人脑顶叶在空间记忆认知功能中的作用

目的:通过功能磁共振成像(fMRI)技术研究健康人脑顶叶在处理空间记忆信息时的作用。方法:在对10例右利手健康志愿者进行一项短时空间记忆任务作业的同时,进行fMRI扫描,实验采用组块设计并采用SPM99软件进行数据分析和脑功能区定位。结果:当统计阈值设为P<0.001时,大脑皮质所激活的脑区有双侧顶叶的楔前叶、顶上小叶、缘上回(BA7/40,BA:BrodmannArea,布鲁德曼分区,下同),双侧前额上中下回(BA6/9/47),双侧枕叶和枕颞交界处(BA17/18/19/37),右侧海马和右侧扣带回;左侧顶叶的激活强度最强,左侧顶叶与双侧前额叶以及右侧顶叶与左侧前额叶之间的激活强度差异均有统计学意义(P<0.05)。结论:人脑在处理短时空间记忆信息时,顶叶起主导性作用。     

轻度认知障碍小脑静息态功能连接的改变及相关因素分析

目的 探讨轻度认知障碍（MCI）患者小脑静息态功能连接（rsFC）改变,并分析功能连接变化与认知功能的相关性。方法 选取2012年9月至2015年12月于首都医科大学宣武医院神经内科记忆障碍门诊就诊的22例MCI患者作为观察组,另选取同时期体检人群中与观察组患者年龄、性别及教育年限相匹配的正常老年人28例作为对照组（HC）。应用静息态功能磁共振成像技术（rs-fMRI）采集数据,比较两组患者小脑认知相关亚区脚Ⅱ和小叶IX与全脑其他脑区功能连接差异,采用偏相关分析法探究MCI组脑功能连接改变与临床量表分值之间相关性。结果 与HC组比较,MCI组小脑亚区主要与额顶叶部分脑区、岛叶及小部分颞叶脑区连接减弱,同时伴有额顶枕叶及边缘叶部分脑区连接增强,但MCI组右侧小脑半球脚Ⅱ亚区无连接增强脑区。MCI组左侧小脑半球脚Ⅱ亚区与左额中回、左内侧额上回功能连接强度分别与听觉词语学习测验延迟再认（AVLT-R）存在正相关性（r=0.501、0.495,P均<0.05）,右侧小脑小叶IX亚区与左额上回背外侧功能连接强度与AVLT-R存在正相关性（r=0.524,P<0.05）。右侧小叶IX亚区与右楔前叶之间功能连接与简易智能精神状态量表（MMSE）呈现相关性（r=0.462,P<0.05）。结论 MCI患者小脑半球脚Ⅱ和小叶IX亚区异常功能连接改变与认知功能相关。     

认知策略调节尼古丁依赖者心理渴求的神经机制研究

目的:认知策略是一种有效的预防成瘾复吸的方法。因此,研究认知策略对尼古丁依赖者心理渴求的影响及其神经机制可以为探索治疗尼古丁依赖和复吸的心理学和药物干预措施提供理论指导。方法:本课题采用功能性磁共振(fMRI)对认知策略调节尼古丁依赖者心理渴求的神经机制进行研究。扫描范式为部分奖赏条件反射范式,在条件性刺激出现前,给予认知策略进行干预。扫描过程中,同时检测皮肤电导反应(SCR),扫描结束后要求受试者填写心理渴求问卷。结果:(1)行为学结果:戒断后的尼古丁依赖者暴露于伴随香烟的条件性刺激(CS+)时,皮肤电导反应显著增加,同时伴有心理渴求的增加。而认知策略可以非常有效地降低CS+诱发的皮肤电导反应及心理渴求。(2)神经影像学结果:戒断后的尼古丁依赖者暴露于CS+时,激活的脑功能区主要包括:双侧辅助运动区、双侧背外侧前额叶、右侧后扣带、左侧枕上回、左侧顶下小叶、左侧楔前叶、左侧顶上小叶、双侧纹状体尾状核。认知策略调节后,戒断后的尼古丁依赖者暴露于CS+时,激活脑区主要包括:右侧前扣带皮层、左侧旁海马回、右侧楔叶、左侧中央后回,左侧顶上小叶、左侧梭状回、右侧眶额皮层、双侧旁中央小叶、左侧中央前回、右侧额内侧回、右侧背外侧前额皮层。(3)相关性分析发现:认知策略调节心理渴求的下降与认知策略调节右侧前扣带皮层及右侧眶额皮层脑区的激活程度成正相关。结论:尼古丁依赖者对香烟产生期待及心理渴求增加时,与奖赏、记忆、动机相关的脑区激活。认知策略降低尼古丁依赖者对香烟的期待及心理渴求,该调节作用与做决定、情感及认知控制和注意力调节等相关的脑区激活有关。这一发现确定了调节尼古丁依赖者心理渴求的脑区,为治疗尼古丁依赖提供了靶点。     

首发精神分裂症药物治疗前后的fMRI分析

目的分析总结首发精神分裂症药物治疗前后的倒背数字作业测试(BDST)静脉息态功能磁共振(f MRI)脑内激活区特点。方法研究对象为20例符合ICD-10精神分裂症诊断的首发精神分裂症患者与20例健康者,经BDST刺激检查f MRI,利培酮治疗患者中10例再次接受fMRI检查。结果 BDST的fMRI检查中,首发精神分裂症患者的左侧额上回、左侧额下回、双侧顶叶后下部等脑区激活低下,10例利培酮治疗后患者左侧额上回、左侧额下回激活低下改善明显(P <0.05)。结论 f MRI不仅可作为首发精神分裂症的诊断指标,还可作为首发精神分裂症的疗效评价指标。     

创伤后应急障碍患者认知功能改变与弥散张量成像的相关性研究

目的探讨创伤后应激障碍(PTSD)作为个体暴露于异常强烈的精神应激人群认知功能的改变与脑白质神经纤维完整性的关系。方法通过韦氏记忆量表、威斯康星卡片分类测验分别对PTSD组患者和健康组患者进行量表评估,然后利用弥散张量成像(DTI)观察PTSD组异常脑区,根据数据统计分析,进而探讨PTSD认知功能改变与异常脑区白质纤维完整性的关系。结果左侧小脑FA值与韦氏记忆量表中的理解、联想、再生3项,以及WSCT中的正确反应数(CT)呈正相关(r=0.586,P=0.003;r=0.457,P=0.021;r=0.463,P=0.014;r=0.505,P=0.008),胼胝体FA值与WSCT的分类数、韦氏记忆量表中长时记忆呈正相关(r=0.568,P=0.004;r=0.498,P=0.006)。结论 PTSD组患者认知功能的异常改变与胼胝体压部脑白质异常增生及右侧小脑神经纤维缺失有关。     

刺激养老穴激活脑功能区的不同阈值分析

目的为针刺的fMRI研究的统计分析选择合宜的的阈值。方法选取健康青年志愿者12例,进行刺激养老穴的fMRI研究,采用组块模式,使用SPM2对扫描后图像进行后处理,采用校正和非校正来统计分析脑功能激活情况。结果在校正象情况下（组分析,FWE,0．05,K≥10）,养老穴主要激活了左顶叶的顶下小叶BA40,右侧额叶的额下回BA45、BA46,其次为左侧颞中回、颞下回BA37,左额上回BA10。而非校正情况下,激活点非常广泛。结论在穴位的脑功能激活实验应选择校正像分析。     

左旋四氢巴马汀对戒断期海洛因依赖者认知功能的干预效应

目的：运用功能磁共振成像（fMRI）方法，评价左旋四氢巴马汀（l-tetrahedropalmatine，l-THP）对戒断期海洛因依赖者认知功能的干预效应，为其在物质成瘾领域的应用提供新的理论依据。方法：采用随机、双盲、安慰剂对照实验设计，30名男性戒断期海洛因依赖者在药物治疗前、后分别完成Go／NoGo反应抑制任务，同时行全脑fMRI扫描。年龄、文化程度相匹配的18名男性健康志愿者完成相同试验任务。     

记忆巩固的神经机制研究进展

记忆是大脑重要的高级神经功能之一,存储着人们所知道的一切信息,理解记忆如何编码、巩固是了解人类认知和行为的关键.记忆巩固的本质是在神经元、脑区或脑亚区之间发展了稳定的新联系,其可以发生在多个神经核团中及其互相联系形成的多个神经环路中,是长时记忆重新组织的过程.记忆巩固可能会持续若干天,甚至若干年.近年来,越来越多研究关...     

早发性抑郁患者基于低频振幅比特低频振幅下脑区功能活动特征研究

目的利用静息态磁共振技术对早发性抑郁症患者特异性脑区进行定位。方法选择20例我院收治的早发抑郁症患者20例和性别、年龄、受教育年限与患者相匹配的20名健康受试者(对照组),分别给予功能磁共振(fMRI)扫描,分别应用低频振幅(ALFF)、比特低频振幅(fALFF)方法进行基于体素的组间比较,分析其静息态脑功能的差异。结果 (1)在右侧缘上回、左侧额中回、右侧中央沟盖、左侧额上回及右侧眶部额中回的ALFF值强于健康对照组,在舌回、左侧中央前回、左侧小脑10区、左侧颞中回区域的ALFF值弱于健康对照组;(2)在右侧眶部额中回、右侧眶部额下回、右侧缘上回、右侧中央沟盖、左侧眶部额下回、左侧扣带回及右侧枕中回的fALFF强于健康对照组,在左侧中央前回、左侧中央后回、右侧楔叶及右侧梭状回区域的fALFF值弱于健康对照组。结论早发性抑郁患者在前额叶、扣带回、边缘系统等多个区域脑自发活动强于健康受试者;在大脑额叶后部、颞叶前部、枕叶及小脑部分区域等多个区域脑自发活动弱于正常受试者;且ALFF及fALFF算法均存在相对一致性,显示这些特定脑区的脑自发活动异常可能是早发抑郁的神经生物学基础。     

点按丘墟穴诱发脑卒中患者Bechterev屈曲反射的脑部激活效应

目的利用fMRI技术研究点按穴位法、常规方法诱发Bechterev屈曲反射法对脑功能重朔的影响。方法选择2014年4月~2015年9月期间,福建中医药大学附属康复医院住院和门诊符合纳入标准23例右脑脑卒中的患者,先后随机用点穴法及常规方法诱发左下肢Bechterev屈曲反射为刺激模式,采用组块设计,使用f MRI检测,利用spm8和xjview软件数据分析。结果本研究两种方法均以激活右侧大脑和左侧小脑为主;点穴方法对脑的激活主要有双侧小脑、双侧枕叶、双侧额叶、双侧颞叶,右中央旁小叶、右顶下小叶;常规方法对脑的激活主要有双侧小脑、双侧枕叶、双侧额叶,右中央旁小叶、右顶下小叶;点穴方法同常规方法比较,点穴方法激活脑区为左颞中回、右颞上回、右颞中回,常规方法未激活上述脑区,激活脑区结果差异有统计学意义(P<0.01,K>10)。结论本研究两种手法均能促进脑卒中患者脑部功能重组;点穴方法比常规手法更具有广泛激活效应,其更易激发Bechterev屈曲反射的机制可能是点穴手法促进颞叶功能区对运动功能的补偿。     

上海市社区卫生服务中心医务人员伦理学知识调查及建议

目的:调查上海社区卫生服务中心医务人员的伦理学知识认知情况.方法:采取分层抽样方式,于2016年6—8月对上海市245家社区卫生服务中心的7552名医务人员进行问卷调查.结果:医务人员对伦理学知识非常了解、基本了解、了解很少和完全不了解的人数分别为536人(7.1%)、5411人(71.7%)、1536人(20.3%)和69人(0.9%).不同岗位、职称、学历的医务人员之间存在着明显的伦理学知识认知差距.结论:上海社区卫生服务中心医务人员的伦理学知识了解程度仍有待提高,需加强伦理学知识的学习和应用.     

Studies on the receptors involved in the action of the various agents in the phenylbenzoquinone analgesic assay in mice

1. Tolerance to the activity of several narcotic analgesics (morphine, levorphanol, and methadone) and several narcotic-antagonist analgesics (pentazocine, cyclazocine, and nalorphine) was studied in the mouse phenylbenzoquinone stretching test. Virtually complete tolerance was induced by chronic treatment with each of the narcotic agents, while no apparent tolerance was induced by the narcotic antagonists.2. In morphine-tolerant mice there was a high degree of cross-tolerance to the effects of not only the other narcotic drugs but also to those of the narcotic antagonists, acetylsalicylic acid, and physostigmine.3. The effects of morphine and pentazocine were antagonized by naloxone but not by atropine, while the effects of physostigmine were antagonized by atropine but not by naloxone. Neither atropine nor naloxone antagonized the effect of acetylsalicylic acid.4. The results of the tolerance study suggest that there is a fundamental difference in the consequences of receptor interaction for the narcotic and the narcotic-antagonist analgesics. Morphine-tolerant mice exhibit cross-tolerance non-specifically. The selectivity of naloxone and atropine differentiates the narcotic and narcotic-analgesics from the other two agents used in this analgesic test.     

Nifedipine in the treatment of hypertension in the elderly

The effect of nifedipine monotherapy, retard tablets, 20 mg bid, was evaluated in 23 hypertensive patients, mean age, 79 +/- 2 years. Twenty-one patients completed an eight-week study. Blood pressure (BP) decreased to 160/90 mm Hg in 15 patients; in four additional patients diastolic BP dropped by 15% to 28%. In a subset of five patients with isolated systolic hypertension, a significant reduction in systolic BP was noted. Side effects were relatively mild and only two patients discontinued the study. The results suggest that nifedipine monotherapy offers an alternative, logic, therapeutic approach to hypertension in the elderly.     

Interactions among the cannabinoids in the antagonism of the abdominal constriction response in the mouse

The ability of ⁹-tetrahydrocannabinol (THC), cannabinol (CBN), cannabidiol (CBD), 11-OH THC and 8,11-diOH THC to antagonise the abdominal constriction response in the mouse induced by formic acid, phenylquinone, 5-hydroxytryptamine, prostaglandin E₁ (PGE₁) and bradykinin was tested. THC was an effective antagonist against all nociceptive agents with an ED₅₀ in all cases between 1.0 and 2.6 mg/kg. CBN, while also effective against all nociceptive agents, was less potent than THC, with an ED₅₀ range between 46.2 and 112.5 mg/kg. CBD in doses as high as 200 mg/kg was without effect. Using PGE₁ as the nociceptive agent, 11-OH THC was equipotent to THC while 8,11-diOH THC was inactive. Naloxone, while able to antagonise the antinociceptive effect of morphine against formic acid-induced writhing, did not reverse the antinociceptive effects of THC. There were no pharmacological interactions between THC, CBD and CBN.     

Neurotensin causes a greater increase in the metabolism of dopamine in the accumbens than in the striatum in vivo

Differential pulse voltammetry with carbon fibre electrodes was used to study the effect of central administration of neurotensin on the extracellular level of 3,4-dihydroxyphenylacetic acid (DOPAC) in the nucleus accumbens and the striatum in anaesthetised rats. Intracerebroventricular injection of neurotensin (10 micrograms) increased the peak height for DOPAC 20 min after administration in the nucleus accumbens but only after 40 min in the striatum. The maximum increase was similar in both regions, with 30% and 27% above the pre-injection basal level, respectively. Neurotensin (1 micrograms) however increased the extracellular level of DOPAC in the nucleus accumbens alone. Neurotensin (0.1, 1.0 and 3.0 micrograms/0.5 microliter), injected into the ventral tegmental area, induced a potent and long-lasting elevation of the peak height for DOPAC in the nucleus accumbens, while the same doses in the substantia nigra produced effects on the metabolism of dopamine in the striatum of smaller amplitude and shorter duration. The maximum effect of each dose was about 2.5 times greater in the mesolimbic, compared to the nigrostriatal system. Amphetamine (2 mg/kg, s.c.) decreased the extracellular level of DOPAC with a similar magnitude, both in the nucleus accumbens (52%) and the striatum (47%). Intracerebroventricular administration of neurotensin (1 micrograms), 5 min after amphetamine, did not alter the effect of amphetamine on the extracellular level of DOPAC either in the nucleus accumbens or the striatum. However, neurotensin (10 micrograms) partially reversed the effect of amphetamine in the nucleus accumbens and had a similar but smaller and delayed effect in the striatum. The results from the present study, together with previous neurobehavioural studies, suggest that neurotensin has a relatively selective action on the mesolimbic dopaminergic system in the rat.     

Role of the liver in the disposition of intravenous nitroglycerin in the rat

Previous studies have indicated that the liver is the main site of nitroglycerin (NTG) elimination when the drug is systematically infused. To examine this hypothesis, we measured the apparent systemic clearance (Cls) of nitroglycerin in anesthesized rats receiving a constant intravenous infusion at a dose of 100 micrograms per kg per min. Animals were divided into shunt and sham groups; the former had undergone a portal vein ligation 10 days prior to the study, while the latter was subjected to a sham operation. On the study day, half of the animals of each group also received probenecid at 200 mg/kg, i.v., a drug previously reported to inhibit organic nitrate ester reductase (ONER) activity in rat liver. Arterial NTG samples were obtained at 41, 43 and 45 min of infusion in all four experimental groups; Cls was 439 +/- 32 ml per kg per min (mean +/- S.E.) in sham, 460 +/- 44 in sham and probenecid, 477 +/- 39 in shunt, and 461 +/- 34 in shunt and probenecid animals. During NTG infusion, hepatic blood flow (measured with a constant infusion of indocyanine green) was decreased markedly in shunted rats as was liver/body weight, indicating hepatic atrophy. The specific activity of hepatic ONER was similar in all four groups. In spite of marked differences in hepatic blood flow and hepatic mass, the Cls was similar in all four groups. The liver does not appear to be a major site for the elimination of systemic nitroglycerin as hitherto assumed.     

抗生素在预防普外科手术切口感染中的价值分析及其预防

目的:分析抗生素在预防普外手术切口感染中的临床价值.方法:选择我院收治的100例普外科手术患者作为观察对象(2015年2～11月),采用随机分组的方式将100例普外科手术患者分成对照组与实验组,分别在术后使用抗生素及术前1h使用抗生素,观察两组手术切口感染率及患者的疼痛评分.结果:对照组切口感染率(16.00％)明显高于实验组(4.00％),两组之间对比疼痛评分存在显著差异(P＜0.05),有统计学意义.结论:针对普外科手术患者根据患者的切口类型科学、合理选择抗生素及选择适当的使用时间能有效减少术后手术切口感染,有效改善患者预后.     

女性医务人员健康状况的研究

目的探讨女性医务人员健康状况的特点。方法对2877例医院工作人员健康查体资料进行统计学分析。结果①女性医务人员中,41.0%的人员患有不同类型的疾病,略高于男性患病率（36.8%）,二者差异有统计学意义（P=0.029）;②女性医务人员高脂血症为31.9%（212/665）,低于男性（65.9%,274/416）;③脂肪肝患病率女性（32.6%,181/556）,亦低于男性（45.9%,151/329）;④女性相关疾病中,乳腺疾病和子宫肌瘤的患病率分别为4.8%和3.4%;而宫颈糜烂为20.2%;⑤女性医务人员高血糖为11.0%（77/702）,高血压为4.6%（56/1229）。结论女性医务人员中妇科与乳腺疾病是健康体检的重点,代谢性疾病也应加以关注。