皮质下缺血性血管性痴呆患者大脑联络纤维弥散张量成像研究

目的应用磁共振弥散张量成像(DTI)技术,研究皮质下缺血性血管性痴呆(SIVD)患者脑白质联络纤维变化的特点,以探讨弥散张量成像在诊断SIVD患者中的诊断价值。方法对60例SIVD患者和45例年龄匹配的非痴呆对照者,应用简易智能状态检查量表(MMSE)、蒙特利尔认知测评量表(Mo CA)及临床痴呆量表(CDR)进行认知功能评估;用全脑磁共振DTI技术,测量上纵束、下额枕束(额部、额颞部和颞部)、胼胝体膝部和压部和扣带束多个感兴趣区的各向异性分数(FA)值和表观弥散系数(ADC)值。结果与对照组比较,SIVD组双侧下额枕束、双侧扣带束、左侧上额枕束和胼胝体膝部FA值明显下降,ADC值明显升高,差异有统计学意义(均P<0.05),右侧上额枕束和胼胝体压部的FA值和ADC值差异无统计学意义(P>0.05)。结论 SIVD患者多个感兴趣区的DTI改变证明联络纤维损伤明显;全脑DTI研究是SIVD患者敏感可靠的技术方法,有助于理解SIVD患者的认知功能与联络纤维损害的关系。     

磁共振弥散张量成像对预测皮质下缺血性血管性痴呆患者认知功能障碍的价值

目的应用磁共振弥散张量成像(DTI)技术,探讨皮质下缺血性血管性痴呆(SIVD)患者不同联络纤维感兴趣区弥散张量参数改变与认知功能的关系。方法对60例SIVD患者和40例年龄匹配的非痴呆对照者,采用测定感兴趣区弥散张量参数的方法,比较其纤维束完整性差异及与神经心理学量表的关系。结果 (1)与对照组比较,SIVD组双侧下额枕束、双侧扣带束、左侧上纵束和胼胝体膝部的FA值显著下降及ADC值显著升高;(2)双侧额叶前部皮质下白质FA值与MMSE及Mo CA评分呈明显正相关;(3)双侧海马区、双侧扣带束的FA值与MMSE评分呈明显正相关。结论不同脑区的弥散张量参数变化特点有助于SIVD患者认知功能障碍的早期预测。     

胼胝体和扣带回弥散张量成像改变对皮质下缺血性血管性痴呆患者认知功能障碍的影响

目的应用磁共振弥散张量成像(DTI)技术,探讨皮质下缺血性血管性痴呆(SIVD)患者胼胝体和扣带回弥散张量参数改变与认知功能的关系。方法对60例SIVD患者和40例年龄匹配的非痴呆对照者,采用测定感兴趣区弥散张量参数的方法,比较其纤维束完整性差异及与MMSE的关系。结果 (1)与对照组比较,SIVD组胼胝体膝部、双侧扣带回的FA值显著下降及ADC值显著升高,而胼胝体压部的FA值和ADC值无显著性差异。(2)胼胝体膝部、双侧扣带回的FA值与MMSE评分呈明显正相关。结论胼胝体和扣带回弥散张量改变有助于SIVD患者认知功能障碍的早期预测。     

磁共振弥散张量成像对阿尔茨海默病脑白质损害的评估及鉴别价值

目的：应用MR弥散张量成像（DTI）观察阿尔茨海默病（AD）患者脑白质纤维束完整性。方法：健康老年志愿者为对照组（NC）组、遗忘型轻度认知障碍（aMCI）组、AD组和皮质下缺血性血管性痴呆（SIVD）组各20例,行常规MRI和DTI扫描后,测定相同感兴趣区（ROI）的各向异性分数（FA）值和表观扩散系数（ADC）值进行比较。结果：与NC组比较, AD组前额叶、颞叶、海马等部位FA值降低,颞叶、海马等部位ADC值升高（P〈0.05）;aMCI组仅扣带束FA值降低,与AD组比差异有统计学意义（P〈0.05）;SIVD组下额枕束等部位FA值下降,ADC值升高,与AD组比较差异有统计学意义（P〈0.05）。结论：DTI可以用来评估白质纤维束完整性,AD组白质损害甚于aMCI患者;扣带束FA值可以作为aMCI患者筛查的指标;根据受累部位不同可对SIVD与AD进行鉴别。     

脑小血管病患者MR弥散张量成像的改变及其与认知功能障碍的关系

目的探讨脑小血管病(SVD)患者脑部MR弥散张量成像(DTI)的改变及其与认知功能障碍的关系。方法给55例SVD患者进行神经心理学量表检查,评定认知功能状态,以及行常规MRI和DTI检查,观察感兴趣区的各向异性分数(FA)、表观弥散系数(ADC)。对DTI FA值与蒙特利尔认知评估(MoCA)量表评分的相关性用Pearson相关分析。结果本组SVD患者中认知功能正常(NCI)的患者25例,非痴呆认知功能障碍(VCIND)患者30例。与NCI组比较,VCIND组双侧半卵圆中心、丘脑、额叶及左侧尾状核的FA值显著降低(P0.05~0.001);双侧豆状核、右侧尾状核FA值的差异无统计学意义;左侧尾状核ADC值显著增高(P0.05),其他部位ADC值的差异均无统计学意义。Pearson相关分析示,双侧半卵圆中心、额叶及左侧尾状核的FA值与MoCA量表评分呈正相关(r=0.279~0.375,P0.05~0.005)。结论有认知功能障碍的SVD患者额叶及脑白质DTI的FA值明显降低,并与其认知功能障碍程度有密切的关系。     

MRS联合DTI评估帕金森病认知障碍的初步研究

目的探讨1~H-磁共振波谱(1~H-MRS)及弥散张量成像(DTI)技术对早期诊断帕金森病(PD)患者认知障碍(PD-CI)患者脑部损害,探讨其在PD-CI的早期诊断及临床病情评估中的价值。方法采用Mo CA量表对14例PD患者及健康对照进行认知功能评定;应用1~H-MRS采集各感兴趣区(ROI)N-乙酰天门冬氨酸(NAA)、胆碱(Cho)及肌酸(Cr)浓度,计算NAA/Cr、Cho/Cr比值。然后对1~H-MRS所选ROI相同区域进行DTI扫描,测定各向异性分数(FA),并进一步分析三者之间及其与Mo CA评分之间的关系。结果 PD组Mo CA量表得分较对照组明显降低(P0.05),认知障碍明显。PD组额叶、颞叶、纹状体NAA/Cr值与对照组相比明显下降(P0.05),而两组黑质NAA/Cr值、各部位Cho/Cr值对比无明显差异。PD组额叶、黑质FA值与对照组相比明显降低(P0.05),而两组颞叶、纹状体FA值对比无明显差异。PD患者额叶、颞叶平均NAA/Cr值与Mo CA量表得分呈正相关(P0.05);额叶平均FA值与Mo CA量表得分呈正相关(P0.05)。PD患者额叶平均NAA/Cr值与FA值呈正相关(P0.05)。结论 1~H-MRS联合DTI扫描能更好地检测出PD认知障碍的患者可能存在的隐匿性损伤;分别从结构和代谢两方面为PD-CI的早期诊断提供客观指标;额叶NAA/Cr、FA值的下降与认知功能下降相关。     

肌萎缩侧索硬化症的磁共振弥散张量成像研究

目的初步探讨磁共振弥散张量成像(DTI)在肌萎缩侧索硬化(ALS)诊断中的应用价值。方法选取54例具有不同诊断级别的ALS患者,包括确诊(21例)、很可能(22例)、可能(11例)的患者,同时选取23名健康体检的志愿者作为健康对照。分别行DTI扫描,测量各感兴趣区(ROI)的平均扩散系数(ADC)和各向异性系数(FA),分析两组间ADC和FA的差异,并对ALS组患者ADC值及FA值与临床资料的相关性进行分析。结果与健康对照组比较,ALS患者大脑脚、内囊后肢区的ADC值升高(P0.01),大脑脚、内囊后肢及中央前回区的FA值降低(P0.01);相关分析显示ALS患者内囊后肢的ADC值与诊断级别呈负相关(r=-0.289,P0.05),与上运动神经元损伤评分呈正相关(r=0.304,P0.05);大脑脚及内囊后肢的FA值与诊断级别呈正相关(r=0.394,P0.01;r=0.547,P0.01),与上运动神经元损伤评分呈负相关(r=-0.301,P0.05;r=-0.653,P0.01).结论 DTI可客观定量评估ALS患者锥体束的损伤情况,在ALS的诊断中具有重要的辅助价值。     

皮质下缺血性血管性痴呆患者脑白质损害的磁共振弥散张量成像研究

目的:应用磁共振弥散张量成像技术(DTI)观察皮质下缺血性血管性痴呆(SIVD)患者脑白质损害程度,探讨DTI对SIVD白质损害的评估及与阿尔茨海默病(AD)鉴别诊断价值。方法:研究对象分为3组,分别是健康老年人(NC)、皮质下缺血性血管性痴呆(SIVD)患者、AD患者,每组各20例。行常规MR I和DTI扫描后,测定相同感兴趣区(RO I)的各向异性分数(FA)值和表观扩散系数(ADC)值进行比较。结果:SIVD组下额枕束、胼胝体膝部、胼胝体压部、上纵束等部位FA值下降,ADC值升高,与NC、AD组比较差异有统计学意义(P<0.05)。与NC组比较,AD组前额叶、颞叶、海马、下额枕束、胼胝体膝部和扣带束等部位FA值降低,颞叶、海马等部位ADC值升高,两组差异具有显著性(P<0.05);结论:DTI可以用来评估痴呆患者白质损害的程度,SIVD患者以下额枕束、胼胝体膝部、胼胝体压部、上纵束等部位受累为主,可作为与AD鉴别的客观指标。     

弥散张量成像与老年人认知功能的相关性

目的：研究老年人认知功能与MRI弥散张量成像（DTI）参数的相关性。方法：年龄〉60岁的老年人43例,按其认知功能量表评分[简易智能状态量表（MMSE）、临床痴呆量表（CDR）、总体衰退量表（GDS）和日常生活活动能力量表（ADL）]分为认知功能正常组、轻度认知功能障碍组和阿尔茨海默病3组,比较各组间头颅MRI部分各向异性（FA）和表观弥散系数（ADC）值是否具有差异,寻找与认知功能相关的颅内结构。结果：左侧颞叶、胼胝体膝部、压部的FA和ADC值,以及右侧额叶、双侧半卵圆中心的ADC值组间差异有统计学意义（P〈0.05）。FA值随认知功能减退而降低;而ADC值随认知功能减退而增高。额叶、颞叶、半卵圆中心和胼胝体等部位的DTI参数与常用的MMSE、CDR、GDS、ADL评分显著相关（P〈0.05）。结论：MRIDTI参数与老年人认知功能水平显著相关。     

线性法测量皮质下缺血性血管病患者脑萎缩及其与认知损害的相关性分析

目的通过线性法测量皮质下缺血性血管病(SIVD)患者脑萎缩,分析其与认知功能损害的相关性。方法共纳入SIVD组50例,健康对照组50例。所有入组对象均完成一般情况评定、Mo CA量表评估认知功能、头颅MRI检查,线性法进行脑萎缩测量。结果 SIVD组代表脑室系统横径的测量值及脑沟测量值,除桥池宽度外,均较对照组显著增大(P 0. 05)。SIVD组的脑萎缩测量相对值除脑干指数外,均显著高于对照组(P 0. 05)。SIVD组双侧侧脑室两额角间最宽距离、双侧侧脑室额角两侧尾状核头间最小距离、第三脑室宽度、双侧侧脑室腰部外侧壁最小距离与Mo CA评分呈显著负相关(P 0. 05)。SIVD组脑萎缩测量相对值中的额角指数、尾状核指数、哈氏值、第三脑室宽度与视空间能力、计算力、延迟记忆和定向力均呈负相关(P 0. 05)。结论 SIVD患者存在明显的皮质和皮质下萎缩,并与认知功能损害相关。哈氏值、额角指数、尾状核指数、第三脑室宽度可作为SIVD患者脑萎缩的预测指标,提示执行功能/视空间及计算力、记忆力的损害。     

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.     

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.     

《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。     

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。     

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.     

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.     

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.     

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。