重复经颅磁刺激对抑郁症患者的抑郁程度和HPA轴的影响

目的探讨重复经颅磁刺激对抑郁症患者的抑郁程度和下丘脑-垂体-肾上腺（HPA）轴活性的影响。方法采取双盲对照试验方案,将确诊的40例抑郁症患者随机分入工组（治疗组）和Ⅱ组（假刺激对照组）,每组治疗10天。在治疗前及治疗结束后当天检测Hamilton抑郁量表（HAMD）积分、血清皮质醇（CORT）及血清促肾上腺皮质激素（ACTH）浓度。结果治疗前全组的HAMD积分与血清CORT（r=0．948）和ACTH（r=0．971）浓度和治疗后治疗组的HAMD积分与血清CORT（r=0．920）和ACTH（r=0．978）浓度间均呈显著正相关关系（均P〈0．05）。治疗前两组的HAMD积分（t〈0．001）、血清CORT（t=-0．328）和ACTH（t=-0．228）浓度无统计学差异（均P〉0．05）;治疗后两组的上述指标均有统计学差异（P〈0．05）。结论抑郁症患者的抑郁程度与其血清CORT和ACTH浓度呈正相关。rTMS有改善抑郁症状的作用,其抗抑郁作用的机制可能与其下调HPA轴的活性有关。     

重复经颅磁刺激对脑瘫患儿功能网络的影响

目的通过功能磁共振成像(fMRI)方法研究重复经颅磁刺激(rTMS)对脑瘫患儿功能网络的影响,为了解rTMS对脑瘫患儿的治疗效果及作用机制提供影像学依据。方法对1例脑瘫患儿进行为期一年的周期性rTMS治疗,刺激频率1Hz,每个治疗周期后进行静息态功能磁共振成像扫描。选取刺激额中回区域为种子点,分析种子点与全脑所有体素的功能连接情况,并将不同治疗阶段的功能网络进行对比分析。结果额中回与全脑的功能连接性随治疗时间逐渐增强,连接区域逐渐增大,尤其是与运动皮层、小脑、楔前叶以及海马的连接范围及强度呈明显的动态变化。结论在前额叶区域对脑瘫患儿进行重复性经颅磁刺激治疗可以有效改善其大脑的功能连接情况,这些结果证明了rTMS对脑瘫患儿的治疗效果。     

HR神经元模型的放电节律分析

目的 研究HR神经元的复杂动力学行为.方法 运用非线性动力学方法,研究外界电流对神经元放电模式的影响.特别地,基于快慢动力学分析,探讨簇模式和峰模式不同的产生机理.结果 数值分析结果揭示了簇振荡和峰振荡模式存在的区域,此外,还发现了分岔序列结构.结论 为进一步研究外界激励对神经元复杂放电模式的影响提供了线索.     

Cholinergic hyperactivity in patients with myasthenia gravis with MuSK antibodies: A neurophysiological study

ObjectivePatients with myasthenia gravis associated with muscle-specific tyrosine kinase antibodies (MuSK-MG) often manifest signs of cholinergic hyperactivity with standard doses of acetylcholinesterase inhibitors (AChE-Is). Aim of the study was to investigate whether repetitive compound muscle action potential (R-CMAP), the neurophysiological correlate of cholinergic hyperactivity, was present in MuSK-MG irrespective of AChE-I treatment.MethodsPatients with confirmed diagnosis of MuSK-MG were consecutively enrolled during follow-up visits, from January 2019 to April 2020. All these subjects underwent the same neurophysiological protocol, including motor nerve conduction studies and repetitive nerve stimulation. In patients taking pyridostigmine, neurophysiological testing was performed at least 12 hours after the last dose. For comparison, the presence of R-CMAP was investigated in 20 consecutive acetylcholine receptor antibody positive myasthenia gravis (AChR-MG) patients.ResultsWe enrolled 25 MuSK-MG patients (20 females), aged 16–79 years at the study time, with disease duration ranging 0.6–48.8 years (median: 17.7 years). R-CMAP was detected in 12/25 (48%) MuSK-MG cases and in none of the AChR-MG controls (p = 0.0003). In the MuSK-MG population, a history of muscle cramps and fasciculations, during low-dose pyridostigmine therapy, was significantly more frequent in R-CMAP positive than in R-CMAP negative patients (100% vs 31%, p = 0.001). At the time of the study, the proportion of patients still symptomatic for MG was higher among R-CMAP positive cases (92% vs 23%, p = 0.0005).ConclusionsCholinergic hyperactivity is a relatively common finding in MuSK-MG patients, independent of AChE-I treatment, and may constitute an intrinsic feature of the disease.SignificanceR-CMAP detection can represent a useful diagnostic clue for MuSK-MG and predicts poor tolerance to AChE-Is.     

Effects of a synbiotic on symptoms,and daily functioning in attention deficit hyperactivity disorder – A double-blind randomized controlled trial

Some prebiotics and probiotics have been proposed to improve psychiatric symptoms in children with autism. However, few studies were placebo-controlled, and there is no study on persons with an attention deficit hyperactivity disorder (ADHD) diagnosis. Our aim was to study effects of Synbiotic 2000 on psychiatric symptoms and functioning in children and adults with ADHD without an autism diagnosis. Children and adults (n = 182) with an ADHD diagnosis completed the nine weeks randomized double-blind parallel placebo-controlled trial examining effects of Synbiotic 2000 on the primary endpoints ADHD symptoms, autism symptoms and daily functioning, and the secondary endpoint emotion regulation, measured using the questionnaires SNAP-IV, ASRS, WFIRS, SCQ, AQ and DERS-16. Levels at baseline of plasma C-reactive protein and soluble vascular cell adhesion molecule-1 (sVCAM-1), central to leukocyte-endothelial cell adhesion facilitating inflammatory responses in tissues, were measured using Meso Scale Discovery. Synbiotic 2000 and placebo improved ADHD symptoms equally well, and neither active treatment nor placebo had any statistically significant effect on functioning or sub-diagnostic autism symptoms. However, Synbiotic 2000, specifically, reduced sub-diagnostic autism symptoms in the domain restricted, repetitive and stereotyped behaviors in children, and improved emotion regulation in the domain of goal-directed behavior in adults. In children with elevated sVCAM-1 levels at baseline as well as in children without ADHD medication, Synbiotic 2000 reduced both the total score of autism symptoms, and the restricted, repetitive and stereotyped behaviors. In adults with elevated sVCAM-1 at baseline, Synbiotic 2000 significantly improved emotion regulation, both the total score and four of the five subdomains. To conclude, while no definite Synbiotic 2000-specific effect was detected, the analysis of those with elevated plasma sVCAM-1 levels proposed a reduction of autism symptoms in children and an improvement of emotion regulation in adults with ADHD.Trial registration number: ISRCTN57795429.     

早期症状改善预测焦虑患者rTMS治疗的疗效

目的 探讨重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)治疗焦虑障碍患者早期症状的改善能否预测最终的临床疗效。方法 选择40例2017年7月-2019年11月本院焦虑障碍患者进行rTMS治疗,早期症状改善的界限值定义为治疗1或2周后汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)减分率15%～40%,分别计算其预测治疗4周后最终临床疗效的灵敏度、特异度、阳性预报值、阴性预报值,并通过受试者工作特征曲线(Receiver operating characteristic curve,ROC曲线)评估其预测效应。结果 治疗总有效率为62.5%; 以rTMS治疗1周后HAMA减分率15%及20%或治疗2周后HAMA减分率15%、20%、25%、30%及35%为界限值预测临床疗效有相对较高的灵敏度和阴性预报值; 以rTMS治疗1周后HAMA减分率30%、35%及40%或治疗2周后HAMA减分率35%及40%为界限值预测临床疗效有相对较高的特异度和阳性预报值; 以治疗1和2周后HAMA减分率预测治疗4周后临床疗效的ROC曲线下面积分别为0.712(P<0.05)和0.856(P<0.01)。结论 rTMS治疗焦虑障碍早期症状改善可有效预测最终临床疗效。     

A case of congenital herpes simplex virus infection diagnosed at 8 months of age

We present the case of an 8-month-old boy with the repeated recurrence of vesicles from the time of birth and who subsequently manifested psychomotor developmental delay. We retrospectively diagnosed the patient with congenital herpes simplex virus (HSV) infection. Computed tomography showed multiple calcifications in the periventricular white matter and thalami. The bilateral deep white matter showed an abnormally high signal intensity on T2-weighted magnetic resonance imaging. The patient required consecutive, suppressive therapy with valacyclovir to prevent the repeated recurrence of vesicles. This case presented a milder phenotype of congenital HSV infection in comparison to previous reports, and highlights the importance of the careful examination for this disease when neonates present with skin lesions.     

Wnt/β-catenin信号通路对孤独症模型大鼠重复呆板样行为的影响

目的　探讨Wnt/β-catenin信号通路对孤独症发生过程中重复呆板样行为的影响。 方法　利用丙戊酸（valproic acid,VPA）孤独症动物模型,检测了经典Wnt信号通路关键信号分子β-catenin及其负性调节因子GSK-3β在孤独症模型大鼠小脑脑区的表达变化;同时检测孤独症模型大鼠重复呆板样行为变化。Western blotting法检测GSK-3β、β-catenin总蛋白及磷酸化蛋白表达,运用旷场实验检测重复呆板样行为持续的时间、次数。 结果　与对照组相比,在小脑脑区模型组GSK-3β磷酸化蛋白表达增加,β-catenin磷酸化蛋白表达减少;重复呆板样行为持续的时间、次数均增加。 结论　孤独症大鼠小脑脑区经典wnt信号通路活性增加,运动亢进,提示经典Wnt信号通路活性增加可能导致重复呆板样行为变化,进而导致对孤独症的易感性增加。     

重复经颅磁刺激对抑郁症患者自杀的影响

目的：探讨重复经颅磁刺激对抑郁症患者自杀的影响。方法：本研究对我院住院并愿意接受研究的89例抑郁症自杀患者进行研究。随机分为两组,研究组40例,对照组49例,两组均给予SSRI类药物治疗,研究组在SSRI类药物治疗的基础上联合重复经颅磁刺激治疗,每周5次,2周为一个疗程,治疗4周。分别于治疗前、治疗2周、治疗4周采用汉密尔顿抑郁量表（HRSD）和自杀意念自评量表（SIOSS）对治疗效果进行评分。结果：两组治疗前HRSD评分及SIOSS评分无显著性差异,治疗后两组的评分均有不同程度的降低,但研究组更显著（ P＜0．05）;研究组在治疗2周后即显效,与对照组比较有显著性差异（χ2＝6．059,P＜0．05）;治疗4周后研究组的有效率明显高于对照组（χ2＝18．460,P＜0．05）。结论：重复经颅磁刺激能缩短起效时间,改善抑郁症患者的临床症状,主要体现在睡眠、认知障碍、躯体化症状、迟缓及绝望感,并且能降低抑郁症患者的自杀风险。     

不同重复经颅磁刺激模式对慢性精神分裂症阴性症状的疗效及安全性

目的：比较不同重复经颅磁刺激（ rTMS）模式对慢性精神分裂症阴性症状的疗效及安全性研究。方法：将90例慢性精神分裂症患者随机分为5Hz组、10Hz组、伪刺激组,每组30例。3组在维持原有抗精神病药物种类及剂量不变的基础上,刺激部位均选择左侧前额叶背外侧皮质区（ DLPFC）,刺激强度为80％运动阈值,每天1次,每周5次,共2周。治疗前后采用阳性与阴性症状量表（ PANSS）和阴性症状量表（ SANS）量表评定疗效。结果：3组治疗后比较,PANSS总分、阴性因子分、SANS评分差异有统计学意义（F＝22．99,39．73,31．90;P均＜0．05）,10Hz组较伪刺激组PANSS总分、阴性因子分、SANS评分低,差异有统计学意义（ q＝－5．60,－5．70,－7．67;P均＜0．05）;10Hz组较5Hz组PANSS总分、阴性因子分、SANS评分低,差异有统计学意义（ q＝－4．97,－5．80,－7．40;P均＜0．05）。与治疗前比较,10Hz组PANSS总分、阴性因子分、SANS评分降低,差异有统计学意义（ t＝－5．45,－7．03,－7．23;P均＜0．05）;5Hz组和伪刺激组PANSS总分及各因子分、SANS评分差异无统计学意义（P均＞0．05）。结论：10Hz rTMS模式能改善慢性精神分裂症患者阴性症状,有较好的安全性。