Chiari畸形合并脊髓空洞症术中不同大小后颅窝减压窗近期疗效的比较

目的 探讨不同大小后颅窝骨性减压窗对Chiari畸形合并脊髓空洞症患者手术近期疗效的影响。方法 回顾性分析2007~2010年收治的117例Chiari畸形合并脊髓空洞症患者的临床资料,均采用环枕减压硬膜成形术,空洞横径>脊髓50%者行空洞穿刺减压术。根据后颅窝减压窗面积分为2组:Ⅰ组,87例,减压面积为12 cm2（3 cm×4 cm）;Ⅱ组,30例,减压面积<6 cm2。术后2周采用Tater评分评定疗效。结果 117例患者手术后症状均无加重,症状改善97例（82.9%）,无变化20例。Ⅰ组症状改善76例（87.4%）,Ⅱ组为21例（70%）;两组症状改善率差异显著（P<0.05）。>结论 Chiari畸形合并脊髓空洞症患者的后颅窝减压面积以不小于12 cm2的近期疗效较好。     

Chiari畸形Ⅰ型的诊治现状

正Chiari畸形是一组以小脑扁桃体突出进入椎管为共同特征的疾病[1],分为四种类型。Chiari畸形Ⅰ型(Chiari malformation typeⅠ,CM-Ⅰ)以移位至枕骨大孔水平以下的形态异常小脑扁桃体为特征,异常的小脑扁桃体使枕骨大孔水平脑脊液流动产生异常,从而出现临床症状,最常见的症状为枕后或颈上疼痛[2],通常在做Valsalva动作时加重[3],还可伴有运动和/或感觉障碍、脊柱侧弯、眩晕、共济失调、晕厥和睡眠呼吸暂停等症状[4],30%～85%的CM-Ⅰ合并有脊髓空洞症。CM-Ⅰ是最常见的亚型,成人发病率在0.5%～0.9%[5],儿童在0.5%～1%[2,6]。     

22例Chiari畸形Ⅰ型合并脊髓空洞症的疗效分析

目的探讨后颅窝减压术合并枕大池重建术治疗Chiari畸形Ⅰ型合并脊髓空洞症的手术疗效。方法回顾性分析22例Chiari畸形Ⅰ型合并脊髓空洞症患者的临床资料。结果手术后1周内症状消失或改善的19例;随访术后6个月~2年,症状消失或改善的14例;其中脊髓空洞症减小或消失10例。结论后颅窝减压合并枕大池重建术是临床治疗Chiari畸形Ⅰ型合并脊髓空洞症安全有效的手术方法。     

Chiari畸形合并脊髓空洞症的外科治疗

目的对Chiari畸形合并脊髓空洞症的手术治疗方法进行探讨,评价其治疗效果。方法对30例Chiari畸形病例(合并脊髓空洞症26例)根据其MRI影像特点,选择不同手术方式进行治疗:18例无或合并轻度脊髓空洞症者行后颅窝减压术,12例合并重度脊髓空洞症行后颅窝减压并脊髓空洞切开分流术,其中4例小脑扁桃体下疝超过C2水平行后颅窝减压并小脑扁桃体切除术。结果患者术后临床症状有不同程度改善。26例获随访1～4年,其中21例空洞明显缩小或消失,5例无明显变化;17例临床症状改善。结论对Chiari畸形合并脊髓空洞症患者依据其影像学特点采取不同的手术方式,疗效满意,手术能使颅颈交界处充分减压,改善临床症状,或控制病情进展。     

Chiari畸形Ⅰ型合并脊髓空洞症的诊疗进展

正Chiari畸形(Chiari malformation,CM)是一种先天性颅颈交界区畸形,基于解剖学异常分为Ⅰ～Ⅳ型,临床以Ⅰ型较多见,普通人群发病率在0.5%～3.5%,其中30%～70%合并脊髓空洞症(syrin-gomyelia,SM)。本文就CM-Ⅰ型合并SM诊疗进展做一综述。1临床表现CM-Ⅰ型发病高峰年龄在8～41岁,临床表现严重程度与小脑扁桃体下疝程度无关[1]。CM-Ⅰ型临     

超声吸引刀在Chiari畸形Ⅰ型手术中的应用

目的 探讨Chiari畸形Ⅰ型手术中使用超声吸引刀(CUSA)切除小脑扁桃体的效果。方法回顾性分析第四军医大学唐都医院神经外科2015年8月—2017年12月,使用CUSA手术治疗20例Chiari畸形Ⅰ型患者的临床资料(其中13例合并脊髓空洞症)。术后随访观察患者症状和影像学表现的改善状况。结果 20例患者术后均得到3～21个月的随访,其中6例患者随访1年以上。术后,症状完全改善的患者5例,改善12例,稳定3例,无恶化病例;症状改善率为85%。术后影像学复查示,所有患者的小脑扁桃体均还纳至正常位置; 13例合并脊髓空洞症的患者中,空洞显著缩小3例,空洞缩小7例,空洞维持原状3例,无空洞扩大病例;空洞缩小率为76. 9%。结论 CUSA可有效切除Chiari畸形Ⅰ型的小脑扁桃体;可作为低频电凝的替代技术用于Chiari畸形Ⅰ型手术治疗中。     

Chiari I型畸形的MRI表现及其手术治疗

目的：探讨Chiari I型畸形的MRI分型及治疗方法。方法：23例Chiari I型畸形患者，21例有颈神经根症状，16例表现为中管周围损害症状，另有8例分别存在小脑及颅神经损害症状。MR检查显示，单纯小脑扁桃体下疝（B型）7例（30．43％），小脑扁桃体下疝合并脊髓空洞症（A型）16例（69．57％）。根据MRI所显示病变部位，采用不同的手术方式，其中11例后颅窝减压术，7例行后颅窝减压并小脑扁桃体切除术，5例行后颅窝减压并脊髓空洞切开引流术。结果：手术后18例患者（78．26％）症状改善，5例（21．74％）与手术前比较无明显变化，对16例伴脊髓空洞症患者中的13例进行随访，其中3例空洞消失，7例空洞显著缩小，3例空洞较手术前缩小50％。结论：手术治疗可使延髓、颈髓充分减压，有效缓解临床症状，并对脊髓空洞症具有良好的治疗效果。     

小范围后颅窝减压治疗Chiari畸形合并脊髓空洞症（附97例报告）

目的评价以更小的创伤治疗Chiari畸形合并脊髓空洞症的临床疗效。方法小范围后颅窝骨性减压窗范围一般在3cm×3cm以内,不切除C1后弓,切除下疝的小脑扁桃体,松解脊髓中央管开口隔膜,疏通第四脑室脑脊液各输出道,使脑脊液循环通畅。结果37例术后12d内MRI示下疝的小脑扁桃体下缘上升到枕骨大孔水平以上。长期随访48例,29例患者症状逐渐改善;14例症状稳定未加重;5例较术前加重,但MRI示脊髓空洞缩小。结论小范围后颅窝减压术能够改善Chiari畸形合并脊髓空洞患者的临床症状,可作为外科治疗Chiari畸形合并脊髓空洞症的一种术式。     

后颅窝减压加广泛型小脑延髓裂蛛网膜切除治疗Chiari I型畸形

综合文献报道,Chiari Ⅰ型畸形合并脊髓空洞症患者的手术治疗有后颅窝骨性减压,骨性减压加硬脑膜外层切开减压,部分作者同时行脊髓空洞分流术等术式.我们根据临床体会,采用了骨性后颅窝减压加膜性减压并行扩大小脑延髓裂蛛网膜切除、蛛网膜粘连带切除术治疗Chiari Ⅰ型畸形合并脊髓空洞症患者21例,取得满意疗效,现报道如下.     

不同手术方式治疗Chiari Ⅰ畸形合并脊髓空洞的临床研究

目的通过同顾性比较枕大孔区减压硬膜成形术及枕大孔区减压环枕筋膜松解术对Chiari Ⅰ畸形合并脊髓空洞的治疗,明确两种不同术式治疗ChiariⅠ畸形合并脊髓空洞的疗效. 方法2002年1月至2004年4月对收治的62例ChiariⅠ畸形合并空洞患者行枕大孔区减压,其中46例患者剪开硬脑膜行硬膜成形术（硬膜成形组）,16例患者未剪开硬膜仅做环枕筋膜松解（筋膜松解组）.结果两组患者无一例死亡,硬膜成形组患者术后1年临床改善39例（84.78%）,脊髓空洞缩小30例,筋膜松解组临床改善9例（56.25%）,x^2=5.528,P=0.019,脊髓空洞缩小7例. 结论枕大孔区减压硬膜成形术是治疗ChiariⅠ畸形合并脊髓空洞症较为合理的术式,疗效优于枕大孔区减压环枕筋膜松解术.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Opiate and digitalis receptor assays distinguish between neuroexcitant and inactive organochlorines and between anesthetics and convulsants

Specific binding of [3H]naloxone to rat brain tissue in vitro was inhibited by the excitant organochlorinated insecticides (OCI), by ether (E) and octanol (OCT), and by the convulsant indoklon (IND) and its anesthetic isomer, isoindoklon (ISO). In the presence of 100 mM NaCl the inhibition of naloxone binding by E, OCT and ISO was greatly potentiated, whereas that by OCI and IND was attenuated. KCl (100 mM) was equally effective as NaCl on the action of anesthetics, but the effect of the excitant drugs was, in contrast to NaCl, unaffected by KCl. Specific binding of [3H]ouabain in the absence of Na, was depressed by anesthetics and enhanced by neuroexcitants. In the presence of NaCl, which by itself inhibits ouabain binding to brain, both anesthetics and excitants enhanced ouabain binding. DDE, a non-insecticidal analog of DDT, and the dimethyl derivative of the OCI, lindane, were inactive in the receptor assays. These observations point to a unique isolated system which responds consistently to anesthetic agents as a class and, in a different way, to neuroexcitant compounds.     

Learning and forgetting new names and objects in MCI and AD

We studied how subjects with mild cognitive impairment (MCI), early Alzheimer's disease (AD) and age-matched controls learned and maintained the names of unfamiliar objects that were trained with or without semantic support (object definitions). Naming performance, phonological cueing, incidental learning of the definitions and recognition of the objects were tested during follow-up. We found that word learning was significantly impaired in MCI and AD patients, whereas forgetting patterns were similar across groups. Semantic support showed a beneficial effect on object name retrieval in the MCI group 8 weeks after training, suggesting that the MCI patients’ preserved semantic memory can compensate for impaired episodic memory. The MCI group performed equally well as the controls in the tasks measuring incidental learning and recognition memory, whereas the AD group showed impairment in this respect. Both the MCI and the AD group benefited less from phonological cueing than the controls. Our findings indicate that word learning is compromised in both MCI and AD, whereas long-term retention of newly learned words is not affected to the same extent. Incidental learning and recognition memory seem to be well preserved in MCI.     

Necdin蛋白与神经元的生长分化

在神经系统 ,Necdin只在成熟神经元的细胞核中表达 ,可能与成熟神经元分裂静止状态的保持有关。近年的研究表明 ,Necdin是一种生长抑制蛋白 ,能与多种因子如SV4 0大T抗原 ,腺病毒E1A ,转录因子E2F1以及肿瘤抑制蛋白p5 3等结合 ,在功能上类似于成视网膜瘤蛋白Rb。necdin基因缺陷时 ,会引起脑内 ,特别是下丘脑神经元分化障碍。人类necdin基因位于PWS综合征的基因缺失区 ,可能与PWS的一些症状有关。本文从Necdin蛋白的基本概况 ,生物功能以及Necdin与疾病三个方面进行了综述     

Satellite cells and myonuclei in young and elderly women and men

The overall aim of this study was to assess the effects of aging on the satellite cell population. Muscle biopsies were taken from the tibialis anterior muscle of healthy, moderately active young (age range, 20-32 years; n = 31) and elderly (age range, 70-83 years; n = 27) women and men with comparable physical activity pattern. Satellite cells and myonuclei were visualized using a monoclonal antibody against neural cell adhesion molecule and counterstained with Mayer's hematoxylin. An average of 211 (range, 192-241) muscle fibers were examined for each individual. Compared with the young women and men, the elderly subjects had a significantly lower (P < 0.011) number of satellite cells per muscle fiber but a significantly higher (P < 0.004) number of myonuclei per muscle fiber. The number of satellite cells relative to the total number of nuclei [satellite cells/(myonuclei + satellite cells)] was significantly lower in the elderly than in the young women and men. These results imply that a reduction in the satellite cell population occurs as a result of increasing age in healthy men and women.     

Necdin蛋白与神经元的生长分化

在神经系统,Necdin只在成熟神经元的细胞核中表达,可能与成熟神经元分裂静止状态的保持有关.近年的研究表明,Necdin是一种生长抑制蛋白,能与多种因子如SV40大T抗原,腺病毒E1A,转录因子E2F1以及肿瘤抑制蛋白p53等结合,在功能上类似于成视网膜瘤蛋白Rb.necdin基因缺陷时,会引起脑内,特别是下丘脑神经元分化障碍.人类necdin基因位于PWS综合征的基因缺失区,可能与PWS的一些症状有关.本文从Necdin蛋白的基本概况,生物功能以及Necdin与疾病三个方面进行了综述.     

Retrospective and prospective design and data

The study of the presentation, symptomatology and family characteristics of an exclusively adolescent sample of patients with borderline personality disorder (BPD) was undertaken. Twenty-four cases of borderline personality disorder, 20 females, 4 males, identified using chart review and meeting the criteria of the Diagnostic Interview for Borderlines (DIB) and DSM III-R, were matched with psychiatric controls. Adolescents with borderline personality disorder were found to have high rates of affective symptomatology with Axis I diagnosis of major depressive disorder - MDD (DSM-III-R), and high rates of interpersonal psychopathology, i.e., manipulation, devaluation, and a pervasive sense of boredom. The latter seem to be characteristic as for adults with borderline personality disorder. The families were particularly angry and volatile.     

Cortisol levels and depression in men and women using heroin and cocaine

Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are well documented in men using illicit drugs and/or infected with HIV; however, less is known about HPA function, or the health consequence of HPA dysfunction, in their female counterparts. People with depression exhibit hypercortisolemia, and depression is common in people with HIV or substance use problems. The current study investigated cortisol secretion in 209 demographically matched men and women, stratified by their HIV and drug use status. Self-reported depressive symptoms were evaluated using a standardized, validated questionnaire (CES-D). Women reported more depressive symptoms than men (p=.01). Male and female drug users exhibited higher cortisol concentrations (p=.03), and were more likely to report depressive symptoms (p=.04), than non-users. Depression was related to elevated cortisol concentrations for the study population (p=.03), and women with elevated cortisol concentrations were significantly more depressed than all other participants (p=.05). While it is unknown whether high cortisol concentrations precede depressive symptoms or vice versa, these data indicate that higher cortisol concentrations are associated with depressive symptoms in heroin and cocaine users, and that this association is more pronounced in women than men. HIV status did not act in an additive or synergistic way with drug use for either cortisol or CES-D measures in the current study. Unique therapies to treat the endocrine and mental health consequences of illicit drug use in men and women deserve consideration as depressive symptoms, and high cortisol concentrations associated with depressive symptoms, differ by gender.     

相关性和一致性：这对相仿概念和测量方法的回顾与阐明

概述：一致性(agreement)和相关性(correlation)是两个广泛使用的概念,用来评估变量之间的关联。虽然二者相似且相关,但是它们代表关联完全不同的概念。评估变量之间的一致性假设变量测量的是相同的结构,而在变量测量完全不同的结构时也可以评估它们之间的相关性。这种概念上的差异就要求使用不同的统计方法,并且当评估一致性或相关性时,统计方法根据数据的分布和研究者的兴趣可能会有所不同。例如, Pearson相关性,作为评估连续变量之间相关性的一种普遍测量方法,只有用于符合线性关系的变量时才能提供有用的信息;当用于不符合线性关系的变量时就无法提供准确信息甚至会产生误导。同样地,内部相关性,作为一种评估连续变量之间一致性的常用方法,如果一致性不好的实质正好是研究兴趣所在,那么该测量就不能为研究者提供充分的信息。本报告回顾了一致性和相关性的概念,并讨论了几种常用方法在应用中的差异。