术中磁共振多模态影像导航下脑内病变穿刺活检术的初步应用

目的探讨超高场强术中磁共振及多模态影像融合应用于颅内病变穿刺活检的临床初步经验、优势与不足。方法利用3.0T超高场强术中磁共振系统在结构影像的基础上结合多模态影像如磁共振灌注成像(PWI)、磁共振波谱分析(MRS)、弥散张量成像(DTI)、血氧水平依赖成像(BOLD)等,通过代谢及功能信息优化靶点选择,实施多靶点活检。结果共实施23例幕上病变穿刺活检,获得78份标本。所有病例得到明确诊断,术中影像证实靶点均实现术前计划,无严重并发症。结论术中磁共振多模态影像可同时提供功能及代谢信息,提高穿刺活检成功率,降低致残率。     

立体定向活检术在颅内无强化效应病变中的诊断价值

目的 探讨立体定向活检术在颅内无强化效应病变中的定性诊断价值.方法 对47例在MRI增强扫描中未见明显强化的颅内病变行立体定向活检,其中MRI引导有框架立体定向活检38例,无框架神经导航定向活检9例.结果 获得明确病理诊断42例,未获得阳性病理结果5例,活检病理诊断阳性率89.4％.对颅内非肿瘤性病变,MRI诊断与病理诊断相符合9例;对肿瘤性病变,MRI诊断与病理诊断相符合14例;MRI诊断与病理诊断的符合率为48.9％.活检术后穿刺道少量出血1例,无颅内感染和死亡病例.结论 对颅内无强化效应的病变,立体定向活检是获得定性诊断安全、可靠的方法.     

颅内多发病灶的立体定向活检术后病理学结果与MRS结果的比较分析

目的探讨立体定向活检术及磁共振波谱成像（MRS）在颅内多发病灶定性诊断中的临床价值。方法回顾性分析37例经MRI、MRS和立体定向活检术后病理学检查确诊的颅内多发病灶患者的临床资料,其中行有框架定向活检术22例,无框架神经导航定向活检术15例。结果 37例均获得明确病理学诊断,其中低级别胶质瘤19例,高级别胶质瘤8例,淋巴瘤3例,多发脱髓鞘3例,炎性病灶2例,转移癌2例。术后出现癫痫发作1例,活检靶点少量出血1例。病理学诊断与MRS诊断符合率为83.8%（31/37）,误诊率为16.2%（6/37）。结论 MRS在颅内多发病灶的诊断中具有较高的准确性,但仍有一定的误诊率;立体定向活检术微创、安全,在颅内多发病灶的诊断中具有决定性的意义;MRS的代谢变化在活检术靶点选择上具有一定的指导价值。     

Rosa机器人辅助立体定向颅内活检术的临床应用

目的 探讨Rosa机器人辅助下立体定向颅内活检术的临床应用效果。方法 回顾性分析2018年10月至2020年8月在Rosa机器人辅助下进行颅内占位立体定向活检术的33例病人的临床资料。结果 术中没有发生导航故障,所有程序都如期完成。33例进行76个靶点穿刺活检术,术后未发现颅内出血,术后无癫痫发作。33例活检阳性率为100%,其中胶质瘤21例,弥漫大B细胞淋巴瘤5例,血管畸形2例,转移性腺瘤1例,生殖细胞肿瘤2例,间变性脑膜瘤1例,炎性脱髓鞘1例。21例胶质瘤中,检测出IDH-1突变6例（28.6%）,MGMT启动子甲基化16例（76.2%）。1例间变性少突胶质细胞瘤检测出1p/19q杂合性缺失。结论 Rosa机器人辅助立体定向无框架活检术是一种相对安全,可行的操作,可用于颅内病变的组织学和分子诊断。     

MRI立体定向活检术在颅内病变诊断中的应用

目的 探讨MRI引导下立体定向活检术在颅内病变诊断中的作用价值。方法 自2009年1月至2015年3月应用立体定向系统与手术计划软件对25例颅内病变诊断不明确的患者行MRI定位下立体定向活检术。结果 除1例活检阴性外,病理诊断与最后诊断（结合临床和其他检查结果）一致20例,不一致4例;最后诊断与术前MRI诊断相符合8例,不符合9例,影像未诊断6例;切除术后病理与影像相符合1例,无明确关系1例。术后6例病变内少量出血,保守治疗;1例左额叶出血30 ml,行开颅血肿清除+去骨瓣减压术。结论 MRI立体定向活检术对颅内多发、深部病变的诊断具有重要价值,其安全性较高,但仍需进一步避免脑出血的风险。     

颅内特殊部位病变的立体定向活检术

目的 探讨颅内特殊部位病变立体定向活检的手术技巧及影响因素.方法 总结1994年12月～2005年12月间对颅内特殊部位病变行MR导向立体定向活检的106例病例.患者年龄6～76岁,平均42.5岁,其中男62例,女44例,病灶位于鞍区13例,基底节区35例,松果体区51例,脑干7例.使用1.0T MR机定位和Leksell-G型定向仪,ASA-602立体定向手术计划系统行定位影像三维重建并选择最佳靶点、入颅点和活检轨迹.所有靶点均使用Sedan活检针活检,活检组织标本行术中快速冰冻病检,术后行常规病理检查,必要时行免疫组化检查.结果 本组106例,获得明确病理诊断103例,其中生殖细胞瘤37例,松果体母细胞瘤5例,淋巴瘤11例,转移瘤14例,感染性病灶7例,胶质瘤26例,脑变性疾病3例;阴性(轻度胶质增生)3例.病理诊断阳性率97.17%.活检后少量出血2例,全组病例无死亡.结论 立体定向活检术是一种安全、定位精确、高诊断率的脑部疑难病变定性诊断方法,对颅内特殊部位病变的病理学诊断具有重要价值.     

内窥镜立体定向活检术的临床应用

立体定向活检术虽有助于颅内病变的早期诊断，但存在着盲目穿刺所致并发症及活检阳性率不够高的缺点。为此，我们于１９９３年１月至１９９７年３月使用内窥镜直视下行立体定向活检术３４例，取得满意结果。现介绍其初步应用经验。资料一般资料本组３４例中，男１８例，女...     

神经外科机器人辅助立体定向活检在脑深部病变的应用(附26例临床分析)

目的 探讨神经外科机器人引导下立体定向活检脑深部病变诊断中的应用价值.方法 回顾性分析2015年6月至2020年9月收治的26例脑深部病变患者的临床资料,患者均在ROSA机器人或者SINO机器人辅助下行无框架立体定向活检术.结果 26名患者在共行29个病变靶点的穿刺活检.有3名患者首次术中冰冻结果为阴性,术中调整穿刺深...     

影像学引导的立体定向脑活检手术

目的探讨现代神经成像技术(CT、MRI)引导的立体定向脑病变活检术对组织病理学诊断的可靠性和正确性,总结手术操作方法和技术要点。方法采用CT、MRI与立体定向技术相结合,进行脑部病变的活检手术共605例,其中450例用CT或MRI片目测靶点坐标定位,155例采用计算机辅助的立体定向手术(CAPN)工作站,自动计算靶点和规划活检入路。结果522例确诊为各种脑肿瘤,39例为炎性病理,23例为寄生虫或先天性囊肿,16例未能提供可供确诊的病理,阳性诊断率为97.36%。并发症15例,其中2例死亡。结论先进影像技术引导下的立体定向脑病变活检术是神经内、外科脑部病变获得定性诊断安全、可靠的手术方法。术中应注意改进操作方法,以提高病理诊断的阳性率,并达到微侵袭性手术的要求。     

术中磁共振实时影像导航下穿刺活检术的临床初步应用

目的 探讨术中磁共振(iMRI)影像导航应用于穿刺活检术的临床初步经验、优势与不足.方法 在0.15T PoleStar N-20 iMRI实时影像引导下,对6例颅内占位性质不明患者进行穿刺活检术.结果 6例均获得组织病理学诊断,活检阳性率为100%;1例颅内多发占位患者术后并发左基底节活检区域局限性血肿.结论 iMRI影像导航能及时纠正术中脑移位,即只有当iMRI确定穿刺针已位于病灶内才进行活检,从而有利于提高活检阳性率,减少术后并发症.     

Impact of severity of personality disorder on the outcome of depression

The influence of severity of personality disorder on outcome of depression is unclear. Four hundred and ten patients with depression in 9 urban and rural communities in Finland, Ireland, Norway, Spain and the United Kingdom, were randomised to individual problem-solving treatment (n = 121), group sessions on depression prevention (n = 106) or treatment as usual (n = 183). Depressive symptoms were recorded at baseline, 6 and 12 months. Personality assessment was performed using the Personality Assessment Schedule and analysed by severity (no personality disorder, personality difficulty, simple personality disorder, complex personality disorder). Complete personality assessments were performed on 301 individuals of whom 49.8% had no personality disorder; 19.3% had personality difficulties; 13.0% had simple personality disorder; and 17.9% had complex personality disorder. Severity of personality disorder was correlated with Beck Depression Inventory (BDI) scores at baseline (Spearman's r = 0.21; p < 0.001), 6 months (r = 0.14; p = 0.02) and 12 months (r = 0.21; p = 0.001). On multi-variable analysis, BDI at baseline (p < 0.001) and type of treatment offered (individual therapy, group therapy, treatment as usual) (p = 0.01) were significant independent predictors of BDI at 6 months. BDI at baseline was the sole significant independent predictor of BDI at 12 months (p < 0.001). There was no interaction between personality disorder and treatment type for depression.While multi-variable analyses indicate that depressive symptoms at baseline are the strongest predictor of depressive symptoms at 6 and 12 months, the strong correlations between severity of personality disorder and depressive symptoms make it difficult to establish the independent effect of personality disorder on outcome of depression.     

Configuration of the circle of Willis,direction of flow,and shape of the aneurysm as risk factors for rupture of intracranial aneurysms

Background   Improved knowledge on risk factors for rupture of intracranial aneurysms may lead to more tailored aneurysm management. We studied whether configuration of the circle of Willis, direction of flow towards the aneurysm, and shape of the aneurysm are risk factors for rupture. Methods   We reviewed CT angiograms of 126 patients with 75 ruptured and 75 unruptured aneurysms, matched for site of the aneurysm, gender and age of the patient, and year of CT angiogram. For the characteristics studied, we calculated odd ratios (ORs) with corresponding 95 % confidence intervals (CIs) for risk of rupture. Configuration of the circle of Willis (incompleteness, asymmetry or dominance) was analyzed on a per site basis. Non-spherical shape was subdivided into elliptical (oval and oblong) and multilobed. In additional analyses, we adjusted for size by means of multivariable logistic regression. Results   Flow straight into the aneurysm (OR 2.0; 95 % CI 1.0–4.1) and non-spherical shape (OR 2.8; 95 % CI 1.5–5.5) were associated with rupture. Both elliptical shape, with increasing ORs for oval (OR 1.8; 95 % CI 0.8–4.0) to oblong shape (OR 6.2; 95 % CI 1.9–21), and multilobed shape (OR 4.1; 95 % CI 1.2–14) were associated with rupture. These ORs decreased after adjustment for size. Configuration of the circle of Willis was not associated with a strong risk of rupture; moderate risk could not be excluded. Conclusion   Direction of flow into the aneurysm and nonspherical (both elliptical and multilobed) shape may contribute to the risk of rupture, but are related to aneurysm size and may warrant more frequent follow-up.     

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.     

Subjective experiences of family caregivers of patients with dementia as predictive factors of quality of life

Background: The aim of the present study was to investigate predictive factors of quality of life (QOL) in home caregivers of patients with dementia. Methods: A total of 118 home caregivers (48 male, 70 female) were asked to complete the World Health Organization (WHO) Quality of Life 26 (WHO/QOL‐26) questionnaire, the Pines Burnout Measure (BM), and the Beck Depression Inventory, second edition (BDI‐II). Patient demographics and clinical data regarding cognitive impairment, neuropsychiatric symptoms, and dementia severity were obtained from medical records. Results: Spearman rank correlation coefficients revealed that caregiver QOL was significantly correlated with patients' neuropsychiatric symptoms (r=−0.19; P < 0.05), as well as depressive symptoms (r=−0.59, P < 0.01) and burnout (r=−0.59, P < 0.01) in caregivers. Stepwise multiple regression analysis revealed that depressive symptoms in caregivers was the strongest predictor for caregiver QOL (R²= 0.37, P < 0.001) and that caregiver QOL was best predicted by the combination of depressive symptoms, burnout, and the cognitive impairment of patients (R²= 0.46, P < 0.05). Conclusion: The results of the present study demonstrate that subjective experiences of caregivers are more strongly correlated with caregiver QOL than patient‐related variables and are thus powerful determinants of caregiver QOL. These findings suggest that caregiver intervention, which aims to increase QOL, may benefit from the incorporation of strategies to reduce depressive symptoms and burnout.     

Modulation of calcium-dependent and -independent components of veratridine-evoked release of glutamate from rat cerebellum

The entry of Ca²⁺ into the presynaptic neuronal terminal is considered to be a prerequisite for exocytosis. However, reports suggest that a Ca²⁺-independent component of release can exist for some neurotransmitters. In this study we have used veratridine-stimulated release of glutamate from rat cerebellar slices to investigate Ca²⁺-dependent and -independent release. A 1-min pulse of veratridine (10 μM) induced release of glutamate in both Ca²⁺-replete and Ca²⁺-free ACSF. Both modes of release, however, could be elicited in a sequential manner following a single application of veratridine in Ca²⁺-free ACSF, with return to Ca²⁺-replete conditions 5 min post-pulse. This separation permitted the modulation of either, or both, phases of release. Apamin and dihydrokainate had little effect on Ca²⁺-independent release but produced enhancement of the Ca²⁺-dependent phase. Tetrodotoxin abolished both phases of release when applied with the veratridine pulse, but had no effect on the Ca²⁺-dependent phase alone. The Ca²⁺-dependent phase was partially sensitive to Co²⁺, although the Ca²⁺ channel blockers verapamil, amiloride, ω-conotoxin and ruthenium red were ineffective, suggesting a lack of involvement of L-, N- or T-type channels. The possible mechanisms mediating the Ca²⁺-dependent and -independent components of endogenous glutamate release from cerebellar slices are discussed.     

The effect of medication and the role of postural instability in different components of freezing of gait (FOG)

Freezing of gait (FOG) is associated with gait asymmetry and arrhythmicity, cognitive impairment in Parkinson's disease (PD). However, the role of postural instability (PI) in and the effect of dopaminergic medication (meds) on FOG are unclear. We investigated the effect of meds on FOG using a validated metric, Stepping in Place (SIP) and the relationship between PI and FOG.MethodsWe assessed static posturography (off meds), SIP, UPDRS-III (off/on meds) and the FOG-questionnaire (FOG-Q) in 15 freezers/15 non-freezers and 14 healthy controls.ResultsUPDRS-III, rigidity, tremor (P < 0.01) and axial subscores (P < 0.05) improved with meds in freezers. Only UPDRS-III and tremor improved in non-freezers (P < 0.01). Meds improved freezing episode (FE) frequency, duration and stride duration in freezers (P < 0.01). Over 73% of freezers did not freeze on meds, although one freezer had more and longer duration FEs. Meds did not improve SIP cycle asymmetry and arrhythmicity, which remained greater in freezers compared to other groups on and off meds (P < 0.01, P < 0.05 respectively). Center of pressure (CoP) mediolateral displacement and velocity (V_CoP) in both directions were larger in freezers (P < 0.05). FOG-Q was correlated with CoP anteroposterior displacement and mediolateral V_CoP (R = 0.42; R = 0.40, P < 0.05).The improvement of FOG frequency and duration but not of gait asymmetry and arrhythmicity on meds suggests that both dopaminergic and non-dopaminergic networks contribute to FOG. The correlations between postural instability and FOG severity and SIP asymmetry on meds, suggest that as the disease progresses, postural instability interferes with gait symmetry and lead to on meds FOG and falls.     

Phenotypes of sleep-disordered breathing symptoms to two years of age based on age of onset and duration of symptoms

ObjectiveChildhood sleep-disordered breathing (SDB) symptoms may comprise multiple phenotypes depending on craniofacial anatomy, tonsil and adenoid growth, body habitus, and rhinitis symptoms. The primary objective of this study is to identify and characterize the different SDB phenotypes to two years of age.MethodsData from 770 infants in the Edmonton sub-cohort of the Canadian Healthy Infant Longitudinal Study (CHILD) were analyzed to identify SDB phenotypes based on age of onset and duration of symptoms. Parents completed the 22-item sleep-related breathing disorder (SRBD) scale. Children with a SRBD ratio greater than 0.33 were considered positive for SDB at each quarterly assessment between three months and two years. The STATA Proc trajectory extension identified SDB phenotypes based on their age of onset and duration of symptoms and attributed the percentage chance of a participant being assigned to each phenotype. Multivariate linear regression identified factors associated with increased risk of being assigned to each SDB phenotype.ResultsTrajectory analysis identified four phenotypes: no SDB (65.7%), early-onset SDB (15.7%) with peak symptoms at nine months, late-onset SDB (14.2%) with peak symptoms at 18 months, and persistent SDB (5.3%) with symptoms from 3 to 24 months. Rhinitis was associated with all three SDB symptom trajectories (p < 0.05). Children with gastroesophageal reflux disease presented with early (p = 0.03) and late SDB (p < 0.001). Maternal obstructive sleep apnea syndrome (OSAS) was associated with persistent (p = 0.01) and late SDB (p < 0.001). Atopy (positive skin prick test at one year) was associated with persistent SDB (p = 0.04). Infants born prior to 36.5 weeks gestational age were more likely to present with late SDB (p = 0.03).ConclusionChildhood SDB symptoms, rather than being a homogenous disorder, may comprise multiple overlapping phenotypes each with unique risk factors.     

Effect of the removal of extracellular Ca on the response of cytosolic concentrations of Ca to ouabain in carotid body glomus cells of adult rabbits

Effect of the removal of extracellular Ca²⁺ on the response of cytosolic concentrations of Ca²⁺ ([Ca²⁺]_i) to ouabain, an Na⁺/K⁺ exchanger antagonist, was examined in clusters of cultured carotid body glomus cells of adult rabbits using fura-2AM and microfluorometry. Application of ouabain (10 mM) induced a sustained increase in [Ca²⁺]_i (mean±S.E.M.; 38±5% increase, n=16) in 55% of tested cells (n=29). The ouabain-induced [Ca²⁺]_i increase was abolished by the removal of extracellular Na⁺. D600 (50 μM), an L-type voltage-gated Ca²⁺ channel antagonist, inhibited the [Ca²⁺]_i increase by 57±7% (n=4). Removal of extracellular Ca²⁺ eliminated the [Ca²⁺]_i increase, but subsequent washing out of ouabain in Ca²⁺-free solution produced a rise in [Ca²⁺]_i (62±8% increase, n=6, P<0.05), referred to as a [Ca²⁺]_i rise after Ca²⁺-free/ouabain. The magnitude of the [Ca²⁺]_i rise was larger than that of ouabain-induced [Ca²⁺]_i increase. D600 (5 μM) inhibited the [Ca²⁺]_i rise after Ca²⁺-free/ouabain by 83±10% (n=4). These results suggest that ouabain-induced [Ca²⁺]_i increase was due to Ca²⁺ entry involving L-type Ca²⁺ channels which could be activated by cytosolic Na⁺ accumulation. Ca²⁺ removal might modify the [Ca²⁺]_i response, resulting in the occurrence of a rise in [Ca²⁺]_i after Ca²⁺-free/ouabain which mostly involved L-type Ca²⁺ channels.     

An Examination of the Frequency of Invalid Forgetting on the Test of Memory Malingering

The Test of Memory Malingering (TOMM) is the most used performance validity test in neuropsychology, but does not measure response consistency, which is central in the measurement of credible presentation. Gunner, Miele, Lynch, and McCaffrey (2012 Gunner, J. H., Miele, A. S., Lynch, J. K., & McCaffrey, R. J. (2012). The Albany Consistency Index for the Test of Memory Malingering. Archives of Clinical Neuropsychology, 27(1), 1–9. doi:10.1093/arclin/acr089.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) developed the Albany Consistency Index (ACI) to address this need. The ACI consistency measurement, however, may penalize examinees, resulting in suboptimal accuracy. The Invalid Forgetting Frequency Index (IFFI), created for the present study, utilizes an algorithm to identify and differentiate learning and inconsistent response patterns across TOMM trials. The purpose of this study was to assess the diagnostic accuracy of the ACI and IFFI against a reference test (Malingered Neurocognitive Dysfunction criteria), and to compare both to the standard TOMM indexes. This retrospective case-control study used 59 forensic cases from an outpatient clinic in Southern Kansas. Results indicated that sensitivity, negative predictive value, and overall accuracy of the IFFI were superior to both the TOMM indexes and ACI. Logistic regression odds ratios were similar for TOMM Trial 2, Retention, and IFFI (1.25, 1.24, 1.25, respectively), with the ACI somewhat lower (1.18). The IFFI had the highest rate of group membership predictions (79.7%). Implications and limitations of the present study are discussed.