下期内容预告

<正>本刊2015年第1和2期报道专题为脑血管病一级预防,重点内容包括:开展个体化脑血管病一级预防;脑卒中一级预防指南解读;常见缺血性卒中病理改变及发病机制;基因多态性与脑卒中相关性研究进展;阿司匹林在脑血管病一级预防中的争议与前景;代谢综合征与脑卒中;健康教育与脑血管病一级预防;社会心理因素在脑血管病一级预防中的作用;脑血管病危险因素及其预防与治疗;HAT、SEDAN评分及相关脑血管病危险因素预测急性缺血性卒中溶栓后出血转化临床研究;     

社会心理因素与脑卒中相关性的探讨

据国内张伯源、杨菊贤等报导,高血压、冠心病皆与患者的性格有一定关系。作为与高血压、冠心病有密切关连的脑卒中与性格的关系,国内报道甚少。为此我们对126例脑血管病患者的性格及社会心理因素进行了调查,现总结分析如下:     

不良心理因素与脑血管病的关系

众所周知,心理是脑的机能。与人类心理活动关系最为密切的是大脑皮层,其次是边缘系统、脑干网状结构和丘脑。许多研究表明,心理因素可影响脑的正常活动,而脑部病变又可引起一系列心理学变化。临床发现,不良心理因素与脑血管病的发生和预后有着密切的关系。为提高对脑血管     

脑血管病患者睡眠障碍的分析及护理

目的 探讨脑血管病患者睡眠障碍的原因及护理对策.方法 采用自行设计问卷进行调查分析可能影响的因素,制定相应的护理措施.结果 其原因主要有脑疾病本身、心理因素、病房环境、病理生理因素和药物因素等.结论 加强心理护理,改善睡眠环境,合理用药,是预防和改善脑血管病睡眠障碍的主要措施.     

脑血管病患者心理分析及护理对策

脑血管病多见于中老年人,特点是发病快、致残重、康复慢,多数留有不同程度的后遗症,给患者造成沉重的心理压力。在脑血管病患者恢复的过程中,心理因素起着重要的作用,也越来越受到人们的重视。笔者结合自己1a来的护理经验,谈一下对脑血管病患者心理护理的体会。1资料和方法1.1临床资料我院2010-05—2011-05收治脑血管病患者     

干预代谢危险因素对脑血管病影响的研究进展

代谢危险因素是脑血管病的重要影响因素。随着代谢性脑血管病概念的提出,如何通过干预代谢危险因素改善此类患者的预后是未来重要的研究方向。代谢危险因素可相互影响并协同作用,降压、调脂、控制血糖等对传统代谢危险因素的干预可有效降低脑血管病的发病率和复发率;抗炎、补充维生素、调节肠道菌群等对残余代谢危险因素的干预同样是影响脑血管病发病及预后的重要措施。新型代谢药物“一专多能”的特点为代谢性脑血管病的治疗和管理提供了新的思路。本综述总结干预代谢危险因素对脑血管病影响的循证医学证据,旨在为代谢性脑血管病的管理提供更多理论支持。     

卒中：回眸2023

在全球脑血管病医疗工作者的共同努力下,近年来脑血管病的诊疗取得了长足的进步。众多高质量的临床研究涵盖了脑血管病多个领域和热点,例如：缺血性卒中急性期取栓/溶栓,针对心房颤动的干预,血压管理等其他卒中急性期干预措施,为脑血管病的临床诊疗提供了扎实可靠的循证医学证据,并促进了脑血管病疾病负担的降低。本文对2023年脑血管病领域重要的临床研究进展进行回顾,帮助读者更好地了解这些临床研究的精华,并期待未来涌现出更多、更好的脑血管病临床研究。     

急性脑血管病情感障碍的临床研究

目的 探讨脑卒中急性期情感障碍的临床特点。方法 对32例脑梗死病人，31例脑出血病人，31例高血压病人及31例政法这人进行SAS和CES－D问卷调查。结果 高血压组，脑梗死组，脑出血组均存在不同程度的抑郁和焦虑症状，脑血管病组与高血压组症状表现不同。结论 脑卒中后急性期可出现抑郁和焦虑症状，焦虑的发病率并不低，应引起重视。脑血管病情障碍的发病与病灶的性质和左右半球部位无关，是生物和社会心理因素相互作用的结果。     

社会心理因素与抑郁症发作次数

目前医学研究比较注重发病因素,尤其重视社会心理因素,认为社会心理因素可能是抑郁症的诱发因素。许多学者已观察到生活事件与抑郁症有关,也有人发现随着抑郁发作次数的增加,生活事件的发生率下降,但由于研究方法有缺陷,如缺乏诊断标准、生活事件的概念各异、无必要的统计分析等,使人难以下一个确切的结论。本文作者研究了社会心理因素与抑郁发作次数之间的关系,由此来评价社会心理因素在抑郁症发病中的重要性,以及生活事件和长期精神刺激与抑郁发作次数的关系等。方法:本研究选择了符合DSM-Ⅲ的单     

对"器质性精神障碍"一章的几点意见

1　对脑血管病所致精神障碍的几点疑问1 1　症状标准的第 4条指出 :“至少有下列 1项局灶性脑损伤的证据 :脑卒中史、单侧肢体痉挛性瘫痪、伸跖反射阳性 ,或假性球麻痹”。但临床上有部分无症状性 (静止性 )脑梗死能够引起精神障碍如抑郁障碍[1] ,并与认知障碍有关[2 ] 。1 2　症状标准从逻辑上讲第 5条包含了第 4、6条的内容 ,后者只是前者的具体化。如第 4条可为第5条所表述的“病史、检查……有脑血管病证据”所包含 ,第 6条可被第 5条所表述的“……检查 ,或化验有脑血管病证据”所包含 ,不应如此重复1 3　“0 1.1急性脑血管病所致精神…     

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.     

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。     

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.     

《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。     

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.     

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。