周口市人群血浆同型半胱氨酸水平与脑梗死发病的相关研究

目的：探讨周口市脑梗死患者血浆同型半胱氨酸水平及其他相关因素与脑梗死的相关性。方法用荧光衍生化后HPLC分离法检测103例脑梗死患者与60例健康体检者的血浆Hcy水平,同时记录多项相关生化指标和临床数据。结果脑梗死组患者血浆同型半胱氨酸水平为（14·32±3·82）μmol/L ,与健康对照组（9·31±2·25）μmol/L相比,具有显著性差异;脑梗死患者中高同型半胱氨酸水平组与正常同型半胱氨酸水平组的血脂相比,差异无统计学意义（Ρ＞0·05）。结论高同型半胱氨酸水平可能是脑梗死患者的独立危险因素,其与血脂的关系并不显著;在脑梗死治疗及二级预防方面检测血清同型半胱氨酸水平有一定的价值。     

高同型半胱氨酸血症与急性脑梗死患者血脂水平相关性分析

目的探讨高同型半胱氨酸(Hhcy)血症与急性脑梗死的关系,说明Hhcy是脑血管病发生的重要危险因素。方法对86例急性脑梗死患者和41例健康对照者测定空腹血清Hcy及血脂水平。结果脑梗死组Hcy水平为32.69±12.43μmol/L,显著高于对照组13.24±4.62μmol/L(p<0.05)。结论血清Hcy水平升高与脑梗死密切相关,提示血清Hcy水平升高可为急性脑梗死的诊断提供新的依据。     

血清同型半胱氨酸水平与帕金森病的关系

目的探讨帕金森病(PD)患者伴发高同型半胱氨酸血症(HHcy)情况及美多巴对其血清同型半胱氨酸(Hcy)水平的影响。方法选择2006-06-01-2009-12-31入住作者医院的PD患者53例,按入院前是否服用美多巴治疗分为非美多巴组和美多巴组,两组患者入院后均予美多巴口服治疗;另选择31名同期健康体检者为对照。采用荧光偏振免疫分析法(FPIA)检测血清Hcy水平,微粒子酶免分析法(MEIA)检测血清叶酸(FA)及维生素B12(VitB12)水平。收集患者初次就诊及初次复诊时的血清Hcy、FA、VitB12水平资料至2010-01-30,并进行分析比较。结果 (1)初次就诊时非美多巴组和美多巴组PD患者血清Hcy水平〔分别(17.28±6.79)、(18.50±6.56)μmol/L〕均高于健康对照组〔(13.49±3.21)μmol/L〕(均P<0.01),HHcy的比例〔分别为50%(14/28)和76%(19/25)〕亦高于健康对照组〔29%(9/31)〕(均P<0.01),而血清FA、VitB12的水平无统计学差异(均P>0.05)。HHcy患者的血清Hcy水平与FA、VitB12水平无相关性(分别r=0.118,P=0.455;r=0.001,P=0.995)。(2)非美多巴组患者复诊时血清Hcy水平〔(15.84±3.33)μmol/L〕较治疗前〔(12.92±3.15)μmol/L〕升高(P<0.05),血清FA、VitB12水平同治疗前比较无统计学差异(P>0.05)。美多巴组患者服用美多巴治疗后血清Hcy、FA、VitB12水平同初次就诊时比较均无统计学差异(均P>0.05)。结论服用美多巴可能使PD患者血清Hcy水平升高,但可能不是PD患者伴有HHcy的惟一原因。     

血浆同型半胱氨酸水平及MTHFR基因多态与血管性痴呆的关系

目的探讨血浆同型半胱氨酸(H cy)水平及M THFR基因多态与血管性痴呆(VD)的关系。方法应用高效液相色谱仪和电化学检测法测定37例VD患者的血浆总H cy水平,并与40例同龄对照组及40例非痴呆脑梗死组比较,运用多聚酶链反应-限制性内切酶片段长度多态性技术(PCR-RFLP)检测M THFR基因多态性,同时测定血浆叶酸及维生素B12水平。结果VD患者血浆总H cy水平显著高于同龄对照组(P<0.001)和非痴呆脑梗死组(P<0.05);M THFR基因型有3种,即纯合子(T/T)型,杂合子(T/C)型,纯合子(C/C)型。3组基因型和等位基因频率相比,差异均无显著性(P>0.05);VD组血浆叶酸及维生素B12水平明显低于同龄对照组(P<0.05)和非痴呆脑梗死组(P<0.05)。结论高同型半胱氨酸血症是VD发病的一个新的危险因素。     

血清同型半胱氨酸水平对氟西汀治疗抑郁症疗效的影响

目的 探讨血清同型半胱氨酸对氟西汀治疗抑郁症疗效的影响.方法 应用荧光偏振免疫法(Fluo-rescence Polarization Immunoassay,FPIA)检测38例抑郁症患者血清同型半胱氨酸水平,并给予8周氟西汀系统治疗,分别于治疗前及治疗后第8周对患者进行17项汉密尔顿抑郁量表(Hamilton rating scale for depres-sion,HAMD17)评定.结果 治疗前抑郁症患者血清同型半胱氨酸水平为(16.45±5.96)μmol/L,高同型半胱氨酸血症的发生率为42.50%;治疗前HAMD评分为(28.38±2.91),与血清同型半胱氨酸水平呈正相关(r=0.724,P=0.000).经过治疗,全部样本中有显著疗效28例(占73.69%),有效8例(占21.05%),无效2例(占5.26%);HAMD减分率为(59.60±19.95)%,与治疗前患者的血清同型半胱氨酸水平呈负相关(r=-0.848,P=0.000).显效组、有效组和无效组患者治疗前血清同型半胱氨酸水平分别为(14.37±2.61)μmol/L,(21.86±3.55)μmol/L,(31.93±11.96)μmol/L,三组组间比较有显著性差异(P=0.000).高同型半胱氨酸血症组和非高同型半胱氨酸血症组患者HAMD减分率分别为(42.64±14.67)%和(73.33±11.03)%,两组比较有显著性差异(t=7.326,P=0.000).结论 血清同型半胱氨酸水平升高可能是抑郁症发病的重要危险因素之一,其对氟西汀治疗抑郁症患者的疗效有一定影响.     

抑郁症患者血清同型半胱氨酸水平的研究

目的探讨抑郁症患者血清同型半胱氨酸水平与抑郁症发病的相关性。方法将94例抑郁症患者作为研究组,选取98例身心健康正常人为对照组,应用荧光偏振免疫法检测血清同型半胱氨酸水平。结果研究组患者血清同型半胱氨酸水平显著高于对照组(16.72±3.94)μmol/L,(10.99±3.51)μmol/L,P<0.05,研究组高同型半胱氨酸血症发生率显著高于对照组(41.5%,14.3%)(χ2=14.89,P<0.05)。结论血清同型半胱氨酸水平升高可能是抑郁症发病的重要危险因素之一,血清同型半胱氨酸水平对抑郁症严重程度有一定的影响。     

幽门螺旋杆菌与脑梗死相关性研究

目的探讨幽门螺旋杆菌(Hp)感染与脑梗死(CI)的相关性。方法选取51例初诊CI患者作为脑梗死组,49例门诊体检患者作为对照组。比较两组患者14碳尿素呼气试验阳性率。分别检测脑梗死Hp阳性组、脑梗死Hp阴性组及体检Hp阳性组患者血浆同型半胱氨酸(Hcy)水平进行比较。结果脑梗死组的Hp感染阳性率(64. 71%)明显高于对照组(57. 14%)。脑梗死Hp阳性组患者血浆同型半胱氨酸水平(35. 83±21. 85)μmol/L显著高于脑梗死Hp阴性组水平(25. 25±13. 02)μmol/L及体检Hp阳性组水平(18. 62±18. 48)μmol/L,且对比差异具有统计学意义(P 0. 01)。结论幽门螺旋杆菌与脑梗死有相关性。     

心脑血管疾病患者血同型半胱氨酸水平的临床价值

目的 探讨心脑血管疾病患者血同型半胱氨酸水平的临床价值.方法 选择我院2011-03 2012-03 60例脑梗死患者作为脑血管病组,60例冠心病患者作为心血管病组,同时选择60例健康体检者作为对照组,所有患者均检测血清同型半胱氨酸水平,对检测结果进行比较.结果 脑血管病组为(25.72±6.71)μmol/L;心血管病组为(21.33±5.22)μmol/L;对照组为(14.52±4.19)μmol/L;脑血管病组与心血管病组Hcy明显高于对照组,组间比较差异有统计学意义P＜0.05.结论 心脑血管病患者同型半胱氨酸水平明显高于正常人,临床对该指标进行检测有利于对疾病进展及预后进行判断,具有重要的临床价值.     

血浆Hcy水平变化对急性脑梗死患者预后的预测价值

目的探讨血浆同型半胱氨酸(Hcy)水平变化对急性脑梗死(acute cerebral infarction,ACI)患者预后的预测价值。方法选择2011-06—2013-12在我院住院治疗的ACI患者84例为ACI组,选取同期在我院接受健康体检的健康人84例作为正常组。利用化学发光法检测2组患者的Hcy、维生素B12(VB12)和叶酸(FA)水平,并对ACI组患者进行神经功能缺损评分(NIHSS)。将ACI组分为2组,每组42例,观察组采用VB12制剂联合FA进行治疗,对照组仅给予常规治疗。结果ACI组Hcy、FA和VB12水平分别为(22.4±7.6)μmol/L、(5.1±1.6)ng/mL和(218.2±97.2)pg/mL,正常组为(13.2±3.3)μmol/L、(7.5±2.4)ng/mL和(307.4±122.6)pg/mL,2组相比差异有统计学意义(P0.05);治疗前脑梗死各亚组Hcy、FA和VB12水平及NIHSS评分相比差异无统计学意义(P0.05),治疗后观察组Hcy、FA、VB12水平和NIHSS评分分别为(12.1±3.5)μmol/L、(6.3±4.2)ng/mL、(1353.4±253.1)pg/mL和(4.8±3.2)分,对照组为(18.8±4.9)μmol/L、(4.2±2.6)ng/mL、(296.3±133.4)pg/mL和(7.1±3.6)分,2组相比差异有统计学意义(P0.05)。结论 ACI患者Hcy水平急剧增加,同时Hcy水平与ACI患者的预后情况紧密相关,Hcy水平可作为ACI患者预后的评价指标。     

高同型半胱氨酸与脑梗死的相关性研究

目的探究脑梗死和高同型半胱氨酸间的相关性。方法选取我院2014-06-2016-03收治的脑梗死患者53例为观察组进行回顾性分析,并选取同期健康体检者53例作对照研究。取患者晨起空腹静脉血,测定2组同型半胱氨酸水平,对比分析测定结果。结果观察组存在高同型半胱氨酸血症17例(32.08%),对照组为8例(15.09%),2组比较差异有统计学意义(P0.05);观察组同型半胱氨酸水平为(24.2±2.8)μmol/L,对照组为(14.8±1.4)μmol/L,2组比较差异有统计学意义(P0.05)。以脑梗死患者性别、年龄及高同型半胱氨酸因素为自变量,以脑梗死发生为因变量,采取多因素Logistic回归分析,高同型半胱氨酸是脑梗死发生的主要危险因素。结论高同型半胱氨酸与脑梗死存在直接相关性,是脑梗死发生的主要危险因素。可通过加强同型半胱氨酸水平检测,降低高同型半胱氨酸血症的发生,对于预防脑梗死发生起到明显作用     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Clobazam for Treatment of Intractable Epilepsy: A Critical Assessment

Summary: Clobazam (CLB), a 1,5-benzodiazepine, is a remarkably effective add-on drug for individual patients with refractory partial epilepsy. CLB has an excellent safety record. As with all benzodiazepines used for treating epilepsy, sedation and withdrawal effects, together with the development of tolerance, limit its usefulness. Recent efforts to prevent or reverse tolerance with intermittent administration of CLB or periodic injection of a benzodiazepine antagonist, flumazenil, are encouraging and justify further investigations.     

La passion de Torquemada et le terrorisme islamique : quelques points de comparaison

This original research compares the doctrinal, psychopathological and operational standpoints of the 15th century Spanish Inquisition (Torquemada) with those of radical Islamism from 1988 to 2005 (Al-Qaeda). The following are reviewed: (a) the main texts codifying the procedure for conducting the criminal investigation of a Holy Office trial (Directorium inquisitorum); (b) the life and work of the grand inquisitor Tomás de Torquemada (1420–1498); (c) the psychopathological relations between passion (passionate psychoses, passionate idealism, paranoid personality) and fanaticism; (d) “the madmen, the enlightened and the criminals” of Islamic terrorism; (e) the cognitive and emotional motives for engagement in the jihadist radicalization of young people; (f) the common principles of monotheistic fanaticism (Inquisition, Al-Qaeda) and the particular dogmas of Islamic terrorism in our time; (g) the operating modes of the Inquisition and the Jihadist holy war. The author concludes that the rigour and seriousness of the inquisitorial judicial procedure, which was precise, individual and personalized, contrasts with the revolutionary pamphlets of Al-Qaeda, which only provide broad guidelines for the modus operandi of the fight against infidels, who are usually random victims.     

Claustration et collectionnisme : réflexions à propos d’un cas de syndrome de Diogène avec vols kleptomaniaques et vengeurs

Social withdrawal is a pathognomonic behaviour that is consistently associated with mental illnesses. Compulsive hoarding can also be interpreted as a pathological behaviour, even when it does not involve kleptomania. Diogenes syndrome (DS) was first described in 1975, and is characterized by both behaviours - social withdrawal and compulsive hoarding. Even though it is often the manifestation of a psychiatric condition, its aetiology is diverse. The most frequent ones are however: dementia, schizophrenia and mental retardation. In this study, we describe an atypical case presenting with DS. Il consists of a young man, seen in a forensic setting, who had been diagnosed with kleptomania in the past, presents with compulsive hoarding, and whose recent thefts were fuelled by revenge. Finally, to our knowledge, the way social withdrawal is viewed is seldom taken into account. We analyse its implication on social withdrawal.     

Neurological soft signs and schizophrenia: a review of current knowledge

Schizophrenia is a frequent and disabling disorder emerging during adolescence or early adulthood. The identification of underlying processes has been hampered by the complex clinical expression and the probable etiological heterogeneity. The frequency of neurological soft signs (NSS) in patients with schizophrenia and their presence early in life (during the first two years) in high risk subjects support the hypothesis that schizophrenia is a "brain disease" reflecting pre- or perinatal insults during development. The growing interest for NSS has lead to multiple studies that are often difficult to compare. The objective of this review is to summarize the current knowledge on NSS, methodological issues and the future perspectives.     

Lacan, lecteur de Minkowski : l'approche structurale

The notion of structure occupies a predominant place in the theory of Lacan. He indicates that was developed from the work of Minkowski. In fact, through his phenomeno-structural approach, Minkowski does not limit himself to purely observable phenomena, but attempts to determine the underlying structure. He refers to the comprehensive phenomenology and psychopathology, and this method provides him with clinical finesse and another means of determining a diagnosis. Thus Lacan has used this as a basis for his approach to structure to develop a theory regarding the individual. This implies that the structure of the individual is based on his relation to language. From this concept, he then develops the clinical structures of neurosis, psychosis, and perversion. These structural landmarks also have an effect on the course of treatment.