经颅磁刺激运动诱发电位检测在脑梗死患者运动功能预后评估中的应用价值

目的探讨经颅磁刺激运动诱发电位(MEP)检测在脑梗死患者运动功能预后评估中的应用价值。方法选取佛山市禅城区向阳医院神经内科2012—2013年收治的46例脑梗死患者作为观察组,选取同期46例体检健康者作为对照组。观察组患者入院3 d内行患肢MEP检测,对照组健肢行MEP检测。观察两组受检者MEP异常情况,比较观察组患者患肢和对照组健肢皮质手区和皮质腿区潜伏期及中枢运动传导时间(CMCT),分析观察组患者患肢皮质潜伏期和CMCT与改良爱丁堡-斯堪的那维亚量表(MESSS)评分及Barthel指数量表(BI)评分的相关性。结果观察组患者MEP异常率为82.6%(38/46),对照组未出现MEP缺失。观察组患者患肢皮质手区和皮质腿区潜伏期及CMCT长于对照组(P0.05)。观察组患者患肢皮质潜伏期与MESSS评分(r=0.74,P0.05)呈正相关,与BI评分(r=-0.59,P0.05)呈负相关;观察组患者患肢CMCT与MESSS评分(r=0.84,P0.05)呈正相关,与BI评分(r=-0.74,P0.05)呈负相关。结论在脑梗死患者运动功能预后评估中,MEP检测安全有效,操作简单,可有效预测患者预后,具有较高的临床应用价值。     

阻塞性睡眠呼吸暂停低通气综合征患者膈肌对经颅磁刺激的反应

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者经颅磁刺激(TMS)膈肌运动诱发电位(MEP)的变化及可能机制.方法 2005年6月至2006年6月就诊广州医学院第一附属医院呼吸疾病研究所的健康体检者及鼾症患者,分为健康对照组16例,单纯鼾症组7例,OSAHS轻中度组13例及重度组16例,均使用TMS结合经颈椎棘突磁刺激(CMS)及多导食管电极测定右侧膈肌MEP的潜伏期、幅值和中枢运动传导时间(CMCT),5例OSAHS患者经有效鼻持续气道正压通气(nCPAP)治疗超过2个月后复查上述指标.采用SPSS 12.0统计软件进行数据分析,检测结果 以x±s表示.结果 OSAHS重度组右侧膈肌MEP的幅值为(152±116)μV,明显低于健康对照纽的(414±201)μV、单纯性鼾症组的(352±99)μV及OSAHS轻中度组的(372±206)μV;其膈肌MEP的潜伏期和CMCT分别为(18.1±1.8)和(10.6±1.8)ms,与健康对照组的(13.9±1.6)和(7.7±1.7)ms相比,单纯性鼾症组的(14.6±1.6)和(8.1±1.6)ms以及轻中度组的(15.4±2.7)和(9.0±2.2)ms明显延长.膈肌MEP的幅值、潜伏期及CMCT与微醒觉指数、呼吸暂停最长时间、夜间最低脉搏容积血氧饱和度(SpO2)、低氧指数、SpO2<90%占总睡眠时间比例以及呼吸暂停低通气指数(AHI)均具有相关性.5例重度OSAHS患者经nCPAP治疗超过2个月后,膈肌MEP的潜伏期较治疗前缩短,分别为(17.5±0.6)和(15.5±0.7)ms.结论 OSAHS患者膈肌MEP的潜伏期和CMCT均延长,而MEP的振幅降低,这些变化可能与反复夜间低氧、二氧化碳潴留及睡眠结构紊乱有关.     

低频阈上重复经颅磁刺激对脑梗死患者运动诱发电位及神经功能的影响

目的研究低频阈上重复经颅磁刺激（rTMS）对脑梗死患者运动诱发电位（MEP）及神经功能恢复的影响。方法收集大脑中动脉供血区脑梗死患者30例,随机分为刺激患侧组、刺激健侧组及自然恢复组（不接受磁刺激治疗）,每组10例。在发病后3～5d,对刺激组患者行rTMS治疗,频率为0.5Hz,70%输出强度（3.0T）,900脉冲/d,连续10d。在治疗前（试验第1天）和治疗后第10、40天记录患侧脑区运动诱发电位（MEP）的潜伏期、波幅、中枢运动传导时间（CMCT）值及美国国立卫生研究院卒中量表（NIHSS）、日常生活活动能力（ADL）评分。结果①刺激患侧组与自然恢复组、刺激健侧组及自身治疗前比较,治疗后第10和40天MEP的潜伏期缩短,波幅加大,CMCT加快,且随着治疗时间的延长,差异更显著（均P〈0.05或〈0.01）。刺激健侧组和自然恢复组比较,上述指标差异均无统计学意义（P〉0.05）;但此两组自身比较,第40天波幅和CMCT均较治疗前差异有统计学意义（P〈0.05）。②两刺激组与自然恢复组和自身治疗前比较,第10和40天NIHSS及ADL评分差异均有统计学意义,第40天差异更显著（P〈0.01）。治疗前两刺激组比较,各时间点差异均无统计学意义。③不同时间点MEP的潜伏期和CMCT均与NIHSS呈正相关,与ADL评分呈负相关;波幅与NIHSS呈负相关,与ADL评分呈正相关（P〈0.05或〈0.01）。结论rTMS作用于脑梗死患者患侧脑区,对MEP有明显影响,对神经功能恢复有促进作用;作用于健侧脑区仅对神经功能恢复有促进作用。     

脑梗死患者的磁刺激运动诱发电位检测及临床相关性初步研究

目的　探讨经颅磁刺激运动诱发电位 (MEP)异常与缺血性脑卒中患者临床病情之间的相关性及临床意义。方法　对 30例缺血性脑卒中患者分别进行经颅磁刺激 ,双侧外展小指肌 (ADM)记录运动诱发电位。结果　临床肌力 (0～ 5级 ) 4级以上者 11例患者在静止状态下可引出MEP波 ,10例肌力 3级者在轻收缩状态下可引出MEP波 ,肌力 0～ 2级的 9例患者不能引出MEP波。脑梗死组病侧中枢传导时间 (CMCT)比健侧明显延长由 (7.9± 0 .7)ms延长至 (10 .2± 0 .8)ms。通过对MEP波的潜伏期、波幅、中枢传导时间以及对照组 30例的MEP波进行统计学分析 ,发现MEP异常与临床运动功能障碍密切相关 ,能反映卒中患者病情的轻重。结论　经颅磁刺激运动诱发电位能较好地反应缺血性脑卒中患者的病情 ,可用于临床判断病情。     

经颅磁刺激诱发运动诱发电位对脑梗死失语患者预后的早期评价

目的探讨经颅磁刺激（TMS）诱发运动诱发电位（MEP）对急性脑梗死失语患者进行早期预后评价的应用价值。方法选择40例急性左侧大脑半球脑梗死伴有运动性失语的右手利患者,分别于发病后7d及90d经TMS后行MEP检查,同时进行汉语失语检查表（ABC）评分、整体神经功能缺损（NIHSS）评分、日常生活能力（BI）评分;分析患侧大脑皮质MEP潜伏期、阈值、中枢运动传导时间（CMCT）及静息期（sP）与临床评分的相关性。结果患侧皮质发病后7d与90d相比,MEP潜伏期、阈值、CMCT和SP有统计学差异（P均〈0．01）,ABC、NIHSS以及BI评分有统计学差异（P均〈0．05）。ABC、BI评分与SP呈负相关（r=-0．652、-0．566,P均〈0．05）,NIHSS评分与SP呈正相关（r=0．43t,P〈0．05）。结论MEP指标的变化可以直接反映中枢运动传导通路的损伤程度,SP可以作为早期评价患者神经损害程度的一项敏感指标。     

利用功能磁共振成像对皮质下脑梗死运动功能恢复机制的研究

目的利用功能磁共振成像(fMRI)对皮质下脑梗死运动功能恢复的神经机制进行探讨。方法选择运动功能恢复较好的慢性期单侧皮质下脑梗死患者23例为患者组,年龄匹配的健康志愿者24例为对照组。用FuglMeyer量表评价患者的运动功能。fMRI实验采用组块设计,分别进行双手虚握拳运动,采用统计参数图比较2组执行手运动任务时脑激活的异同。结果对照组及患者组健手运动主要激活运动对侧感觉运动区、同侧小脑半球及双侧辅助运动区。患者组患手运动激活部位与对照组相同。与对照组比较,患者组患手运动时病灶侧初级运动皮质(M1)激活增强。结论在运动通路皮质下脑梗死患者运动功能恢复中,病灶侧M1区激活增强起重要作用。     

Graves病患者磁运动诱发电位改变的探讨

应用磁运动诱发电位(MEP)检测46例Graves(GD)病患者和50名正常对照组MEP潜伏期、波幅及中枢运动传导时间(CMCT)。GD患者MEP潜伏期延长、波幅降低及CMCT缩短,提示GD患者神经元有损害。     

经颅皮层电刺激对脑梗死病人运动功能的影响

目的 探讨经颅皮层电刺激对急性脑梗死病人运动功能恢复的疗效.方法 60例急性脑梗死病人随机分为两组,治疗组用经颅皮层电刺激加常规治疗,对照组仅用常规治疗.用Fugl-Meyer运动功能(FMA)评分法、Barthel指数评分法及经颅皮层电刺激运动诱发电位(MEP)观察病人疗效.结果 治疗30 d后, 治疗组FMA及Barthel指数得分高于对照组(P<0.01),MEP皮层电位潜伏期及CMCT均较对照组明显缩短(P<0.01),皮层电位波幅明显增高(P<0.01).结论 经颅皮层电刺激是促进急性脑梗死病人肢体运动功能恢复的有效方法.     

急性脑梗死患者脑磁图运动相关磁场特征研究

目的研究急性脑梗死患者脑磁图运动相关磁场的变化特征。方法2003-06~2004-08对河北省人民医院9例急性脑梗死患者和6名健康志愿者进行MEGMRCFs检测。患者看到一侧闪光信号提示后,相应侧食指做一次抬起放下运动触发光电耦合作为“0”时刻,MRCFs波峰由等价电流偶极子(ECD)评估,并与超薄MRI进行影像融合。结果MRCFs波峰的ECD均位于两侧初级运动皮层“手区”,患者组MRCFs波峰潜伏期延迟(P<0.01),尤以患侧为重,患侧ECD强度较健侧减小(P<0.01)。结论MEG测定MR-CFs可客观、灵敏的检测出急性脑梗死患者运动皮层功能的损伤。     

不典型帕金森患者皮质脊髓束损害的电生理特点——三重刺激技术研究初探

目的 分析三重刺激技术（TST）对评价不典型帕金森患者皮质脊髓束损害的临床应用价值。方法 病例组为2009年7月在北京协和医院就诊的6例不典型帕金森患者（多系统萎缩5例，进行性核上性麻痹1例），对照组为12例年龄匹配的正常人或非神经系统疾病患者。对受试者进行右上肢小指展肌TST和传统运动诱发电位（MEP）测定，分析TST波幅比（TST测试/TST对照）、中枢运动传导时间（CMCT）、静息运动阈值（RMT）、MEP潜伏期特点。对上述电生理指标进行与病程和年龄的相关性分析。结果 与对照组相比，不典型帕金森患者的TST波幅比明显降低[（40.7%±18.6%） vs （96.8%±3.0%），P＝0.001]，RMT明显升高[（63.3±5.2） vs （48.6±8.4），P＝0.001]，MEP潜伏期和CMCT在两组间差异无统计学意义（P＞0.05）。TST和传统MEP相关参数与病程或年龄之间均未见显著性相关，但是TST波幅比与病程呈现负相关趋势。结论 TST较传统MEP能更好地评价不典型帕金森患者的皮质脊髓束损害。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.