奎的平与氯氮平治疗精神分裂症的对照研究

目的 比较奎的平、氯氮平对精神分裂症患者认知功能的影响及其疗效、副作用。方法 采用随机分配原则，选择符合CCMD-3精神分裂症诊断标准的患者50例，分奎的平组和氯氮平组治疗8周，治疗前、治疗8周末用阴性与阳性症状量表(PANSS)、韦氏成人智力测验中不分心／记忆因子(FD／M)、韦氏记忆测验（WMS)、威斯康星卡片分类测验(WCST)、以及药物副作用评定量表(TESS)评估。结果 患者经过8周治疗，PANSS总分均下降，两组之间疗效差异无显著性，PANSS各因子评分亦无差异。两组对精神分裂症患者认知功能的改善均有效，在记忆评定中奎的平组对累加、记忆总分的改善与氯氮平组比较差异有显著性。氯氮平较奎的平的副作用多，各种副作用中氯氮平组在嗜睡、活动减少、视物模糊、便秘、唾液增多、头昏晕厥、血糖增高、体重增加的评分较奎的平组高，两组比较差异有显著性。结论 奎的平与氯氮平在治疗精神分裂症中疗效相当；奎的平对认知功能有较好的改善；且副作用较氯氮平更少；是治疗精神分裂症患者理想的一线药。     

Molecular biology of the voltage-gated sodium channel

The integral membrane protein composing the voltage-sensitive sodium channel is a bagel-like structure (Fig. 1) with a central pore that is highly selective for sodium ions. When the electric field across a cell's membrane becomes depolarized, the pore of the channel opens to allow sodium ions to flow down their electrochemical gradient into the cell¹. Voltage-gating, a common feature of all voltage-activated channels, is an essential functional property that is only now being understood in terms of the structural features of the protein.     

Gabapentin Enhances the Morphine Anti-Nociceptive Effect in Neuropathic Pain via the Interleukin-10-Heme Oxygenase-1 Signalling Pathway in Rats

In the present study, we investigated the anti-inflammatory mechanisms by which gabapentin enhances morphine anti-nociceptive effect in neuropathic pain in rats and the interaction between the anti-nociceptive effects of gabapentin on morphine and the interleukin (IL)-10-heme-oxygenase (HO)-1 signal pathway in a rat model of neuropathic pain. The neuropathic pain model was induced via a left L5/6 spinal nerve ligation (SNL) in rats. The anti-nociceptive effect of gabapentin and IL-10 on morphine was examined over a 7-day period, and the effects of the anti-IL-10 and HO-1 inhibitor zinc protoporphyrin (ZnPP) on gabapentin/morphine co-injection were assessed. Drug administration was given over 7 days, and on day 8, both anti-inflammatory cytokine IL-10, a stress-induced protein HO-1 and pro-inflammatory cytokines IL-1β, IL-6 and TNF-α were measured. Gabapentin attenuated morphine tolerance over 7 days of co-administration, and reduced the expression of pro-inflammatory cytokines but increased IL-10 and HO-1 expression. The effect of gabapentin on morphine was partially blocked using the anti-IL-10 antibody or the HO-1 inhibitor zinc protoporphyrin. Our findings indicated that the anti-nociceptive effects of gabapentin on morphine might be caused by activation of the IL-10-HO-1 signalling pathway, which resulted in the inhibition of the expression of pro-inflammatory cytokines in neuropathic pain in the rat spinal cord.     

29例原发性中枢神经系统淋巴瘤的诊断与治疗

目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的诊断、治疗及效果。方法收治29例经病理证实的PCNSL患者，根据治疗方法的不同分为3组：6例患者肿瘤切除范围较小（包括2例活检），因颅高压不能承受进一步的治疗；7例术后接受放疗；16例术后接受放疗＋化疗的综合治疗。出院后皆随访。结果单纯手术治疗者平均生存时间3．20个月，手术＋放疗和手术＋放疗＋化疗者平均生存时间分刖为32及40个月，综合治疗效果显著提高（P〈0．05）。结论单纯手术不能有效控制PCNSL的发展，术后及时辅以放疗和（或）化疗可显著延长患者的生存时间。手术应以充分降低颅内压为目的，使患者能承受进一步的放疗和化疗。     

垂体Rathke囊肿的诊断和手术治疗

目的分析和讨论垂体Rathke囊肿的诊断和手术治疗。方法回顾分析41例经手术和病理证实的垂体Rathke囊肿的病例,男性16例,女性25例,平均年龄32.8岁,平均病程为20.6月。主要临床表现包括头痛(62.5%)、垂体功能紊乱(55%)、视功能障碍(32%)等。CT及MR检查发现鞍区囊性肿物。39例采用经口鼻蝶窦入路显微外科手术,2例采用开颅手术,切除部分囊壁,敞开囊腔,清除囊肿内容物。结果术前正确诊断为垂体Rathke囊肿的仅为7例,术后随诊3月至8年,头痛病人的症状全部缓解,垂体功能紊乱病人55%得到改善,视功能障碍病人75%得到改善。41例病人术后均无复发。结论垂体Rathke囊肿术前较难明确诊断,MR检查信号呈多样性,无特异性。经口鼻蝶窦入路显微外科手术可以明确诊断,缓解症状,患者预后良好,是治疗垂体Rathke囊肿的有效方法。     

多系统萎缩的影像学特征

多系统萎缩(MSA)是一种散发的、迅速进展的神经系统变性疾病,临床表现为自主神经功能障碍和帕金森病样症状、小脑性共济失调的不同组合。对此疾病早期识别的研究进展导致了诊断标准的修订,包含首次将神经影像学特征列入诊断标准。例如MRI显示壳核、小脑中脚、脑桥、小脑萎缩;FDG-PET显示壳核、脑干、小脑代谢减退;SPECT或PET显示突触前黑质纹状体多巴胺能失神经支配。MSA的影像学特征可以作为临床生物学标记物用于早期识别MSA。     

超早期应用丹参注射液治疗颅脑损伤的临床研究

目的探讨丹参注射液治疗颅脑损伤后脑水肿及颅内压增高的最佳作用阶段。方法选择98例颅脑损伤,随机分为超早期(伤后6～12h,T1)、早期(伤后24～72h,T2)给药组及对照组(C)。给药组加用丹参注射液,观察各组伤后第1、3、5、7天颅内压(ICP)及第7、14天脑水肿情况,并加以比较。结果T1组伤后第3、5、7天ICP均明显低于C组(P<0.05),T2组至第7天ICP才明显低于C组(P<0.05)。伤后第7天重度脑水肿比率T1组明显低于C组(P<0.05),T2组与C组无显著性差异(P>0.05);第14天脑水肿消退比率T1组及T2组均明显高于C组(P<0.05),但T1组更加明显(P<0.01)。结论超早期应用丹参注射液将更有利于减轻颅脑损伤后脑水肿及降低脑水肿所致高颅内压。     

Inflammation and proinflammatory cytokine production,but no demyelination of facial nerves,in experimental autoimmune neuritis in Lewis rats

Experimental autoimmune neuritis (EAN) is a CD4⁺ T cell-mediated, inflammatory demyelinating disease of the peripheral nervous system (PNS) that serves as a model for Guillain–Barré syndrome (GBS) in humans. The facial nerve paralysis is relatively commonly found in GBS patients. Here, EAN was established in Lewis rats by immunization with P2 peptide 57–81, a purified component of peripheral nerve myelin, and Freund's complete adjuvant (FCA). To study whether the facial nerves are involved in the pathogenic process during the EAN course, we observed the clinical and pathological changes as well as cytokine production in facial nerves on Day 14 postimmunization (p.i.), i.e. at height of clinical EAN. As a result, all rats immunized with P2 peptide 57–81 developed severe EAN on Day 14 p.i., but none of the rats manifested clinical signs of facial nerve paralysis. Additionally, only mild inflammatory cell infiltration and proinflammatory cytokine, interferon-γ (IFN-γ) and tumour necrosis factor (TNF-) production as well as devoid demyelination were seen in facial nerves of the EAN rats. On the contrary, severe inflammation and demyelination as well as upregulated IFN-γ and TNF- production were observed in sciatic nerves of the same EAN rats. The underlying mechanism for the difference of the local manifestation of the disease process of EAN remains to be resolved.     

银杏叶提取物对大鼠皮质缺血再灌注后自由基系统动态平衡的影响

目的　研究不同浓度银杏叶提取物 (GBE)对大鼠脑缺血再灌注损伤皮质内自由基动态平衡的影响。方法　将 119只Wistar大鼠随机分为 17组 ,假手术组 7只 ,缺血组—缺血 3h组 ,缺血 3h分别再灌注 1h、2h、3h组各 7只 ;治疗组 (即在缺血前 30分钟给予GBE 5mg/kg、10mg/kg、15mg/kg ,腹腔给药 )—缺血 3h ,但缺血 3h分别灌注 1h、2h、3h组各 7只。动物模型参照Zivin的大脑中动脉线栓模型并加以改进。结果　比较缺血组和治疗组 ,可见给予GBE后能明显减少丙二醛 (MDA)的产生 ,增加的超氧化物歧化酶 (superoxidedismutase ,SOD) ,SOD的测定采用黄嘌呤法 ,谷胱甘肽过氧化物酶 (glutathioneperoxi dase ,GSH PX)生成和释放 ,5mg/kg组与 10mg/kg、15mg/kg组间有显著差别 ,而后二者间无显著差别。结论　血小板活化因子拮抗剂GBE可通过增强SOD和GSH PX的合成、释放 ,降低MDA的合成、保护缺血的神经元 ,且与用药剂量有关。     

慢性前列腺炎患者的抑郁症状及相关因素研究

目的探讨慢性前列腺炎患者的抑郁症状及相关因素。方法采用抑郁自评量表(SDS)和相关因素调查表按2∶1匹配对200例慢性前列腺炎患者和健康男性的抑郁症状及相关因素进行对照研究。结果慢性前列腺炎患者的抑郁症状发生率为35.50%,极显著的高于对照组。生活满意度和经济状况差是影响患者抑郁症状的重要因素,未婚者抑郁症状的发生率高于已婚者,差异性显著。结论慢性前列腺炎患者常伴有不同程度的抑郁症状,影响其生活质量,应适时进行心理干预。