论医院建设选址

对医院建设选址原则及涉及主要因素展开论述,并结合＂绿色建筑＂理念,展望未来医院建筑设计及项目管理创新。     

Topography of essential tremor

IntroductionTopography of tremor manifestations is poorly investigated in essential tremor. The present study explores the prevalence and clinical correlates of head and/or voice tremor in essential tremor.MethodsOut of a prospectively designed registry of 972 patients, 884 patients with definite and probable essential tremor had complete information on tremor localization. Demographic and clinical characteristics were compared among four subgroups: group A (without head or voice tremor, n = 619), B (with head but without voice tremor, n = 155), C (with voice but without head tremor, n = 47), and D (with both head and voice tremor, n = 63).ResultsIn our patients, total prevalence of tremor was 24.7% for head, 12.4% for voice and 7.1% for the combination of head and voice. Logistic regression analyses showed that female gender is strongly associated with head tremor, which was confirmed by an additional meta-analysis. Severe hand tremor was the only factor associated with voice tremor. Both female gender and severe hand tremor increase the odds for having the combination of head and voice tremor. For males, hand tremor severity is significantly increased among those with head and voice tremor alone and in combination, but for females only for the combination. Patients with both head and voice tremor have more frequent involvement of legs and other localizations and are less responsive to β-blockers.ConclusionsFemale gender and severe hand tremor may increase the odds of head and/or voice tremor in essential tremor. The association of hand tremor severity with midline tremor is stronger for males than females.     

人工泪液对成年近视眼角膜厚度的影响(英文)

目的:研究人工泪液爱丽和倍然对成年近视眼角膜厚度的影响。方法:应用Orbscan Ⅱ角膜地形图系统(Orbscan,Inc,SaltLakeCity,UT,USA,Version3.00E)对滴人工泪液爱丽或倍然0.5h后的最薄角膜厚度(THN)变化进行测量,38例(76眼)被随机分成爱丽组和倍然组,分别于滴药前和滴药后0.5h进行3次THN测量。结果:两组THN在滴药前无差异(t=0.264),但滴药0.5h后两组THN均显著增加(爱丽组5.57±7.00μm,t=4.906,P<0.01,倍然组7.89±7.64μm,t=6.369,P<0.01),两组之间的角膜厚度变化无显著性差异(t=1.381,P>0.05);爱丽组共有32眼(84%)角膜厚度增加,而倍然组33眼(87%)角膜厚度增加。结论:对生产工艺要求相对严格的人工泪液能短时间内显著增加近视眼角膜厚度,角膜厚度的变化可作为评估人工泪液等眼药制剂舒适度的客观指标之一。     

弱视斜视临床与发病机理的研究

本文报告了弱视931例(1332只眼)的远期疗效,结果表明视力提高与年龄、弱视深度、弱视类型等因素有明显关系。治愈的弱视患者中有81.07％建立立体视,弱视深度与体视有关,斜视性弱视获立体视率明显低于屈光不正和屈光参差两组。体视建立随年龄增长而逐渐发育。弱视复发是治疗中的一个重要问题,随访3年以上者无1例复发。同时在国内外首次3年治愈的随访期限。用多导视诱发电位地形图的研究结果提示:(1)内斜弱视的弱视眼鼻侧视网膜呈抑制现象;(2)恒定性外斜弱视颞侧视网膜抑制;(3)间歇性外斜弱视和屈光参差弱视眼未见半侧视网膜抑制;(4)内斜弱视眼对侧眼为非“正常眼”。     

Functional topography of cat primary auditory cortex: representation of tone intensity

Summary The neuronal response to tones as a function of intensity was topographically studied with multiple-unit recordings in the primary auditory cortex (AI) of barbiturate-anesthetized cats. The spatial distribution of the characteristics of rate/level functions was determined in each of three intensely studied cases and their relationship to the distribution of spectral parameters (sharpness of tuning and responses to broadband transients) in the same animals was determined. The growth of the high-intensity portion of rate/level functions was estimated by linear regression. Locations with monotonically growing high-intensity portions were spatially segregated from locations with nonmonotonic rate/level functions. Two noncontiguous areas with a high degree of non-monotonicity were observed. One was located at the dorsoventral center of AI, and a second in the dorsal third of AI. The more ventral aggregate of high non-monotonicity coincided with the region of sharp frequency tuning. The stimulus levels that produced the highest firing rate (strongest response level, SRL) at any sampled location ranged from 10 to 80 dB sound pressure level (SPL). Several spatial aggregates with either high or low SRLs were observed in AI. The region of sharpest tuning was always associated with a region of low SRLs. The response threshold to contralateral tones at the characteristic frequency (CF) ranged from — 10 dB SPL to 85 dB SPL with the majority between 0 and 40 dB SPL. The spatial distribution of response thresholds indicated several segregated areas containing clusters with either higher or lower response thresholds. The correlation of response threshold with integrated bandwidth and transient responses was only weak. Low- and high-intensity tones of the same frequency are represented at different locations in AI as judged by the amount of evoked neuronal activity and are largely independent of the frequency organization. The spatial distribution of locations with high monotonicity and low strongest response levels were aligned with the organization of the integrated excitatory bandwidth and covaried with the response strength to broadband stimuli.     

Global Field Power measurement versus classical method in the determination of the latency of evoked potential components

Summary The Global Field Power measurement (GFPM) was proposed as a method for the determination of component latency in multichannel evoked potential (EP) recordings (Lehmann and Skrandies 1980). In contrast to the classical method (CM) of peak latency determination using only two or three electrodes, multichannel recordings deal with data from twenty or more recording electrodes. We compared the GFPM and CM in evoked potential recordings. Sixty five subjects volunteered for 3 different response tasks. In a P3 oddball paradigm targets consisted of 2000 Hz tonebursts, nontargets of 1000 Hz tonebursts. Flash and Pattern Visual Evoked Potentials (VEP) also were recorded. At peak GFPM latency we found steeper voltage gradients than at CM latency. Both N200 and P300 had a significantly different topography at latencies determined by GFPM than at latencies determined by CM. For VEP we did not find a significant difference between CM and GFPM. Our Data suggests that multichannel recording adds additional dimensions to EP measurements and that only GFPM leads to an unbiased data-reduction as it determinesone momentary map in time which has maximal field strength.Acknowledgments: The authors wish to thank Prof. D. Lehmann, University Hospital, Zurich for scrutinizing the text and for his useful comments and Dr. C. Michel for his computer program to calculate and plot G.F.P.     

Steady-State Visually Evoked Potential topography associated with a visual vigilance task

Summary This paper describes data which demonstrate a correlation between the magnitude of the Steady-State Visually Evoked Potential (SSVEP) and visual vigilance. The SSVEP was recorded from 64 scalp sites and elicited by a 13Hz uniform visual flicker presented continuously while subjects undertook a visual vigilance task. Fifteen right-handed males were required to view three times a series of 180 geometrical shapes comprising a sequence of 60 squares, 60 circles and a further 60 squares. Each viewing of the 180 shapes constituted a trial. Trials 1 and 2 were identical while trial 3 differed from the first two in that one of the circles was modified. Subjects were ignorant as to the location of the modified circle and prior to the third trial, were challenged to identify the modified circle. A comparison of trials 2 and 3 indicated that the appearance of the modified circle was associated with an attenuation of the SSVEP in the occipito/parietal region. The same comparison indicated a pronounced SSVEP attenuation in the centro/parietal region during the interval that subjects were anticipating the appearance of the modified circle. These results suggest a distinction between the cortical activation patterns occurring during different phases of a visual vigilance task.This work was supported in part, by a grant from the Rebecca L. Cooper Foundation. The authors are happy to acknowledge the assistance of Mr. M. Cowey in the recording and analysis of the data, Dr. J. Currie for his helpful advice on conceptual and methodological issues, Prof. P. Finch and Mr. N. Garnham for their statistical advice and assistance, Dr. E. Gordon for his helpful comments on an earlier draft of this paper and Mr. F. Musci for his development of the task presentation software.     

26例克汀病患者脑等电位图的观察

用脑等电位图等手段对26例青少年克汀病患者进行检查,并与同龄的22例正常人作对比。结果发现青少年克汀病患者α频带的能量降低,分布呈广泛性改变;θ频带分布亦呈广泛性改变,能量无明显增高。本文将这些结果与头颅 CT、临床症征作了对比分析,考虑与克汀病脑部弥漫性病变和额叶萎缩有关。     

Visual evoked potentials to a faint light: Signal propagation analyzed with peak latency and topographic mapping

Summary Accurate localization for the process of recognition of a light stimulus is yet to be determined. We studied 19-channel VEP from nine healthy volunteers, evoked by physiologically faint light less than 200 Cd/m², using a light emitting diode (5 mm ø,0.3°, energized for 5 msec). VEP was bandpass filtered from 0.16 to 120 Hz, and analyzed from 20 msec pre-stimulus to 184.2 msec post-stimulus. The grand average VEP suggested an initial positive peak at 115.8 msec at the frontal poles and at 136 msec over the occipital areas. An initial negative peak was noted at 156 msec a the frontal poles and at 179.2 msec over the occipital areas. This might suggest that the potentials evoked had propagated from the frontal poles to the occipital areas, taking about 20 msec. However, the topographic maps contained little evidence for such a propagation, but rather indicated the waxing and waning of positive or negative extremes.     

Topographic distribution of neurofibrillary tangles and granulovacuolar degeneration in hippocampal cortex of aging and demented patients. A quantitative study

Summary Topographic analysis was performed of the distribution of Alzheimer's neurofibrillary tangles and the granulovacuolar degeneration of Simchowicz in the hippocampal cortex of patients with Alzheimer's dementia and mentally normal aged controls. A semiautomated scanning stage microscope was linked potentiometrically to an XY pen recorder in order to plot cytoarchitectonic scattergrams from the sequentially screened hippocampal formations. The density of both lesions per cubic mm of pyramidal cortex was quantified by measuring the area of each of six zones, using a digitizer and programmable calculator.In elderly normal brains as well as those of Alzheimer's disease, the statistically most representative ranking order of predilection forneurofibrillary tangles (in decreasing severity) was: entorhinal cortex > subiculum > H₁ > end-plate > presubiculum > H₂. Forgranulovacuolar degeneration the best rank order was: subiculum > H₁ > H₂ > end-plate > entorhinal cortex > presubiculum. The notable similarities of both such orders of predilection to the well-recognized selective vulnerability of certain hippocampal neurones in clinical conditions of hypoxia, ischemia and epilepsy suggest some common, focally accentuated cytotoxic mechanism may underlie all these regional predispositions.