小脑幕切迹脑膜瘤的显微外科手术治疗

目的探讨小脑幕切迹脑膜瘤的显微外科手术治疗技巧。方法对9例经显微外科治疗的小脑幕切迹脑膜瘤的临床资料进行回顾性分析。结果9例患者中肿瘤全切除8例，1例次全切除，无手术死亡病例。无脑脊液漏及颅内感染发生。9例患者平均随访9个月，术后均恢复良好，生活能够自理，未见肿瘤复发。结论显微外科手术是治疗小脑幕切迹脑膜瘤的有效方法。根据患者术前影像学资料的特征．选择恰当的手术入路．术中良好的病变显露及术后并发症的及时处理是小脑幕切迹脑膜瘤显微外科手术治疗成功的关键。     

单侧Poppen入路切除松果体区脑膜瘤(附16例报告)

目的总结单侧Poppen入路显微手术治疗松果体区脑膜瘤的经验。方法回顾性分析2009年3月至2013年7月收治16例松果体区脑膜瘤患者的临床资料,均采用显微手术切除肿瘤,其中经右侧Poppen入路13例、左侧人路3例,术中行脑室引流术处理脑积水4例。结果肿瘤全切除12例,次全切除3例,大部分切除1例。病理学诊断均为脑膜瘤。术后发生同向偏盲2例,Parinaud综合征加重1例,复视加重1例。11例（全切8例,未全切3例）术后随访0．5—4年,全切患者均恢复;未全切患者行放疗,随访肿瘤无进展。结论单侧Poppen入路显微手术适用于大部分中小型松果体区脑膜瘤;对于体积较大或者对侧侵袭较多的脑膜瘤,因显露不完全而难以全切,小脑幕上下或者大脑镰两侧联合入路可作为备选方案。术中或术前行脑室外引流术可增加术中显露程度,提高手术效果。     

小脑幕脑膜瘤显微手术治疗

目的探讨不同分型小脑幕脑膜瘤手术入路和显微手术的治疗策略。方法回顾性分析36例小脑幕脑膜瘤病例资料,根据肿瘤基底附着于小脑幕的位置及肿瘤主体部位所在而分为6个类型:幕上内侧型6例,幕上外侧型8例,幕下内侧型7例,幕下外侧型4例,跨幕型6例和镰幕型5例,采取个体化手术入路进行显微手术切除。结果小脑幕脑膜瘤达到SimpsonⅠ级切除18例(50.0%),Ⅱ级切除13例(36.1%),Ⅳ级切除5例(13.9%),无手术死亡病例。术后随访6～96个月,失访2例。术前KPS为(85.83±8.74),术后1个月为(65.83±10.52),术后6个月为(83.06±11.42)。5例肿瘤残留病人与2例复发病人,均采用伽玛刀治疗,随访中未见再次复发。结论根据小脑幕脑膜瘤不同分型,个体化选择手术入路并运用显微操作技术,可提高手术全切率,减少并发症,提高手术疗效。     

颞下经天幕入路显微手术治疗岩斜区脑膜瘤

目的探讨颞下经小脑幕入路切除岩斜区脑膜瘤的显微手术方法和结果。方法 25例岩斜区脑膜瘤病人,全部经CT、MRI明确诊断,其中大型(瘤径2.5~4.4 cm)18例、巨大型(4.5 cm)7例。均采用颞下经小脑幕入路显微手术切除肿瘤。结果镜下全切除肿瘤20例(80%),大部分切除5例,无死亡。术后新增颅神经损伤11例。术后随访1~24个月,全切病例有4例复发。结论颞下经小脑幕入路是切除中上斜坡以上尤其是侵及麦氏腔的岩斜区脑膜瘤实用的手术入路。     

小脑幕脑膜瘤显微手术切除33例临床分析

目的分析小脑幕脑膜瘤的临床显微手术方法,为进一步改善治疗方案提供依据。方法选取我院2005-01—2011-01收治的33例临床诊断并经影像学检查证实为小脑幕脑膜瘤患者为研究对象,对所有患者采用显微手术切除法,对手术方法、手术人路的选择以及手术结果进行总结分析。结果33例患者中28例（84．85％）全切,5例（15．15％）次全切;临床治愈或缓解27例（81．82％）,术后死亡1例,死于脑干功能衰竭;全切肿瘤的患者中无复发,次全切肿瘤患者复发2例。且手术后患者的生活质量较手术前明显改善,差异有统计学意义（P〈0．05）。结论手术入路的选择应该根据肿瘤的大小,基底部在小脑幕上的位置,侵犯静脉窦的程度及血供,是否避免了损伤脑组织和脑神经;如果全切除肿瘤有可能造成严重的后果,则选择切除部分肿瘤,残留肿瘤用伽玛刀来治疗;为了降低患者术后的复发率,争取选择全切除肿瘤。对小脑幕脑膜瘤患者采用显微手术切除,有明显疗效。     

小脑幕脑膜瘤的显微外科手术治疗

目的探讨小脑幕脑膜瘤的临床特点、手术入路及显微手术技巧。方法回顾性分析安徽宿州市立医院2008年6月~2014年2月间住院手术的17例小脑幕脑膜瘤患者的临床资料。依据肿瘤基底附着部位和主体生长方向选择不同的手术入路。幕上型脑膜瘤采用颞枕部入路2例,采用枕部入路4例;幕下脑膜瘤采用枕下乙状窦后入路6例,采用后正中幕下小脑上入路2例;小脑幕切迹缘采用枕下经天幕入路2例;幕上下脑膜瘤采用幕上下入路1例。结果本组患者中小脑幕脑膜瘤全切除(SimpsonⅠ级和Ⅱ级)14例,次全切除1例,大部分切除2例。结论小脑幕脑膜瘤适宜积极的手术治疗,合适的显微手术入路以及恰当的手术方法能提高治疗效果。     

后颅窝小脑幕脑膜瘤的诊断及手术治疗

目的 总结后颅窝小脑幕脑膜瘤诊断、分型及手术治疗的经验。方法 回顾分析了我院1990年1月至2002年5月间收治经手术和病理证实的后颅窝小脑幕脑膜瘤30例，其中小脑幕外侧型10例，中央型9例，内侧型5例，小脑幕切迹缘型2例，跨小脑幕上下双向生长4例。均采用显微手术。SimpsonⅠ级切除12例，Ⅱ级切除13例，Ⅲ级切除5例。结果 术后死亡1例，术后因脑积水行V-P分流术1例。29例随访6个月至6年，均恢复学习或工作，1例复发，行γ-刀治疗。结论 充分术前准备，正确选择手术入路，熟练的显微手术技术，可提高治愈率，减少术后复发及术后严重并发症。     

岩斜区肿瘤的显微手术治疗

目的 探讨岩斜区肿瘤的显微手术治疗方法及其效果。方法 自2010年10月至2014年10月收治岩斜区肿瘤23例,分别采用颞下经小脑幕入路（11例）、乙状窦后经小脑幕入路（7例）和幕上幕下（颞下-乙状窦后）联合入路（5例）进行手术切除。结果 23例岩斜区肿瘤中脑膜瘤9例,神经鞘瘤12例,胆脂瘤2例。颞下经小脑幕入路11例中,肿瘤全切9例,次全切2例;乙状窦后经小脑幕入路7例均全切除;幕上幕下联合入路5例中,次全切4例,部分切除1例。23例患者随访6~36个月;术前Karnofsky功能状态评分为（83.0±7.0）分,术后1月为（75.2±9.0）分,术后6个月为（80.0±6.0）分;6例次全切除及1例部分切除患者术后1月行伽玛刀治疗,在随访时间内未见肿瘤复发。结论 根据岩斜区肿瘤的不同类型,选择颞下经小脑幕入路、乙状窦后经小脑幕入路和幕上幕下联合入路,可以提供肿瘤全切率,减少并发症,提高手术疗效。     

大脑镰旁脑膜瘤显微手术治疗

目的探讨大脑镰旁脑膜瘤的显微手术方法,提高镰旁脑膜瘤治疗效果。方法回顾性分析32例大脑镰旁脑膜瘤患者的临床资料和显微手术入路选择,采用Simpson评分标准对手术疗效进行评价。结果 32例患者均行显微手术治疗,术后Simpson评分28例为I~Ⅱ级切除,4例为Ⅲ级切除,无手术死亡病例。术后随访6个月至4年,均无复发。结论显微外科手术是大脑镰旁脑膜瘤的有效治疗方法,可提高镰旁脑膜瘤的全切率,减少术后并发症,改善预后。     

小脑幕脑膜瘤显微手术治疗及手术入路选择

目的 探讨小脑幕脑膜瘤的手术治疗和手术入路选择。方法 回顾性分析2008年6月至2017年3月手术治疗的92例小脑幕脑膜瘤的临床资料。内侧型和外侧型向幕上发展者,采用扩大翼点入路10例,颞下入路23例,颞枕部入路18例;肿瘤全部或主体在颅后窝21例,采用枕下或枕部幕上下联合入路;20例镰幕型采用枕部经小脑幕入路。结果 肿瘤全切除86例,部分切除6例。无手术死亡病例。83例术后随访1~8年,正常工作、生活71例,生活自理8例,生活需要照顾4例;肿瘤复发再次手术7例（次全切除5例,全切除2例）。结论 手术全切除小脑膜脑膜瘤可获得满意效果及良好预后;根据肿瘤特点设计合适的手术入路以及熟练掌握局部神经解剖和显微神经外科技术是手术成功的关键;术中深静脉系统及大静脉窦的保护具有重要意义。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

奥氮平治疗精神分裂症对照研究的Meta分析

目的：探讨奥氮平治疗精神分裂症的疗效和不良反应。方法：应用M eta分析对17篇奥氮平与其他抗精神病药治疗精神分裂症对照研究的文章进行再分析。结果：奥氮平自身对照比较的治疗效应极大（χ^2=141.00，P〈0.05）。治疗2周和治疗结束，奥氮平与对照药疗效比较差异无显著性（P〉0.05）;阳性与阴性症状量表（PANSS）评分比较差异亦无显著性（P〉0.05）。与对照药相比，奥氮平的不良反应显著少于对照药组（P〈0.05或P〈0.01）。结论：奥氮平与对照药的临床疗效相仿，但不良反应明显较少。