重复经颅磁刺激对精神分裂症患者前额叶代谢物质的影响

目的：探讨10 Hz重复经颅磁刺激(rTMS)对精神分裂症患者双侧前额叶代谢物质的影响及rTMS安全性。方法以符合ICD-10中精神分裂症诊断标准的55例患者为研究对象,随机分为研究组(n＝27例)和病例对照组(n＝28例),分别给予4周10 Hz rTMS真刺激和假刺激治疗,两组治疗期间均联合应用利培酮片。rTMS治疗前后进行磁共振氢质子波谱(1H-MRS )检测。结果治疗前两组间双侧前额叶NAA/Cr值、Cho/Cr值无明显差异(P＞0.05);治疗后研究组左侧前额叶NAA/Cr值高于病例对照组,差异有统计学意义(P＜0.05)。与治疗前比较,研究组治疗后左侧前额叶NAA/Cr值增高,差异有统计学意义(P＜0.05)。病例对照组双侧前额叶NAA/Cr值和Cho/Cr值与治疗前比较,均无明显差异(P＞0.05)。两组患者不良反应发生率比较,差异无统计学意义(P＞0.05)。结论10 Hz rTMS可以修复精神分裂症患者受损的左侧前额叶神经元功能。     

男性精神分裂症患者前额叶和丘脑质子波谱分析

目的 探讨男性精神分裂症患者前额叶、丘脑的氢质子磁共振波谱(1H-MRS)的特点.方法 以26例7 d内未使用抗精神病药物及影响脑内乙酰胆碱神经递质药物的男性精神分裂症患者为研究组,以28名正常人为对照组.在入组24 h内两组采用多体素1H-MRS检测前额叶和丘脑生化代谢物N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),完成NAA/Cr值、Cho/Cr值和NAA/(Cho+Cr)值的计算.结果 与对照组相比,研究组左侧前额叶及左、右侧丘脑NAA/Cr值(分别为1.40±0.34、1.45±0.31和1.51±0.32)均低于对照组(分别为1.69±0.31、1.69±0.23和1.70±0.28),差异有统计学意义(P均<0.05).Cho/Cr值和NAA/(Cho+Cr)值两组间比较差异无统计学意义.结论 男性精神分裂症患者的1H-MRS与正常人存在差异,左侧前额叶及丘脑同时存在神经元的功能和(或)结构异常.     

青年抑郁症患者额叶三维氢质子波谱和扩散张量成像研究

目的 应用MR三维氢质子波谱（3D1^H MRS）和扩散张量成像（DTI）技术，探讨青年抑郁症患者额叶可能存在的神经生化异常。方法 对54例青年抑郁症患者（抑郁症组）和50例年龄和性别匹配的志愿者（正常对照组）进行3D1^H MRS和DTI研究，测量双侧额叶背外侧白质和前部扣带回皮质的N-乙酰天门冬氨酸（NAA）、胆碱复合物（Cho）、肌醇（mI）和肌酸（Cr）的绝对值，计算NAA、Cho、mI与Cr的比值，以及双侧额叶白质的表观弥散系数（ADC）和各向异性分数（FA），并对两组进行对比分析。结果 ①抑郁症组患者前额叶扣带回皮质Cho、mI的绝对值及Cho/Cr、mI/Cr比值明显高于对照组，P〈0.01;而NAA绝对值、NAA/Cr比值两组间差异无统计学意义，P〉0.05。②抑郁症组前额叶背外侧白质内NAA、Cho、mI的绝对值以及与Cr的比值与对照组比较，均无统计学意义，P值均〉0.05。③抑郁症组患者前额叶白质的ADC值明显高于对照组，FA值明显低于对照组P值均〈0.01）。结论 前额叶扣带回皮质的Cho、mI值及Cho/Cr、mI/Cr比值增高、以及前额叶白质的ADC值增高和FA值降低可能构成了青年抑郁症患者发病的神经生物学基础。     

1H-MRS评价精神分裂症幻听患者扣带回代谢物比值

目的:基于~1H-MRS探讨精神分裂症幻听患者扣带回各代谢物比值改变。方法:精神分裂症患者30例,根据PANSS中P3值,分为无幻听组(P3值≤3分)15例和幻听组(P3值3分)15例,另选择同期健康受试者15例为对照组。3组均行扣带回~1H-MRS扫描,比较3组扣带回的N-乙酰天门冬氨酸(NAA)/[胆碱复合物(Cho)+肌酸(Cr)]、NAA/Cr、NAA/Cho和Cho/Cr比值,分析精神分裂症幻听患者扣带回各代谢物比值与病程、发病年龄及幻听分值的相关性。结果:幻听组的NAA/(Cho+Cr)、NAA/Cr、NAA/Cho低于对照组(P0.05)、无幻听组(P0.05),且无幻听组以上指标均低于对照组(P0.05);而3组间Cho/Cr相比无统计学意义(P0.05)。扣带回NAA/(Cho+Cr)、NAA/Cr比值与幻听分值明显相关(P0.05),Cho/Cr比值与幻听分值无相关性(P0.05);NAA/(Cho+Cr)、NAA/Cr、NAA/Cho与发病年龄、病程无明显相关性(P0.05);Cho/Cr与发病年龄相关(P0.05),与病程、幻听分值无相关性(P0.05)。结论:精神分裂症幻听患者扣带回存在显著的代谢异常,扣带回可能作为传导通路的一个环节,与幻听发生可能有密切的关系。     

2型糖尿病患者海马氢质子磁共振波谱分析研究

目的总结2型糖尿病患者海马氢质子磁共振波谱（proton magnetic resonance spectroscopy,1 H-MRS）的特点。方法 29例2型糖尿病患者为观察组,25例体检健康者为对照组,入组24h内采用多体素1 H-MRS检测2组双侧海马N-乙酰基天门冬氨酸（N-acetylaspartate,NAA）、胆碱复合物（choline,Cho）与肌酸复合物（creatine-phosphocreatine,Cr）,计算NAA/Cr比值和Cho/Cr比值并进行比较。结果观察组左侧海马NAA/Cr比值（1.44±0.38）低于对照组（1.73±0.37）（P〈0.05）,右侧海马NAA/Cr比值（1.59±0.40）与对照组（1.68±0.61）比较差异无统计学意义（P〉0.05）;观察组左、右侧海马Cho/Cr比值（1.74±0.40和1.67±0.42）均高于对照组（1.39±0.47和1.36±0.49）（P〈0.05）;2组左侧海马NAA/Cr和Cho/Cr比值与右侧比较差异均无统计学意义（P〉0.05）。结论 2型糖尿病患者存在海马神经元代谢的异常。     

抑郁症中医辩证与前额叶及海马^1H-MRS的相关性探讨

目的 探讨抑郁症中医辨证分型与前额叶及海马磁共振氢质子波谱(1H-MRS)变化的相关性.方法 随机选取60例抑郁症患者,辨证分型为A组(痰热型)、B组(瘀血型)、C组(虚热型)、D组(寒湿型)四型,应用三维磁共振氢质子波谱(3D1 H-MRS)检查,并分别与20例健康者对照,比较双侧前额叶背外侧白质和海马组织氮-乙酰天门冬氨酸(NAA)/胆碱(Cho)、NAA/肌酸(Cr)和Cho/Cr的比值.结果 A、C组双侧前额叶Cho/Cr与对照组的差异有显著性意义(P<0.05);B、C、D三组双侧海马NAA/Cr与对照组的差异有显著性意义(P<0.05).结论 抑郁症患者前额叶、海马部位的相关生化物质代谢改变与不同中医证型有一定相关性.     

血管性痴呆不同中医证型磁共振波谱特点

目的:探讨血管性痴呆(VD)患者不同中医证型磁共振波谱(1H-MRS)检查特点。方法:对VD肾精亏虚、痰浊阻窍、瘀血阻络患者各15例,行头颅1H-MRS检查,测得N-乙酰天门冬氨酸(NAA)、乙酰胆碱(Cho)、肌酸(Cr)及NAA/Cr、Cho/Cr。结果:其中右侧丘脑中Cho/Cr及NAA/Cr3组比较未见明显差异。左侧丘脑中NAA/Cr肾精亏虚组低于瘀血阻络组(P0.05);3组Cho/Cr比较未见明显差异。右侧额叶中Cho/Cr痰浊阻窍组高于瘀血阻络组(P0.05);肾精亏虚证患者NAA/Cr比值明显低于痰浊阻窍组(P0.01)和瘀血阻络组(P0.05)。左侧额叶中Cho/Cr痰浊阻窍组高于瘀血阻络组(P0.05);肾精亏虚证患者NAA/Cr比值明显低于痰浊阻窍组(P0.05)和瘀血阻络组(P0.01)。右侧海马Cho/Cr痰浊阻窍组高于其他2组(P0.01);3组NAA/Cr比较未见明显差异。左侧海马中Cho/Cr及NAA/Cr3组比较未见明显差异。结论:肾精亏虚证、痰浊阻窍证及瘀血阻络证患者的1H-MRS有不同表现。其中,肾精亏虚证患者双侧额叶NAA/Cr水平较其他2组下降,可作为其诊断成立的依据之一。痰浊阻窍证患者双侧额叶及海马Cho/Cr较其瘀血阻络组有不同水平的升高,可作为鉴别诊断。     

轻度认知功能障碍患者记忆损害特点及与氢质子磁共振波谱的相关性研究

目的分析轻度认知功能障碍(MCI)和阿尔茨海默病(AD)患者的记忆损害特点及其与氢质子磁共振波谱(1H-MRS)的关系,探讨记忆功能评定及1H-MRS对MCI和AD的诊断和鉴别诊断的作用。方法用中文听觉词汇学习测验、Rey-Osterrieth复杂图形测验(ROCFT)和韦氏记忆量表中文版的逻辑记忆分测验分别对30例MCI患者、24例AD患者和20例健康对照进行听觉记忆、视觉记忆和逻辑记忆的评分;采用刺激回波序列进行检测,计算双侧额叶和双侧海马的N-乙酰天冬氨酸/肌酸(NAA/Cr)、胆碱/肌酸(Cho/Cr)、肌醇/肌酸(MI/Cr)、N-乙酰天门冬氨酸/肌醇(NAA/MI)等的比值;比较各组间记忆功能评分和各代谢物比值的差别,并进行相关分析。结果 (1)MCI组和AD组的MoCA总分、短时延迟记忆、长时延迟记忆、延时再认、视觉记忆、逻辑记忆评分及AD组的即刻记忆评分均低于对照组(P<0.05);MCI组的MoCA总分、长时延迟记忆、延时再认、视觉记忆、逻辑记忆评分均高于AD组(P<0.05),而即刻记忆、短时延迟记忆评分与AD组差异无统计学意义(P>0.05)。(2)MCI组和AD组左侧额叶、左侧海马的NAA/Cr比值均低于对照组(P<0.05);MCI组和AD组左侧额叶MI/Cr比值高于对照组(P<0.05);MCI组和AD组左侧额叶、双侧海马的NAA/MI比值低于对照组(P<0.05)。与AD组相比,MCI组左侧额叶、左侧海马的NAA/Cr比值升高,差异有统计学意义(P<0.05),左侧额叶、双侧海马的NAA/MI比值升高,差异有统计学意义(P<0.05);Cho/Cr比值在各组间差异无统计学意义(P>0.05)。(3)MCI组和AD组的记忆减退与左侧额叶、左侧海马NAA/Cr和NAA/MI存在正相关(P<0.05)。结论在记忆功能损害方面MCI患者与AD患者具有相似性,且记忆损害与左侧额叶、左侧海马的1H-MRS有相关性,记忆功能评分与1H-MRS结合可作为MCI和AD早期诊断及鉴别诊断的重要工具。     

1H-MRS评价颞叶癫痫患者杏仁核代谢物比值

目的 采用¹H-MRS探讨颞叶癫痫(TLE)患者双侧杏仁核的各代谢物比值改变.方法 对15例TLE患者(TLE组)和15名健康志愿者(正常对照组)行杏仁核¹H-MRS扫描,比较两组杏仁核的N-乙酰天门冬氨酸(NAA)/、NAA/Cr、NAA/Cho和Cho/Cr比值,分析TLE患者双侧杏仁核各代谢物比值与癫痫病程和发病年龄的相关性.结果 TLE组患侧杏仁核NAA/(Cho+Cr)和NAA/Cr比值与正常对照组比较均明显减低(P均 <0.05);TLE组患侧杏仁核NAA/(Cho+Cr)、NAA/Cr、NAA/Cho和Cho/Cr比值与TLE组对侧比较差异均无统计学意义(P均 >0.05);TLE组对侧杏仁核NAA/(Cho+Cr)、NAA/Cr和NAA/Cho比值与正常对照组比较均明显减低(P均 <0.05).TLE组双侧杏仁核NAA/(Cho+Cr)、NAA/Cr和NAA/Cho比值与癫痫病程及发病年龄均无相关性(P均 >0.05).结论 TLE患者双侧杏仁核存在显著的代谢异常,双侧杏仁核可能作为传导通路的一个环节,参与TLE的发病过程.     

帕金森病抑郁患者双侧额叶的磁共振波谱改变及意义

目的研究帕金森病抑郁(DPD)患者额叶磁共振波谱(1H-MRS)的改变及其临床意义。方法对20例DPD患者、23例PD患者和20名正常对照者的双侧额叶进行~1H-MRS检测,分析3组双侧额叶的N-乙酰基天门冬氨酸(NAA)/肌酸复合物(Cr)和含胆碱化合物(Cho)/Cr值的变化。结果 DPD患者症状首发侧额叶的NAA/Cr值显著低于PD患者(P0.05),Cho/Cr值显著高于PD患者(P0.05)。DPD患者症状首发侧额叶的NAA/Cr和Cho/Cr值与PD患者比较无显著差异。结论~1H-MRS可以检测到DPD患者额叶的代谢改变,有助于DPD的病因诊断及风险预测。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。