多发性肌炎/皮肌炎的组织病理定量研究和超微结构观察

对３１例多发性肌炎／皮肌炎（ＰＭ／ＤＭ）肌活检标本的７种病理改变进行了定性和定量研究。结果发现ＤＭ组束周萎缩的定性和定量评价指标均显著高于ＰＭ组和重迭综合征组（ＩＭ￣＋），其它６种病理改变各组间有很大程度的重迭。１１例ＰＭ／ＤＭ的超微结构观察发现肌纤维的改变为非特异性。毛细血管损伤仅见于ＤＭ组和ＩＭ￣＋组．。本研究提示：（１）束周萎缩足ＤＭ较具特征性的病理改变；（２）毛细血管损伤可能为电镜下区别ＰＭ和ＤＭ的参考依据。此外，本文还对束周萎缩的发生机制进行了探讨。     

多发性肌炎／皮肌炎的组织病理定量研究和超微…

对３１例多发性肌炎／皮肌炎肌活检标本的７种病理改变进行了定性和定量研究。结果发现ＤＭ组束周萎缩的定性和定量评价指标均显著高于ＰＭ组和重迭综合征组，其它６种病理改变各组间有很大程度的重迭，１１例ＰＭＫＭ的超微结构观察发现肌纤维的改变为非特异性。毛细血管损伤仅见于ＤＭ组和ＩＭ＾＋组，本研究提示（１）束周萎缩是ＤＭ较具特征性的病理改变；（２）毛细血管损伤可能为电镜下区别ＰＭ和ＫＭ的参考依据，此外，本文还     

多发性肌炎和皮肌炎患者肌肉组织中组织相容性白？…

目的 检测多发性肌炎（ＰＭ），皮肌炎（ＤＭ）和非肌炎患者肌肉组织中组织相容性白细胞，Ｉ，Ⅱ类抗原（ＨＬＡ－Ｉ，Ⅱ）分子，探讨ＰＭ和ＤＭ的发病机制，方法 用链菌素亲生物蛋白－过氧化物酶连结技术对１７例已确诊的ＰＭ和ＤＭ患者，７例非肌炎患者肌肉组织染色观察。结果 ＨＬＡ－１和ＨＬＡ－Ⅱ类分子在肌炎组的阳性率分别是８８．２４％和６４．７１％，对照组为阴性，它们主要沉积在肌纤维表面，单核细胞，毛细血管和小     

包涵体肌炎的临床研究进展

包涵体肌炎的临床研究进展段宏伟郭玉璞包涵体肌炎（ＩＢＭ）属于特发性炎性肌病（ＩＩＭ）范畴，在ＩＩＭ中以多发性肌炎（ＰＭ）、皮肌炎（ＤＭ）和ＩＢＭ最为常见。关于前两组肌病，国内外研究报道颇多，并为临床医师熟知。而ＩＢＭ目前正引起国外学者的关注，其临床病...     

急性一氧化碳中毒后迟发性脑病的诱发电位,CT和脑电图研究

目的：研究急性一氧化碳中毒后迟发性脑病（ＤＥＡＣＭＰ）患者的诱发电位（ＥＰ）、ＣＴ和脑电图（ＥＥＧ）。方法：对４６例ＤＥＡＣＭＰ患者进行ＥＰ、ＣＴ和ＥＥＧ检查，结果：异常率体感诱发电位（ＳＥＰ）８３％、视觉诱发电位（ＶＥＰ）６３％，脑士听觉诱发电位（ＢＡＥＰ）３０％，ＣＴ７１％，ＥＥＧ１００％。ＳＥＰ中的Ｐ４０、Ｎ５０，Ｐ６０和Ｎ７５峰潜伏期（ＰＬ）比正常对照组显著延长，ＶＥＰ的Ｐ１００ＰＬ较对照     

脑血管病分类亚型与血脂关系的研究

目的：阐明血脂与脑血管病分类亚型的关系。方法：检测了２０８例脑血管病患者血清血脂７项指标含量。并与对照组５０例结果进行比较。ＴＧ、ＴＣ及ＨＤＬ－Ｃ采用酶法测定，ＡＰＯＡ－１、ＡＰＯＢ１００及ＬＰ（ａ）用免疫多点定标法测定，ＬＤＬ－Ｃ由ＴＧ、ＨＤＬ－Ｃ结果按公式计算。结果：脑梗塞（ＣＩ）患者ＴＧ、ＴＣ、ＬＤＬ－Ｃ、ＡＰＯ１００及ＬＰ（ａ）含量显著高于对照组，其ＴＧ、ＡＰＯＢ１００、含量也显著高于脑出血组，且ＬＰ（ａ）与ＡＰＯＢ１００，ＨＤＬ－Ｃ相关，复发ＣＩ亚组ＴＣ、ＬＤＬ－Ｃ、ＡＰＯＢ１００含量，首发及老年ＣＩ亚组ＴＧ、ＴＣ、ＡＰＯＢ１００含量显著高于对照组。结论：血清ＴＧ、ＴＣ、ＬＤＬ－Ｃ、ＡＰＯＢ１００及ＬＰ（ａ）水平升高是ＣＩ的危险因素，其中ＴＣ、ＬＤＬ－Ｃ、ＡＰＯＢ１００对复发ＣＩ危险性大，而首发及老年ＣＩ可能主要与ＴＧ、ＴＣ、ＡＰＯＢ１００有关     

遗传性运动感觉性神经病合并肥厚性心肌病的3D—TCD,rCBF,BAEP…

目的了解遗传性运动感觉性神经病（ＨＭＳＮ）合并肥厚心肌病（ＨＣＭ）的经颅多普勒（ＴＣＤ）局部脑血流量（ｃＣＢＦ），脑干听觉诱发电位（ＢＡＥＰ）和心电图（ＥＣＧ）的变化。方法，对一家三代ＨＭＳＮ合并ＨＣＭ１２例患者和１例无症状者常规进行了这四项检查，结果ＴＣＤ，ｒＣＢＦ，ＢＡＥＰ和ＥＣＧ的异常率分别为８５％，７６％，９２％和９２％。结论绝大多烽ＨＭＳＮ合并ＨＣＭ患者的ＴＣＤ，ｒＣＢＦ，ＢＡＥＰ和ＥＣ     

急性脑梗死和Alzheimer病脑脊液高水平髓鞘素抗原B细胞免疫应答

目的确认急性脑梗死（ＡＣＩ）和Ａｌｚｈｅｉｍｅｒ病（ＡＤ）对髓鞘素碱性蛋白（ＭＢＰ）、髓鞘素结合糖蛋白（ＭＡＧ）和含脂质蛋白（ＰＬＰ）的Ｂ细胞免疫应答。方法采用酶联免疫斑点技术检测了ＡＣＩ、临床可能ＡＤ和其它神经疾病（ＯＮＤ）对照组患者外周血和脑脊液（ＣＳＦ）中ＭＢＰ、ＭＡＧ和ＰＬＰ抗体分泌细胞。结果ＡＣＩ、ＡＤ和ＯＮＤ患者外周血中均可检出ＩｇＧ、ＩｇＡ、ＩｇＭ三种表型ＭＢＰ、ＭＡＧ、ＰＬＰ抗体分泌细胞，无显著差异。但ＡＣＩ和ＡＤ患者ＣＳＦ中ＩｇＧ型ＭＢＰ、ＭＡＧ和ＰＬＰ抗体分泌细胞均呈显著性增高。结论ＡＣＩ急性脑缺血损伤和ＡＤ神经变性可能导致体内Ｂ细胞激活及ＣＮＳ内髓鞘素反应性Ｂ细胞免疫应答，其病理意义有待探讨。     

椎基底动脉供血不足ENG,BAEP,TCD的对照研究

目的：探讨眼震电图（ＥＧＮ）脑干听觉诱发电位（ＢＡＥＰ）及脑超声波（ＴＣＤ）三项检查联合用于椎基底动脉供血不足（ＶＢＩ）的诊断价值。方法：５２例临床诊断为ＶＢＩ的病人均在发病一周内行ＥＮＧ、ＢＡＥＰ及ＴＣＤ检查。结果：ＥＮＧ异常率为８８％ＢＡＥＰ异常率为５３％，ＴＣＤ异常率为７６％，结论：三项检查联合应用，可以反应小脑及脑干的功能，为评估小脑及脑干的供血情况提供有益的信息。     

多发性肌炎和皮肌炎患者肌肉组织中组织相容性白细胞Ⅰ和Ⅱ类抗原分子的表达

目的检测多发性肌炎（ＰＭ）、皮肌炎（ＤＭ）和非肌炎患者肌肉组织中组织相容性白细胞Ⅰ、Ⅱ类抗原（ＨＬＡ－Ⅰ、Ⅱ）分子，探讨ＰＭ和ＤＭ的发病机制。方法用链菌素亲生物蛋白－过氧化物酶连结技术对１７例已确诊的ＰＭ和ＤＭ患者、７例非肌炎患者肌肉组织染色观察。结果ＨＬＡ－Ⅰ和ＨＬＡ－Ⅱ类分子在肌炎组的阳性率分别是８８．２４％和６４．７１％，对照组为阴性。它们主要沉积在肌纤维表面、单核细胞、毛细血管和小血管壁上。结论研究结果提示ＨＬＡ－Ⅰ、ＨＬＡ－Ⅱ类分子在ＰＭ和ＤＭ的免疫发病机制中占有重要地位。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.