Impaired modulation of motor cortex excitability by homonymous and heteronymous muscle afferents in focal hand dystonia.

A decrease of heteronymous median nerve-evoked inhibition of corticospinal projections to forearm extensor muscles was reported in a group of 10 dystonic patients by Bertolasi and colleagues in 2003. Here we tested the excitability of corticomotoneuronal connections to both wrist extensor (ECR) and flexor (FCR) muscles after conditioning stimulation of median and also radial nerve at rest in a group of 25 patients with focal hand dystonia compared to 20 healthy subjects. We also investigated the effect of the wrist dystonic posture, either in flexion or in extension, on the afferent modulation of ECR and FCR motor evolved potentials (MEPs). The heteronymous (median-induced) but also homonymous (radial-induced) inhibitions (interstimuli intervals 13-21 ms) of ECR MEP size observed in healthy subjects were decreased in patients. In addition, homonymous (median-induced) facilitation of FCR MEP size was also decreased in patients while heteronymous inhibition (radial-induced) was not. Neither the involvement of the target muscle in the dystonic posture nor the origin of the afferent volley (from a dystonic muscle) influenced the degree of impairment of afferent modulation of the MEP. These findings support the view that a global abnormal somatosensory coupling in focal hand dystonia may contribute to an inadequate motor command to wrist muscles.     

A nationwide survey of excessive daytime sleepiness in Parkinson's disease in France

To determine the prevalence of excessive daytime sleepiness (EDS) and that of dozing and sudden onset of sleep episodes (SOS) while driving in ambulatory patients with Parkinson's disease (PD) in France, a national sample of private and public neurologists was asked to recruit the first 10 consecutive nondemented PD patients. Each patient completed a questionnaire including the Epworth Sleepiness Scale (ESS) and the likelihood of dozing off and experiencing SOS episodes behind the wheel. Clinical and demographic data were collected. One thousand six hundred and twenty‐five patients with PD were included in the survey. Twenty‐nine percent of the patients suffered from EDS (ESS score ≥10) but only 0.8% declared a high chance of dozing while driving and 0.5% reported totally unpredictable SOS episodes while driving. Risk factors for EDS were male gender, reduced activity of daily living, and a high daily levodopa equivalent dosage. Risk factors for SOS episodes while driving were an ESS score ≥10, male gender, and low Hoehn and Yahr staging. EDS is common in ambulatory patients with PD and is a major risk factor for dozing and for SOS episodes behind the wheel in patients who drive. © 2007 Movement Disorder Society     

医护人员对术后痛和术后止痛态度的调查

目的 调查了解医护人员术后痛和术后止痛的认识和态度。方法 用问卷式调查表采取面对面方式调查了本院130名医护人员。结果 ①128人（98.5%）完成答卷。②绝大多数认为应控制术后痛，但约40%不知道术后痛可致并发症。③有20%-50%的人对术后止痛有误解。④仅半数人了解术后止痛用药现状。⑤认为术后止痛应主要由外科医师和麻醉医师负责者分别占55.5%和35.9%。⑥绝大多数认为术后止痛宣传力度不够。⑦对本院术后镇痛工作评价良好。⑧非手术科室人员在某些方面不如手术科室更了解。结论 医护人员术后止痛意识较好，但仍有许多不足之处。有必要进一步加强医护人员术后止痛意识的教育。     

两种不同方法定位肌间沟臂丛神经阻滞的临床观察

目的 观察经肩胛舌骨肌定位和运用神经刺激器定位肌间沟臂丛神经阻滞两种方法的临床效果。方法 选择ASAⅠ-Ⅱ级的择期上肢手术患者60例，随机分为两组：I组（30例）通过肩胛舌骨肌定位穿刺点寻找异感；Ⅱ组（30例）使用神经刺激器定位肌间沟臂丛神经，观察肌肉节律性收缩。两组分别观察进针深度，阻滞效果及不良反应。I组还同时观察肩胛舌骨肌触摸难易度，穿刺部位以及一次异感获得率等。结果 I组肩胛舌骨肌触摸容易者27例（90％），穿刺部位距锁骨上缘1.6-3.1cm，进针深度0.5-1.5cm，一次获得异感26例（87％），阻滞效果完善，无不良反应。Ⅱ组有28例阻滞完善，另2例阻滞不全，2例出现不良反应。结论 运用神经刺激器定位肌间沟臂丛神经阻滞切实可行。而以肩胛舌骨肌定位肌间沟臂丛神经阻滞定位明确，效果满意，简单易行。     

Cerebellar abscess and syringomyelia due to isoniazid-resistant Mycobacterium tuberculosis.

A 19-year-old immunocompetent man was admitted to hospital with diplopia, nausea, vomiting and change in mental status. The patient had a history of tuberculous meningitis that was diagnosed at another hospital 6 months before the present admission, and at that time anti-tuberculosis treatment was initiated using a first-line drug combination. A computed tomography (CT) scan of the brain revealed non-communicating hydrocephalus. A ventriculo-peritoneal shunt was inserted surgically. Two months later, the patient was hospitalized again for fever, dysphagia and left hemiparesis. At that time, his cranial CT findings were within normal limits; however, magnetic resonance imaging (MRI) revealed an irregular multilocular peripheral contrast-enhancing lesion in the posterior fossa. The abscess was surgically drained. The presence of acid-fast bacilli in the abscess material was demonstrated by Ziehl-Neelsen staining. Mycobacterium tuberculosis grew on Lowenstein-Jensen culture medium, and the strain was found to be resistant to isoniazid. One month after the operation, the patient became quadriparetic. Cervical MRI revealed a cervico-thoracic syringomyelitic cavity, after which a syringoperitoneal shunt was placed. Treatment with four drugs was continued for 10 months, and then treatment with three drugs for a total period of 18 months. The patient recovered, with residual quadriparesis. Even though very rare, isoniazid-resistant M. tuberculosis may be the causative agent of progressive tuberculosis.     

网络化人类精子库管理信息系统的建立与应用

目的 :建立网络化人类精子库管理信息系统。　方法 :用SQLServer2 0 0 0和PowerBuilder 8.0开发人类精子库管理信息系统。　结果 :系统形成了档案管理、体检与检查管理、检验与冷冻管理、供应与随访管理 4个模块 ,系统以远程传输与实时监控的方法控制和管理供应点。　结论 :本系统具有数据容量大、安全性能好、保密性能强 ,具有远程传输与实时监控功能     

蟾毒灵抗小鼠原位移植性肝癌整体药效学研究

目的　探讨蟾毒灵对小鼠原位移植性肝癌的抗肿瘤作用。方法　建立肝原位移植瘤模型。随机分为 5组 ,每组 15只 ,蟾毒灵 3组分别给予 1.5、1.0、0 .5mg/kg体重 ,腹腔注射 ;生理盐水 (NS)组给予等体积的生理盐水 ,用法同蟾毒灵组 ;阿霉素 (ADM )组按 8mg/kg体重给药。用药后第 11天每组分别处死 10只荷瘤鼠 ,测量肿瘤大小 ,取瘤组织行病理学检查和瘤细胞超微结构观察。剩余各组观察带瘤生存期。结果　蟾毒灵组肿瘤大小均较NS组明显缩小 (P <0 .0 1) ;中、大剂量的蟾毒灵组带瘤生存期较NS组明显延长 (P <0 .0 5 ,P <0 .0 1)。大、中剂量的蟾毒灵瘤组织以中重度坏死为主 ,小剂量以轻中度坏死为主。电镜下大、中剂量蟾毒灵组可见肿瘤细胞凋亡征象。结论　蟾毒灵对小鼠原位移植性肝癌有显著的抗肿瘤作用 ,诱导肿瘤细胞凋亡可能是蟾毒灵的抗肿瘤机理之一。     

工频磁场对星形胶质细胞间隙连接通讯功能的影响

目的　探讨工频磁场 (PFMF)是否有促癌或协同促癌作用。方法　利用荧光光漂白后再恢复法观察漂白细胞荧光强度的恢复以判断经间隙连接的细胞间通讯 ,以相对荧光强度恢复速率(CFIRR)作为对细胞间隙连接通讯 (GJIC)作用的评价指标 ,研究不同磁场强度单独作用或协同佛波酯(TPA)对星形胶质细胞GJIC功能的影响。结果　 3ng/mlTPA作用 1h时CFIRR的中位数 (Md)值为4 .53 % /min ,空白对照组为 9.74% /min ,两组的差异有显著性 (H =1 2 .0 84,P <0 .0 0 5)。 0 .8或 1 .6mT磁场作用 2 4h时CFIRR的Md 分别 8.2 5、6 .68% /min ,与空白对照组比较 ,差异无显著性 (H =32 .61 7,P >0 .0 5)。 0 .8或 1 .6mT磁场作用 2 3h ,再与TPA共同作用 1h时CFIRR的Md 分别为 3 .32、2 .85% /min ,与TPA组比较 ,差异无显著性 (H =2 .589,P >0 .0 5)。结论　 0～ 1 .6mT的 50Hz磁场单独作用不能抑制星形胶质细胞GJIC功能 ;协同TPA ,不能增强TPA对星形胶质细胞GJIC的抑制作用 ;但是磁场对星形胶质细胞GJIC的抑制作用随着磁场强度增强呈递增趋势