神经电生理监测下高颈段椎管神经鞘瘤的显微外科治疗

目的探讨高颈段椎管神经鞘瘤在神经电生理监测下显微手术方法及疗效。方法回顾性分析74例高颈段椎管神经鞘瘤的临床资料。椎管内外哑铃状肿瘤35例,椎管内肿瘤39例。结果在神经电生理监测下进行显微手术,肿瘤全切除70例(94.6%),次全切除4例(5.4%)。术后症状完全消失67例(90.5%),症状改善7例(9.5%)。术后均未发生脊髓和神经根损伤并发症,2例病人发生中枢神经系统感染,无死亡。6例失访,68例病人术后随访3个月～4年,2例术后复发(1例再次手术),其他病人恢复良好。结论神经电生理及显微手术技术联合应用显著提高高颈段神经鞘瘤的全切率,最大程度地保护脊髓、神经,减少术后复发及并发症,提高高颈段神经鞘瘤的疗效及安全性。     

内固定技术在椎管肿瘤切除中的应用

目的探讨内固定技术在椎管肿瘤切除手术中的作用。方法回顾性分析2016年10月至2019年4月采用内固定技术结合显微手术治疗21例椎管肿瘤的临床资料,在神经电生理监测下,利用显微手术技术切除椎管肿瘤,然后利用内固定技术维持脊柱稳定性。结果 21例肿瘤中,19例完全切除,2例近全切除,1例术后复发,1例转移至三脑室内;术后患者均无神经功能损伤加重情况发生,内固定时无神经、脊髓、血管损伤;术后无感染,随访无内固定松动、断裂、脱落等情况发生,95.2%达到骨性融合。结论内固定技术结合显微外科手术,能在切除椎管肿瘤的同时,维持脊柱的稳定性,对于扩大暴露范围及保护脊髓神经功能方面均有帮助。     

内固定技术在椎管肿瘤切除中的应用

目的 探讨内固定技术在椎管肿瘤切除手术中的作用。方法 回顾性分析2016年10月至2019年4月采用内固定技术结合显微手术治疗21例椎管肿瘤的临床资料,在神经电生理监测下,利用显微手术技术切除椎管肿瘤,然后利用内固定技术维持脊柱稳定性。结果 21例肿瘤中,19例完全切除,2例近全切除,1例术后复发,1例转移至三脑室内;术后患者均无神经功能损伤加重情况发生,内固定时无神经、脊髓、血管损伤;术后无感染,随访无内固定松动、断裂、脱落等情况发生,95.2%达到骨性融合。结论 内固定技术结合显微外科手术,能在切除椎管肿瘤的同时,维持脊柱的稳定性,对于扩大暴露范围及保护脊髓神经功能方面均有帮助。     

神经电生理监测技术在脊髓手术中应用11例报告

目的 总结脊髓手术中应用神经电生理监测技术的初步经验.方法 同顺性分析11例腰骶段椎管内病变手术中应用运动诱发电位(MEP)+体感诱发电位(SEP)+电刺激器触发肌电图(EMG)监测脊髓和神经根功能的效果和体会.结果 1例脊髓内囊性病变获得次全切除;1例脊髓内肿瘤大部分切除:9例脊髓拴系综合征术后自觉症状明显好转者8例,1例与术前相比症状无明显变化.11例手术中脊髓和脊神经功能保留率100%;无圆锥、马尾神经损害发生.结论 联合应用MEP+SEP+触发EMG对于脊髓和神经根的保护和拴系组织的判断以及提高手术的安全性具有重要价值.     

皮质体感诱发电位与肌电图监测在椎管内疾病手术中的应用

目的初步探讨神经电生理监测技术在椎管内疾病手术中的临床应用价值。方法回顾性分析30例椎管内疾病病人的临床资料。术前Frankel分级:C级4例,D级16例,E级10例。术中应用皮质体感诱发电位(CSEP)与肌电图(EMG)监测脊髓和神经根功能,分析手术过程并评价其效果。结果肿瘤全切10例,次全切13例,大部切除2例,部分切除2例;另有脊髓栓系综合征3例,术中完全松解黏连病变。术后10 d Frankel分级:改善6例,无变化22例,加重2例;术后1年Frankel分级:改善14例,无变化15例,加重1例。术前Frankel分级3组病人进行比较,术后10 d和1年的疗效差异均无统计学意义(均P>0.05)。结论在椎管内手术中联合应用CSEP与EMG监测可以更好地保护脊髓和神经根功能。     

术中实时超声导航在椎管内病变手术中的应用研究

目的探讨术中实时超声导航在椎管内病变手术中的应用价值。方法对36例椎管内病变患者施行术中实时超声导航辅助下显微外科手术。所有手术均采用后正中入路、传统椎板切除术，利用超声影像对病变部位进行术中定位，并在实时超声导航辅助下开展显微外科手术处理病变。结果术中实时超声导航准确定位了椎管内病变及其范围。对于24例占位性病变．手术全切21例，大部分切除3例，病理诊断包括髓内胶质瘤3例、脂肪瘤2例、脊膜瘤2例、神经鞘瘤13例、骶管囊肿3例、结核瘤1例。另有12例脊髓空洞症无病理报告。术后2周症状体征改善者22例，稳定者11例，手术后出现新的神经功能损害症状或者加重者3例，无死亡病例。结论显微神经外科手术是椎管内病变目前最有效的治疗措施。术中实时超声可以实现实时神经导航，有助于提高椎管内病变手术的精确性和全切除率，减少手术并发症。     

全脊柱内镜下手术治疗椎管内髓外占位性病变的临床研究

目的探讨全脊柱内镜下治疗椎管内髓外占位性病变的临床疗效。方法回顾性分析46例椎管内髓外占位性病变的临床资料。均行全脊柱内镜下手术治疗。结果病变完全切除45例,部分切除1例;术中平均出血量50 ml。术后病人临床症状改善40例(86.9%),无变化6例(13.1%)。病理结果:神经鞘瘤29例(63.0%),脊膜瘤12例(26.0%),蛛网膜囊肿2例(4.4%),肠源性囊肿2例(4.4%),瘢痕组织1例(2.2%)。皮下积液1例,经物理治疗1周治愈;无其他并发症发生,围手术期无死亡病例。术后平均住院时间5 d。随访6～24个月,影像学检查未发现肿瘤复发,未发现脊柱不稳定。结论应用全脊柱内镜手术治疗椎管内髓外占位性病变,具有手术创伤小,不影响脊柱稳定性,病人康复快等优势,值得临床推广应用。     

婴儿脊髓脂肪瘤一例报道及文献复习

目的探讨儿童脊髓脂肪瘤的临床特征、诊断、分型及治疗方法。方法报道一例婴儿脊髓脂肪瘤的病例,结合文献对其临床表现、分型及诊治进行讨论。结果本例表现为巨大皮下脂肪瘤,通过腰骶部椎管缺损与脊髓脂肪瘤相连,背侧硬脊膜被脂肪瘤侵蚀,失去正常结构,脊髓脂肪瘤压迫脊髓腰骶段并与马尾神经混杂生长。肿瘤在电生理监测下近全切除,解除脊髓栓系,手术无神经系统并发症发生。结论脊髓脂肪瘤是先天性疾病,好发于腰骶部。婴幼儿期多不出现明显神经系统症状,在儿童逐渐成长过程中,脊髓受到异常牵拉才产生出脊髓栓系综合征表现。一旦患者的神经损害加重,通常不可逆。因此,早期诊断、尽早外科干预非常重要。手术应尽可能一期全切除肿瘤,减轻脊髓压迫,完全松解脊髓和神经的粘连,避免再栓系的发生。     

椎管内髓外硬膜下肿瘤的显微手术治疗

目的 探讨椎管内髓外硬膜下肿瘤影像学特征、临床特征、显微手术疗效。方法 回顾性分析2014年4月至2019年12月手术治疗的34例椎管内髓外硬膜下肿瘤的临床资料。结果 34例中,脊膜瘤19例,神经鞘瘤15例;脊膜瘤以女性多见,疼痛少见,多出现囊变,T2WI多为等信号;而神经鞘瘤以男性多见,多有疼痛表现,囊变较少,T2WI多为高信号。34例肿瘤均全切除;全椎板切除28例,半椎板切除6例。术后未出现感染、脑脊液漏和脊髓缺血病变。术后随访12个月,McCormick脊髓功能分级Ⅰ级28例,Ⅱ级5例,Ⅲ级1例。结论 椎管内髓外硬膜下肿瘤以脊膜瘤和神经鞘瘤最为常见,T2WI具有鉴别诊断价值;全椎板或半椎板入路手术治疗,肿瘤全切率高,复发率低,术后并发症少,能有效改善病人预后。     

脊髓血管母细胞瘤(5例报告)

目的 探讨脊髓血管母细胞瘤的诊断与治疗.方法 报告5例脊髓血管母细胞瘤,结合文献就其临床特征、神经影像学特点、手术治疗及预后进行回顾性分析.结果 脊髓血管母细胞瘤大多数表现为边界清晰的实质性占位,增强后明显均匀强化,病变周围上、下蛛网膜下腔可见迂曲增粗血管流空影,常伴有脊髓空洞或囊性变.本组5例均获全切除,术后症状明显改善4例,1例无明显变化.结论 脊髓血管母细胞瘤的诊断及鉴别诊断主要依靠MRI影像学特点,正确的术前诊断有助于手术策略制定及手术全切除肿瘤.     

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.     

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.     

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。     

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。     

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.     

他汀类药物的使用和颅内动脉瘤破裂相关性分析

目的 探讨他汀类药物对颅内动脉瘤破裂的影响。方法 2010年3月至2014年3月收治颅内囊状动脉瘤67例,其中破裂者32例,未破裂者35例。采用多变量Logistic回归评估他汀类药物的使用和颅内动脉瘤破裂的关系。结果 破裂组术前使用他汀类药物4例（12.5%,4/32）,未破裂组16例（45.7%,16/35）。破裂组服用他汀类药物的百分比显著低于未破裂组（P<0.01）。纠正潜在的混杂干扰后（or值: 0.30,95%可信空间:0.12~="" 0.64）显示,颅内动脉瘤破裂与他汀类药物的使用呈显著负相关,也与高血清总胆固醇浓度有关。结论 本结果提示他汀类药物对颅内动脉瘤破裂有一定的预防效果。