诱发电位在Arnold-Chiari畸形合并脊髓空洞症中的应用

目的：探讨体感诱发电位（SEP）、运动诱发电位（MEP）与脑干听觉诱发电位（BAEP）在阿-基畸形（Arnold—Chiari malformation,ACM）合并脊髓空洞症（SM）手术疗效判定中的作用。方法：对ACM—SM患者行术前、术后上下肢SEP、MEP及BAEP检查,对比分析术前术后潜伏期、波幅及传导时间。结果：58例ACMSM患者,术前40例SEP异常,46例MEP异常,28例BAEP结果异常,表现为潜伏期延长、波幅降低及MEP的中枢传导时间（CMCT）延长。行后颅窝减压术＋硬脑膜扩大成形术＋后颅窝重建术后患者症状改善,复查MRI示小脑扁桃体回缩、空洞缩小;39例SEP、45例MEP及27例BAEP潜伏期、CMCT延长与波幅降低均有不同程度改善,SEP、MEP、BAEP分别各有1例与术前比较无明显改变。结论：SEP、MEP、BAEP可以作为评价ACM—sM手术前后效果判定的客观指标。     

中老年人脑白质疏松症的电刺激运动诱发电位研究

目的 :探讨电刺激运动诱发电位在中老年人脑白质疏松的临床应用价值。方法 :用大脑皮层电刺激仪刺激大脑上、下肢皮层运动区及颈椎7、胸椎1 2 棘突的相应皮肤 ,在大鱼际肌及胫前肌记录相应的运动诱发电位 (MEP) ,分别对 30例脑白质疏松的中老年人和 30例无白质疏松的对照组进行测定。结果 :脑白质疏松MEP的异常率 37% ,和正常人比较有显著性差异 (χ2 =9 79,P <0 0 1) ,其异常形式有 :中枢运动传导时间 (CMCT)延长 ,MEP潜伏期 (PL)延长 ,波幅增大和波形消失。下肢CMCT和PL延长与对照组比较有显著差异 (t=11 8,P <0 0 1)。结论 :MEP客观反映了脑白质疏松中老年人的运动传导功能 ,对判断亚临床锥体束损害有实用价值。     

症状性颈动脉粥样硬化性狭窄患者经颅电刺激运动诱发电位的研究

目的：探讨经颅电刺激运动诱发电位(MEP)对症状性颈动脉粥样硬化性狭窄的诊断价值。方法：对32例颈动脉粥样硬化狭窄患者和20例正常人行经颅电刺激MEP检查,评价狭窄程度与MEP的关系。结果：症状性颈动脉粥样硬化患者电刺激狭窄侧大脑皮层手区与对侧上肢记录MEP的潜伏期和中枢传导时间(CMCT)较正常对照组和健侧延长(P＜0．05)；对侧下肢CMCT较正常对照组和健侧延长(P＜0．05)。结论：MEP异常程度与临床病情轻重和病变部位密切相关,提示MEP能客观反映颈动脉狭窄患者中枢运动传导通路亚临床受损的情况,具有定量的价值。     

经颅电刺激对大鼠脑梗死后运动功能恢复的影响

目的 :观察经颅皮层电刺激治疗对大鼠脑梗死后运动功能恢复的作用。方法 :选择12 0只SD成年雄性大鼠制作大脑中动脉闭塞 (MCAO)模型 ,将大鼠随机分为治疗组和对照组各 6 0只 ,治疗组在术后 3天给予经颅电刺激治疗 ,对照组术后不进行治疗 ,于术后第 1、2、3、4、5、6周末 ,分别以横木行走试验 (BWT)及运动诱发电位为指标评价大鼠运动功能恢复情况。结果 :经颅磁刺激治疗的大鼠 ,运动功能较对照组明显改善 (P <0 .0 1)。第 6周末治疗组患侧MEP波幅与潜伏期基本恢复正常 ,而对照组患侧MEP波幅仅恢复到 73.5 % ,潜伏期仍有所延长 ,两组相比有显著差异 (P <0 .0 5 )。结论 :经颅电刺激可以促进急性脑梗死大鼠瘫痪肢体运动功能的恢复 ,其机理可能与电刺激直接兴奋大脑皮层的运动中枢有关     

经颅电刺激在急性脑梗死患者运动功能康复中的作用

目的:研究经颅电刺激(TES)对急性脑梗死偏瘫患者运动功能的康复作用。方法:选取经CT或MRI确诊的急性脑梗死患者60例,随机分为TES组和对照组各30例,两组在基本治疗相同的情况下,TES组自患病后第八天始加作TES治疗共14天,每天给予TES治疗1次,每次磁刺激患侧运动皮层10回。两组分别于患病后第七天(第一次)和患病后第二十一天(第二次)进行TES运动诱发电位(MEP)检查,记录MEP波幅和中枢运动传导时间(CMCT);用简式Fugl-Meyer运动功能量表(FMS)评分和徒手肌力检查法进行运动功能评分。结果:在患病后第七天,MEP波幅和CMCT、FMS和肌力评分等方面,两组结果比较差异无显著意义;在患病后第二十一天(TES组治疗14天)后,两组上述结果均有改善,与治疗前相比差异均有显著意义,特别是TES组运动功能改善更为明显,两组比较差异有显著意义。同时发现当第一次给患者行TES治疗后即刻,部分患者肌力即可提高Ⅰ-Ⅱ级,数小时后又减退至原肌力,经数次治疗后患者肌力得到巩固而且逐步提高。治疗前有15例患者未引出MEP,其中TES组8例,对照组7例;治疗后,未引出MEP的15例患者TES组8例中有3例引出MEP,但潜伏期及CMCT明显延长,而对照组无1例引出MEP。结论:脑梗死急性期进行TES治疗可明显促进患者运动功能的恢复。     

经颅磁刺激对帕金森氏病患者的运动诱发电位的研究

目的： 本研究主要通过经颅磁刺激(TMS)检测帕金森氏病 (PD) 患者的运动诱发电位（MEP）,总结PD患者的MEP特点,探讨PD患者的运动皮质兴奋性。方法：选取健康志愿者20例作为正常对照组（A组）,男12例,女8例,年龄52-79岁,平均(62.3±16.7)岁。通过TMS检测左右两侧MEP,作左右侧比较。选取2007年5月-8月浙江大学医学院附属第二医院神经内科住院或门诊的PD患者共21例（B组）,均症状左右不对称,男12例,女9例,年龄46-80岁,平均(63.3±16.7)岁,按症状轻重程度比较MEP,且将PD组与正常组比较。结果：正常对照组左右侧MEP参数无显著差异。PD组与正常对照组相比,静息运动阈值（RMT）降低,波幅（Amp）升高,皮质潜伏期（CL）缩短,有显著差异,中枢运动传导时间（CMCT）改变无显著差异。PD症状重侧与轻侧相比较,重侧的RMT更低,有显著差异,AMP、CL、CMCT改变无显著差异。结论： PD患者的运动皮质兴奋性增高,且与症状严重程度相关。利用PD患者的MEP特点有助于辅助诊断,有助于评估症状严重程度,以RMT敏感性最高。     

应用MEP，NCV联合诊断糖尿病性神经病

目的：探讨运动诱发电位（MEP）、神经传导速度（NCV）检测对糖尿病（DM）运动神经中枢及神经根、周围神经病变的诊断价值。方法：检测50例DM病人的MEP及NCV。结果：MEP异常率82％（41／50）。表现皮层、脊髓刺激MEP潜伏期延迟、波形分化欠佳，部分伴有中枢运动传导时间（CMCT）异常。MEP异常率与病程长短呈正相关；空腹血糖地MEP结果无明显影响。NCV异常率70％，主要表现运动神经传导速度（MCV）、感觉神经传导速度（SCV）减慢。结论：MEP、NC检查对诊断DM的锥体束功能损害及神经根、周围神经病变有重要价值，二者结合可对DM的神经系统功能提供全面客观指标。     

帕金森病运动诱发电位及其影响因素的研究

目的：从运动功能、电生理检测方面观察帕金森病（PD）患者的皮质兴奋性的改变及其影响因素。方法：共68例PD患者,另选择30名健康者为对照组。采用统一帕金森病评定量表（UP-DRS）、经颅磁刺激运动诱发电位（MEP）作为评定指标。结果：PD患者MEP的静息阈值（RMT）、中枢传导时间（CMCT）较正常对照组明显降低或缩短,而波幅（Amp）则无明显差异。〉5年患者的RMT（40．70±4．74）,比≤5年患者的RMT（42．60±4．61）缩短;强直型患者的RMT（40．92±5．28）,比震颤型患者的RMT（42．93±3．97）缩短,差异有统计学意义。结论：PD患者存在运动功能障碍,大脑皮质兴奋性升高;强直型和病程长的患者病情较重,大脑皮质兴奋性升高更明显。     

经颅磁刺激治疗癫痫部分性发作患者前后运动皮质功能研究

目的：观察癫痫部分性发作患者经低频重复经颅磁刺激（repetitivefrequenttranscranialmagneticstimulation,rTMS）和奥卡西平（oxcarbazepine,OXC）添加治疗的疗效并观察其前后运动皮质兴奋性的改变。方法：将36例癫痫部分性发作患者分为rTMS治疗组和0XC治疗组,在继续原有抗癫痫药物治疗的基础上分别行0．5Hz低频rTMS治疗及OXC添加治疗,分析并评价患者治疗前后的癫痫发作频率,记录治疗前后的运动诱发电位（MEP）,评价其皮质运动兴奋性的改变。结果：36例患者经低频rTMS治疗和0XC治疗后,临床发作减少,与治疗前相比差异有统计学意义（P〈0．01）,但两组间差异无统计学意义（P〉0．05）。rTMS组运动阈值（motorthreshold,MT）明显增高,皮质静息期（corticalsilentperiod,CSP）延长,与治疗前相比差异有统计学意义（P〈0．01）,OXC组仅MT增高,与治疗前相比差异有统计学意义（P〈0．01）。结论：低频rTMS治疗癫痫部分性发作疗效良好,MEP能有效地反映中枢运动皮质功能状态,有助于提高部分发作性癫痫的疗效。     

交感皮肤反应在糖尿病患者中的应用价值

目的：探讨交感神经皮肤反应（sympathetic skin response,SSR）在糖尿病（DM）患者中的应用价值。方法：对68例DM患者和32例健康人进行了四肢SSR检查,并与周围神经运动、感觉传导速度和临床表现及不同病程进行相关分析比较。结果：健康对照组均引出正常SSR波,而DM组13．2％未引出SSR波;与健康对照组相比,DM组SSR波潜伏期延长、波幅降低,经统计学分析差异有显著意义（P〈0．01,P〈0．05）。伴有感觉异常症状及体征的DM患者,SSR消失率最高（18％）、潜伏期最长、波幅最低;有神经异常等症状而无体征者次之,既无症状又无临床体征者最低,三组组间相比差异显著（P〈0．05）。周围神经传导异常的DM患者SSR潜伏期明显长于正常组,波幅亦明显低于正常组（均P〈0．05）;病程越长,SSR异常率越高,异常程度越明显,以病程超过10年的DM患者潜伏期最长,波幅降低最为明显（P〈0．05）。结论：SSR异常程度与DM性周围神经损害的程度相一致,SSR可作为评价DM性周围神经损害程度及植物神经功能状况的客观指标。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.