段]     

Mechanisms of the suppression of the nociceptive reflex of the opening of the mouth during stimulation of the structures of the limbic brain

The comparative effectiveness of the inhibitory influence of tetanic stimulation of hypothalamus, amygdala and limbic cortex on EMG-response of m. digastricus evoked by electrical stimulation of tooth pulp nociceptive afferents was studied in cats anesthetized with a mixture of chloralose and nembutal. It was found that inhibition of the EMG-component of the jaw-opening reflex is most pronounced in case of stimulation of medial and lateral region of the hypothalamus, the inhibitory effect of central and medial nuclei of the amygdala is less pronounced and the effect of the limbic cortex is the weakest. It was shown that the mechanism of the antinociceptive effect of tetanic stimulation of the hypothalamus is not related to the concomitant increase of the blood pressure. After stabilization of the blood pressure the suppressive effect of the hypothalamus remains without changes, that points out to a direct, primary, not baro-afferent mechanism of the inhibition of the activity of nociceptive neurons of the trigeminal sensory nuclei. Noradrenaline, injected intravenously, induced a large increase of the blood pressure accompanied by a pronounced inhibition of the pain reflex. Angiotensin causes the same degree of blood pressure elevation without changes in the amplitude of the EMG-response of the pain reflex. Hypothalamic and noradrenergic mechanisms for control of pain sensitivity are discussed.     

药物治疗与合并认知行为治疗对强迫症疗效的比较

目的探讨认知行为心理治疗(CBT)在强迫症(OCD)患者各亚型治疗中的有效性和规律性。方法本研究为临床对照研究。符合入组标准的强迫症患者按患者自愿原则分为两组,治疗观察3、6、12个月。疗效评定分别运用Yale-Brown强迫量表,自拟的自评好转程度量表和临床疗效评定。结果认知行为心理治疗合并药物治疗组31例,临床有效率70.9%,其中治愈率1.8%。单纯药物治疗组24例,临床有效率33.3%。Yale-Brown强迫量表和自评量表得分在6个月和12个月两组有显著差异(P<0.05)。其中强迫症亚型(怕脏型、反复检查型和反复担心型)的疗效比较,怕脏型在治疗3个月末两组间自评量表评分有显著性差异(P<0.05);反复担心型在治疗6个月末两组间Yale-Brown强迫量表总分有显著性差异(P<0.05);反复检查型两组间无统计学差异。结论认知行为心理治疗合并药物治疗强迫症的疗效明显优于单纯药物治疗。强迫症的亚型在治疗中的有效性次序为:反复担心型>怕脏型>反复检查型。     

Characteristics of the sympathetic innervation of the nictitating membrane and of the vasculature of the nose and tongue of the cat

Summary Vasomotor responses from the nasal mucosa and tongue, and contractions of the nictitating membrane, were recorded on stimulation of the cervical sympathetic or internal carotid nerves.Preganglionic sympathetic nerve fibres which elicited a membrane response possessed a lower threshold than those which evoked nasal vasoconstriction, while the latter displayed a lower threshold than fibres which evoked tongue vasoconstriction. The sympathetic vasodilator fibres to the tongue, whose activity was revealed after-receptor blockade, had a similar threshold to the vasoconstrictor fibres.Membrane contraction, nasal vasoconstriction and occasionally tongue vasoconstriction could be evoked by stimulating the internal carotid nerve. The postganglionic fibres innervating the nasal mucosa had a similar threshold to those of the nictitating membrane, which may indicate that there are small myelinated fibres innervating the mucosa.The preganglionic compound nerve action potential had four major components, S₁–S₄. S₁, S₂ and usually S₃ fibres were associated with membrane contraction; S₂, S₃ and sometimes S₁ fibres were associated with nasal vasoconstriction; and S₃, usually S₂ and occasionally S₁ fibres were associated with vasoconstriction in the tongue. It is concluded that each of these three groups of nerve fibres, but not S₄ fibres, may include fibres associated functionally with the three effectors.There was a considerable difference between the relative amplitude of the responses of the three effectors elicited by stimulation of the cervical sympathetic nerve at frequencies between 0.2 and 2 Hz. Vasoconstrictor responses were relatively larger than membrane contractions suggesting differences in the mechanisms of neurotransmission at the neuroeffector junctions.     

Development of the projection from the nucleus of the brachium of the inferior colliculus to the superior colliculus in the ferret

Neurons in the deeper layers of the superior colliculus (SC) have spatially tuned receptive fields that are arranged to form a map of auditory space. The spatial tuning of these neurons emerges gradually in an experience-dependent manner after the onset of hearing, but the relative contributions of peripheral and central factors in this process of maturation are unknown. We have studied the postnatal development of the projection to the ferret SC from the nucleus of the brachium of the inferior colliculus (nBIC), its main source of auditory input, to determine whether the emergence of auditory map topography can be attributed to anatomical rewiring of this projection. The pattern of retrograde labeling produced by injections of fluorescent microspheres in the SC on postnatal day (P) 0 and just after the age of hearing onset (P29), showed that the nBIC-SC projection is topographically organized in the rostrocaudal axis, along which sound azimuth is represented, from birth. Injections of biotinylated dextran amine-fluorescein into the nBIC at different ages (P30, 60, and 90) labeled axons with numerous terminals and en passant boutons throughout the deeper layers of the SC. This labeling covered the entire mediolateral extent of the SC, but, in keeping with the pattern of retrograde labeling following microsphere injections in the SC, was more restricted rostrocaudally. No systematic changes were observed with age. The stability of the nBIC-SC projection over this period suggests that developmental changes in auditory spatial tuning involve other processes, rather than a gross refinement of the projection from the nBIC.     

A contribution to the study of the architecture of the autonomic nervous system of the digestive tract of the rat

Summary The distribution of aminergic and non-aminergic nerve fibres to the different constituents of the wall of the digestive tract in various regions is described. Aminergic fibres synapse with all nervous perikarya. Densely interlacing networks of nerve fibres are found in both layers of the tunica muscularis and in the lamina muscularis mucosae. A finely meshed plexus is observed in relation to the wall of the blood vessels in the wall of the gut. There are many fibres connecting the muscular and the vascular plexus. No nerve fibres have been observed in direct relation to the epithelium.The functional implications of these findings are discussed.