前颞叶内侧切除术治疗颞叶内侧型癫痫

目的探讨前颞叶内侧切除术治疗颞叶内侧型癫痫的治疗效果。方法21例顽固性颞叶癫痫患者,采用无框架神经导航辅助,经颞中回行前颞叶内侧切除术,切除前颞叶、杏仁核及海马。采用分级量表进行针对癫痫发作控制效果的评价。结果21例术后随访6～29个月,神经功能均改善,无严重手术并发症。16例（76%）癫痫发作完全消失（EngelⅠ级）,3例（16%）癫痫发作极少（EngelⅡ级）,2例（8%）癫痫发作减少（EngelⅢ级）。结论前颞叶内侧切除术是治疗颞叶癫痫的有效方法。神经导航辅助下手术彻底切除杏仁核及海马,避免了语言区和视放射的损伤。     

颞叶癫痫中的过度运动性发作(附2例报告)

目的过度运动性发作常见于额叶癫痫,总结我中心病例,探讨颞叶癫痫表现为过度运动性发作时的临床决策。方法回顾2007～2009年进行手术治疗的颞叶癫痫患者,对所有患者的术前评估资料包括病史、MRI、头皮视频脑电图、PET和颅内脑电记录进行回顾性分析。根据Luders的描述对过度运动性发作进行识别。结果 102例患者中有2例表现为典型的过度运动性发作,尽管症状学提示额叶起源,但是头皮脑电图均提示颞叶为发作起始区,1例进行颅内电极监测,另1例因为MRI的阳性发现而直接进行手术切除。2例患者进行了前颞叶切除术,术后2 a以上无发作。结论过度运动性发作发作偶尔可见于颞叶癫痫,如果其头皮EEG结果与影像学检查一致,则手术治疗效果比较理想。     

颞叶癫痫术前定位方法的评价

目的 探讨颞叶癫痫不同术前定位方法的效果。方法 回顾性分析58例难治性颞叶癫痫手术患者的临床资料。分别统计头皮脑电图、视频脑电监测、皮层电极、深部电极、头颅CT、MR1、PET七种检查定位方法的阳性结果,计算出准确定位率,对数据进行统计学分析。结果 CT、头皮脑电图的定位能力明显低于视频脑电监测、皮层电极、深部电极监测及MRI、PET检查,后五种评估方法的定位能力无显著差异。结论 上述术前定位方法单一应用不具有特异性．颞叶癫痫灶的准确定位需综合应用各种定位方法。     

颞叶癫痫大鼠学习记忆障碍与海马病理变化的相关性研究

目的 探讨大鼠颞叶癫痫发作后不同时问学习、记忆障碍程度与海马病理变化的相关性。方法 采用立体定向技术在大鼠右侧海马注射红藻氨酸诱发颡叶癫痫发作,观察其行为学表现、脑电图变化,Morris水迷宫评价不同时间段学习、记忆障碍程度,以及海马、皮质病理变化。结果 注射红藻氨酸大鼠出现颞叶癫痫发作,随发作时间延长出现不同程度学习、记忆障碍,定位航行实验示逃避潜伏期延长,空间搜索实验示原平台象限内游泳时问百分比下降,与对照组比较均有显著性差异（P〈0．05）,发作后2个月达到高峰。右侧海马锥体细胞逐渐出现变性、坏死,由CA3区向CA4、CA2、CA1区扩展,2个月达到高峰;对侧海马锥体细胞也出现变性、坏死。但程度明显低于注射侧。结论 大鼠颡叶癫痫发作后,其学习、记忆障碍程度与海马变性、坏死程度具有一定相关性。     

难治性枕叶癫痫的手术治疗（附7例报告）

目的分析难治性枕叶癫痫的手术治疗效果和视觉功能保护效果。方法对7例难治性枕叶癫痫患者,行视力视野检查,致痫灶行皮层或局部病灶及周围胶质增生带切除术,对5~10 s内迅速跟随发作起始的症状产生区行低功率皮层热灼术或局部皮层切除术,疑有功能区放电或发作起始者加行脑磁图功能区定位,功能区行低功率皮层热灼术,并注意保护好其白质传导纤维。其中确定发作起始于功能区的2例行功能区皮层热灼术。根据Engel′s术后效果分级评估疗效;行视力视野检查,观察术后患者视觉功能变化。结果术后随访6-12个月,6例无癫痫发作,达到Engel′sⅠ级,1例术后存在稀少癫痫发作,达到Engel′sⅡ级。6例（包括行功能区皮层热灼术2例）术后视觉功能无明显变化,1例视觉功能障碍较术前加重。结论定位明确的难治性枕叶癫痫患者可行致痫灶皮层或局部病灶及周围胶质增生带切除术;功能区低功率皮层热灼术可有效控制癫痫发作,且不造成功能缺失。术前精确定位功能区,术中保护功能区皮质及白质传导纤维,可有效减少视觉功能损伤机会。     

Resting-state fMRI in temporal lobe epilepsy patients with cognitive impairment: A protocol for systematic review and meta-analysis

Background:Temporal lobe epilepsy is a group of neurological diseases caused by the repeated abnormal discharge of brain neurons. Patients with this disease are often accompanied with cognitive impairment. However, the pathogenesis of the cognitive impairment remains unclear. Resting state functional magnetic resonance imaging is a kind of magnetic resonance imaging method based on blood oxygen level dependence. This can reflect the spontaneous brain functional activity of a human brain in the resting state. In recent years, a number of researchers have used resting state functional magnetic resonance imaging to study the changes in resting spontaneous brain function in patients with temporal lobe epilepsy with cognitive impairment (TLE-CI). However, due to the differences in sample and methodology, the results of these studies were inconsistent. Therefore, the present study aimed to investigate the characteristics of the resting spontaneous brain function in patients with TLE-CI through a meta-analysis.Methods:A search was conducted on electronic databases, including PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure, WANGFANG DATA and Chinese Biomedical Literature Database, and Baidu scholar Database, from the establishment of the database to April 20, 2021. Randomized controlled trials that employed amplitude of low-frequency fluctuations/regional homogeneity to investigate the changes in resting spontaneous brain function in patients with TLE-CI were selected. Anisotropic effect size version of signed differential mapping was applied to perform the data analysis.Results:The study summarized the changes in spontaneous brain function in patients with TLE-CI.Conclusion:The conclusion for the functional cerebral alterations based on the latest studies will be provided.     

18F-FDG PET脑显像SPM分析法在颞叶内侧癫痫术前定位中的价值

目的探讨18F-FDG PET脑显像像素统计参数图（SPM）法在颞叶内侧癫痫术前定位中的价值。方法对17例颞叶内侧癫痫患者行脑18F—FDG PET检查,对其所有PET图像进行感兴趣区（ROI）法及SPM分析法比较。SPM分析法所用健康对照组选自同期于本中心健康查体者20例。结果ROI法对癫痫灶准确定侧率为70．6％,准确定位率为29．4％;SPM法分别为70．6％、47．1％。二者准确定位率比较,P〈0．05。SPM法发现双侧颞叶代谢异常9例（52．9％）,伴额、顶叶皮层代谢异常者12例（70．6％）。结论18F-FDG PET脑显像SPM法是一种简便、客观、有效的颞叶癫痫灶定位方法,且有助于发现脑代谢异常。     

涟波振荡与大鼠颞叶癫癎发作关系的研究

目的探讨脑电中的涟波振荡与大鼠颞叶癫癎发作的关系。方法10只SD大鼠,在双侧齿状回和海马分别置入深部电极,用氯化锂-毛果芸香碱腹腔注射诱发大鼠颞叶癫癎,记录癫癎发作前后的深部脑电(采样频率10KHz,低通为5000Hz)。用小波变换提取脑电中的涟波和快速涟波成分,并用能量法对癫癎发作前后的涟波成分进行分析。结果涟波和快速涟波的能量变化与癫癎发作的状态十分符合。癫癎发作时,快速涟波和涟波的能量都有明显增加,累积速率大。给予地西泮后,两者的能量都有所减小,累积速率趋于稳定,但快速涟波的能量累积速度降低得更快。结论脑电中的涟波振荡成分对癫癎发作有指示性作用。     

Risk factors for atelectasis of the middle lobe after right upper lobectomy: preoperative bronchial diameter and stapling of the fissure

BackgroundAtelectasis of the middle lobe after right upper lobectomy is often seen. However, the risk factors for atelectasis are uncertain. Therefore, we assessed cases in our institution and investigated risk factors for atelectasis of the middle lobe following right upper lobectomy.MethodsWe identified 354 cases in which right upper lobectomy had been performed in our institution between January 2009 and December 2018, and 342 were included in this retrospective analysis. We divided patients into two groups according to the presence of postoperative atelectasis of the middle lobe, and then preoperative clinical variables and perioperative variables were compared between the two groups. Multivariable analyses for postoperative atelectasis of the middle lobe were performed using the logistic regression model.ResultsMiddle lobe atelectasis was detected in 59 cases (17.3%). Multivariable analysis demonstrated that the preoperative diameter of the middle lobe bronchus [P=0.012; confidence interval (CI), 0.525–0.930] and stapling of the fissure between the upper and middle lobes (P=0.004; CI, 1.997–37.050) were independent risk factors for postoperative atelectasis of the middle lobe.ConclusionsA small preoperative diameter of the middle lobe bronchus and stapling of the fissure between the upper and middle lobes are risk factors for middle lobe atelectasis following right upper lobectomy.     

Lung lobectomy surgical approach and resource utilization differ by anatomic lobe in a statewide discharge registry

BackgroundAnatomic lobe-specific differences with respect to pulmonary lobectomy have been suggested in the thoracic surgery literature but hard data has been lacking in larger population studies in part due to coding systems that do not distinguish pulmonary lobectomy by anatomic lobe. International Classification of Diseases, Tenth Revision (ICD-10) procedure codes, adopted in the United States in 2015, may provide novel methodologic accessibility for pulmonary lobectomy studies as they classify lobectomy operations by specific anatomic lobe. We queried the Texas Inpatient Public Use Data File (TPUDF) ICD-10 codes for both open and endoscopic approach lobectomy with a specific view to differences based on anatomic lobes.MethodsBetween fourth fiscal quarter (Q4) 2015 and Q4 2017, all pulmonary lobectomy operations performed in Texas state-licensed hospitals were identified by querying the TPUDF for ICD-10 procedure codes for pulmonary lobectomy as classified by anatomic lobe. Surgical approach, additional procedures and diagnosis codes, length of hospital stay (LOS), and discharge status were recorded with aggregate values undergoing statistical analysis.ResultsRight and left upper versus lower lobe resections were more prevalent however minimally invasive surgery was less commonly performed for upper than right lower lobectomy. LOS, irrespective of surgical approach, was longer for upper versus lower lobe resection as was need for transfer to additional inpatient facilities. LOS was longer and need for additional surgical or procedural interventions days after the primary procedure of lobectomy was greater for right versus left upper lobe resection, suggesting some differential properties of the right versus left pleural space.ConclusionsThe marked clinical differences between anatomic lobes in the setting of pulmonary lobectomy observed in this study have the potential to translate to differences in expected hospital and health system costs and surgeon time-expenditure and experience premium that currently have no mechanism for their accounting. These findings highlight the value of ICD-10 coding for analysis of pulmonary lobectomy in administrative databases and suggest a possible path to more informed patient counseling and equitable hospital and surgeon reimbursement based on payment adjustment by anatomic lobe in pulmonary lobectomy operations.     

颞叶癫(癎)的临床特征和脑电图分析

目的分析和总结颞叶癫癎的临床、脑电图特征。方法对2004年6月至2006年1月于首都医科大学北京天坛医院癫癎中心门诊和病房确诊为颞叶癫癎的145例患者的临床、脑电图和神经影像学资料进行分析。结果患者的发作类型包括简单和复杂部分性发作以及全面强直阵挛发作,以复杂部分性发作最常见。病因分析显示,45例病灶性颞叶癫癎的病因依次为脑血管病、颅内感染、脑外伤等,100例非病灶性颞叶癫癎中,海马硬化29例。脑电图显示颞区癫癎样放电。结论颞叶癫癎是一组临床常见、病因复杂、表现多样的癫癎综合征。正确诊断、规范化治疗是提高其疗效的关键。     

正常人颞叶质子磁共振波谱研究

目的 运用质子磁共振波谱（^1H—MRS）研究年龄对正常人颞叶脑组织代谢物浓度的影响。方法 将80例健康人分为4个不同年龄组并对双侧颞叶进行^1H—MRS检测，对比分析不同年龄组的颞叶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比值的变化。结果 随着年龄的增长，在≤50岁年龄段颞叶的NAA／Cr和Cho／Cr比值无明显改变（P〉0．05），但在〉50岁年龄段颞叶的NAA／Cr比值逐渐降低（P〈0．05）、Cho／Cr比值逐渐增高（P〈0．05）。结论 ^1H-MRS是一种可以为正常人颞叶与年龄相关的代谢物浓度改变提供有价值信息的无创技术。     

Complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection

We describe herein a case of complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The patient was a 67-year-old man. A physical examination revealed a nodule in the left lower lobe that had been present for 7 years. According to the chest computed tomography (CT) report recently, a diagnosis of lung cancer was not excluded. Due to the surgical indications, he was underwent complete video-assisted thoracoscopic lobectomy of the left lower lobe and lung lymph node dissection. The frozen pathology report was consistent with adenocarcinoma. He recovered smoothly, without any perioperative complications.     

用RT-PCR方法检测颞叶癫痫脑内SH3GL2基因的表达

目的 研究难治性颞叶癫痫患者脑组织中的SH3GL2mRNA的表达,从分子水平探讨难治性颞叶癫痫发病的可能机制。方法 运用RT-PCR检测SH3GL2mRNA在10例难治性癫痫患者及10例正常对照组脑部的表达。结果 利用RT-PCR检测SH3GL2mRNA在难治性癫痫患者脑部表达增强,其电泳条带目的片断值与对照组比较差异有统计学意义（P〈0.01）。结论 中枢神经系统的SH3GL2在难治性癫痫患者脑部表达增强,可能在人类难治性癫痫的发病机制中起到一定作用。     

Unidirectionally progressive resection of left upper pulmonary lobe under video-assisted thoracoscopy

The case is a nodule in the upper left lobe, and intraoperative frozen section pathological diagnosis on the removed nodule confirmed well differentiated mucinous adenocarcinoma. Unidirectionally progressive resection of the left upper pulmonary lobe under video-assisted thoracoscopy is selected as the surgical method. Right below the operation hole, surgeons gradually advanced in one direction, and dissociated and divided in such order: the upper left pulmonary vein, the upper left lobe bronchus, the upper left pulmonary arterial branches and the fissures. Endoscopic linear cutters and hem-o-lok clip applicator were used to deal with the blood vessels, bronchus, and under-differentiated fissures. At last, the removed upper left lobe was put into a size eight sterile glove and taken out through the main operation hole. General anesthesia with double-lumen endotracheal intubation is used. The patient took a 90 degree decubitus on his contralateral side. The surgeons were on the ventral side of the patient, and operated with endoscope apparatus under the monitor.     

Middle lobe syndrome: a nationwide study on clinicopathological features and surgical treatment

Introduction: Middle lobe syndrome (MLS) is a relatively uncommon lung disease that is characterized by damage to the middle lobe and often needs surgical intervention. Objective: To study clinical, radiological and histological features of all patients who underwent surgical resection for MLS in Iceland over a 13‐year period, including evaluation of surgical outcome. Methods: Information on patients who underwent surgery of the right middle lobe in Iceland from 1984 to 2006 was obtained from a centralized diagnosis and pathology registry. Clinical data were collected retrospectively from clinical records from hospitals and from private offices. All pathology specimens were reviewed. Results: We studied 18 patients, 3 males and 15 females between the ages 2 and 86 years (mean 55). The most common clinical features were recurrent infection (n = 15), chronic cough with productive sputum (n = 9), chest pain (n = 8) or dyspnea (n = 7). The most common findings on chest radiographs and on computerized tomography of the chest were atelectasis, consolidation and bronchiectasis. One patient had a foreign body. The most common major histological finding was bronchiectasis in nine patients, and two had foreign body reaction. Minor findings included bronchiolitis, organizing pneumonia and peribronchial inflammation. All patients survived surgery with minor peri‐ and postoperative complications. Conclusion: MLS is more common in females, and recurrent infections, chronic productive cough and dyspnea were the most common symptoms. Bronchiectasis is the most common histological finding. MLS can be treated effectively with lobectomy with low mortality and rate of complications. Please cite this paper as: Einarsson JT, Einarsson JG, Isaksson H, Gudbjartsson T and Gudmundsson G. Middle lobe syndrome: a nationwide study on clinicopathological features and surgical treatment. The Clinical Respiratory Journal 2009; 3: 77–81.     

颞叶内侧萎缩对阿尔茨海默病认知功能衰退的预测作用

目的探讨颞叶内侧(MTL)萎缩对阿尔茨海默病(AD)认知功能衰退的预测作用。方法18例AD患者(NINCDS-ADRDA Probable AD标准)参加为期两年的随访,分别于基线和两年后接受简易智能状态检查(MMSE)、韦氏记忆量表(WMS-R)和AD评定量表-认知部分(ADAS-Cog)评估,以及磁共振成像检查,测量MTL结构(海马、杏仁核、海马旁回与海马杏仁核复合体)体积。结果与基线比较,AD患者两年随访MMSE和WMS-R总分显著下降(P<0.001),ADAS-Cog总分显著升高(P<0.001);标准化海马体积显著下降(P<0.05)。海马旁回体积变化率与ADAS-Cog总分变化率呈类正弦曲线式关系。多重回归分析表明,基线标准化海马体积与MMSE总分变化率显著相关(β=-0.759,P<0.05),基线标准化海马旁回体积与ADAS-Cog总分变化率显著相关(β=0.906,P<0.05)。结论MTL萎缩与AD认知功能衰退具有一定相关性,对AD进展可能具有预测价值。