原发性脊髓黏液乳头型室管膜瘤的诊断和治疗

目的 探讨原发性脊髓黏液乳头型室管膜瘤的临床特征和手术治疗.方法 回顾性分析复旦大学附属华山医院神经外科2008年1月至2012年12月收治的18例原发性脊髓黏液乳头型室管膜瘤的临床特点、诊断、手术治疗及预后.结果 本组18例患者手术全切除15例,次全切除3例.术后均未行放疗和化疗.术后15例获得随访,平均随访32个月,无术后复发、转移及死亡病例.结论 原发性脊髓黏液乳头型室管膜瘤为少见类型室管膜瘤,遵循正确、合理的操作方法全切后可获得良好预后.     

脊髓黏液乳头型室管膜瘤的诊断与治疗

目的探讨脊髓黏液乳头型室管膜瘤(spinal myxopapillary ependymoma,MPE)的诊断与治疗效果。方法回顾性分析9例脊髓MPE病人的临床资料,均经后正中入路手术切除肿瘤。结果肿瘤全切除8例;次全切除1例,术后行放射治疗。术后病理证实均为脊髓MPE (WHOⅠ级)。随访9例,时间3～60个月;1例出现局部转移,但无临床症状,继续随访;余8例病人无复发。结论脊髓MPE是临床少见的室管膜瘤类型,手术全切肿瘤是病人获得良好预后的主要因素,术中神经电生理监护和术中超声的运用可提高手术的安全性及全切率,无法全切的病人建议术后放疗。     

脊髓室管膜下瘤诊断和显微外科治疗

目的总结脊髓室管膜下瘤的临床特点和治疗方法。方法回顾性分析9例脊髓室管膜下瘤的临床资料,均采用显微外科手术治疗,结合术中所见对诊断和治疗进行分析。结果肿瘤全切除3例,近全切除4例,大部分切除2例。病理检查显示:室管膜下瘤8例,室管膜下瘤含室管膜瘤成分1例。术后肢体肌力不同程度好转7例,减退2例;括约肌障碍恢复正常1例;短期浅、深感觉障碍均较术前略加重;无手术死亡病例。随访12~36个月,非全切病人中肿瘤复发3例。结论脊髓室管膜下瘤少见,手术可缓解病人临床症状,显微镜下全切除是最佳治疗选择。     

第四脑室室管膜瘤的临床特点和治疗(附19例临床分析)

目的探讨第四脑室室管膜瘤的临床特点和治疗方法。方法回顾性分析2011年1月至2015年12月安徽省立医院收治的19例第四脑室室管膜瘤患者的临床特点、治疗和预后。结果首发症状多为头痛、呕吐等高颅压症状,常伴有梗阻性脑积水。本组患者肿瘤全切除12例,次全切除4例,大部切除2例,部分切除1例。无手术死亡病例。术后接受放疗9例,3例还接受了化疗。术后随访16例,平均随访36.2个月,复发5例,再次手术2例,死亡4例。结论第四脑室室管膜瘤容易复发,治疗应采用手术联合放疗。复发患者可再次手术。     

包膜外整体切除技术在脊髓室管膜瘤手术中的应用

目的 探讨包膜外整体切除技术在脊髓室管膜瘤手术中的应用效果。方法 回顾性分析2018年9月～2020年2月应用包膜外整体切除技术手术治疗的14例脊髓室管膜瘤的临床资料。采用McCormick分级评估脊髓功能。结果 肿瘤全切除13例,次全切1例。术后随访12个月,未见肿瘤复发。术后7 d,脊髓功能改善4例,稳定7例,恶化3例;术后3个月,脊髓功能改善9例,稳定4例,恶化2例;术后12个月,脊髓功能改善11例,稳定2例,恶化1例。结论 在脊髓室管膜瘤手术中,包膜外整体切除技术,有助于提高肿瘤全切除率、减少肿瘤复发风险。     

原发性脊髓间变性室管膜瘤的临床特点和诊治

目的探讨原发性脊髓问变性室管膜瘤（PSAE）的临床特点、治疗及预后。方法回顾性分析2008年1月至2015年10月于首都医科大学附属北京天坛医院神经外科行显微外科手术治疗的PSAE患者的临床资料,共11例,占同期脊髓室管膜瘤患者总数的1．4％（11／765）。11例中,男／女=5／6,发病年龄为8—44岁,平均（22．7±12．4）岁。发病至手术时间为1．5～18．0个月,中位时间为3．0个月。术后6例患者接受放疗,1例接受化疗。结果11例患者中,肿瘤全切除5例,近全切除5例,大部分切除1例,无手术相关并发症。术后随访17～110个月,平均（48．9±7．9）个月。5例复发,复发距离手术时间为4～39个月,平均（25．0±7．2）个月,其中3例再次接受手术治疗,2例由于一般状况较差未手术。至随访期末,4例临床症状改善,3例无明显变化,4例症状加重（其中2例死亡）。结论PSAE是一种罕见的高级别室管膜瘤,病程较短,进展较快;术后易复发,预后差。     

颅内脑室外室管膜瘤的临床特点和治疗效果

目的探讨颅内脑室外室管膜瘤的临床特点、影像学表现和治疗效果。方法回顾性纳入2010年3月至2016年6月武汉大学人民医院神经外科收治的17例颅内脑室外室管膜瘤患者。术前均行影像学检查,17例患者的肿瘤均为单发,均位于幕上,其中5例位于枕叶、2例位于枕顶叶、3例位于颞叶、4例位于额叶、3例位于顶叶;7例呈实性、10例呈囊性。所有患者均行手术切除治疗,术后行门诊及电话随访。结果17例患者中,15例肿瘤全切除(其中10例为WHO Ⅱ级,5例为WHOⅢ级),2例部分切除(WHOⅢ级)。病理学检查结果:10例为室管膜瘤(WHO Ⅱ级),7例为间变型室管膜瘤(WHO Ⅲ级)。术后所有患者的症状均缓解,其中4例(均为WHO Ⅲ级,其中2例为部分切除)术后接受放疗。17例患者的随访时间为10-74个月,中位随访时间为33.2个月。随访期间,17例患者均无脊髓转移征象,7例患者复发,其中4例(WHO Ⅲ级)为术后接受放疗的患者,分别为1例接受二次肿瘤全切除并行术后放疗,1例行二次肿瘤全切除术后3个月死亡,2例肿瘤部分切除的患者拒绝二次手术并分别于术后4个月、6个月死亡;3例为术后未接受放疗的患者,均接受二次肿瘤全切除,其中1例为WHO Ⅲ级的患者,术后发生脑出血死亡。结论颅内脑室外室管膜瘤患者元特异性的临床症状和影像学表现,术前诊断困难。肿瘤全切除是治疗的首选方案,手术方式的选择和肿瘤级别可以作为患者预后判断的预测性指标。     

黏液乳头型室管膜瘤9例临床病理分析

目的探讨黏液乳头型室管膜瘤的临床病理特征、鉴别诊断及治疗与预后。方法回顾性分析9例黏液乳头型室管膜瘤病人的临床资料,行组织学观察及免疫组织化学分析。结果 9例肿瘤均发生于脊髓圆锥、马尾终丝区,典型病理形态为立方形或梭形肿瘤细胞,以乳头放射状结构排列在血管黏液样间质轴心周围,大量黏液聚集在血管和瘤细胞之间或微囊内,伴血管壁增厚、玻璃样变;瘤细胞大小、形态较一致,核分裂像少见或无。免疫组织化学显示肿瘤细胞胶质纤维酸性蛋白(GFAP)、vimentin及S-100阳性,细胞角蛋白(CK)及上皮膜抗原(EMA)阴性。病人均手术全切,术后辅助放疗2例。6例随访17个月～5年,MRI复查仅1例复发。结论黏液乳头型室管膜瘤特征性发病部位、形态学特征及免疫表型是其诊断和鉴别诊断要点,肿瘤全切后预后良好。     

脊髓室管膜瘤的临床特点及显微手术治疗

目的探讨脊髓室管膜瘤的临床特点、显微手术治疗及预后。方法回顾性分析2013年1月至2016年1月显微手术治疗的35例脊髓室管膜瘤的临床资料。结果术前Mc Cormick临床功能分级Ⅰ级15例,Ⅱ级15例,Ⅲ级3例,Ⅳ级2例。肿瘤主体位于脊髓颈段6例,颈胸交界区3例,胸段10例,腰段16例。35例中,肿瘤全切除33例,次全切除2例。30例出院后随访1年,肿瘤复发2例,再次行手术治疗;术后Mc Cormick临床功能分级Ⅰ级19例,Ⅱ级8例,Ⅲ级2例,Ⅳ级1例。结论在神经电生理监测下应用显微神经外科技术治疗脊髓室管膜瘤,术中熟练运用手术技巧以及肿瘤切除后行椎板复位,可以提高手术治疗效果。     

显微手术治疗脊髓室管膜瘤预后的影响因素分析

目的 探讨显微手术治疗脊髓室管膜瘤的疗效及影响预后的因素。方法 对手术治疗的80例脊髓室管膜瘤的临床资料进行回顾性分析,参照欧洲脊髓病评分（EMS）和McCormick分级评估手术前后脊髓功能;采用多因素Logistic回归分析检验预后影响因素。结果 肿瘤全切除51例,次全切除25例,大部分切除4例。术后平均随访（37.6±19.0）个月,复发5例,均为WHOⅡ级,复发时间为（58.4±43.1）个月。末次随访有49例脊髓功能较术前改善,19例无变化,12例加重。术后McCormick分级:Ⅰ级35例,Ⅱ级22例,Ⅲ级12例,Ⅳ级11例。多因素Logistic回归分析发现,术前存在大小便功能障碍是不良预后独立危险因素,而伴脊髓空洞是预后良好因素。末次随访EMS[（15.01±0.3）分]明显高于术前[（13.55±0.35）分;P<0.001]和术后3 d[（13.20±0.31）分;P<0.001]。结论 脊髓室管膜瘤显微手术治疗后脊髓神经功能在短期内以趋于稳定为主,但从长远来看,显微手术能有效治疗脊髓室管膜瘤。存在大小便功能障碍的室管膜瘤建议及早手术治疗;伴有脊髓空洞的脊髓室管膜瘤手术预后良好。     

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.     

奥氮平治疗精神分裂症对照研究的Meta分析

目的：探讨奥氮平治疗精神分裂症的疗效和不良反应。方法：应用M eta分析对17篇奥氮平与其他抗精神病药治疗精神分裂症对照研究的文章进行再分析。结果：奥氮平自身对照比较的治疗效应极大（χ^2=141.00，P〈0.05）。治疗2周和治疗结束，奥氮平与对照药疗效比较差异无显著性（P〉0.05）;阳性与阴性症状量表（PANSS）评分比较差异亦无显著性（P〉0.05）。与对照药相比，奥氮平的不良反应显著少于对照药组（P〈0.05或P〈0.01）。结论：奥氮平与对照药的临床疗效相仿，但不良反应明显较少。