咪达唑仑导致神经功能损伤及作用机制研究

目的：探讨镇静药咪达唑仑导致神经功能损伤及其机制。方法：将72 只大鼠分为生理盐水对照组、咪达唑仑组、右美托咪定组三个组别，每组各24 只，比较三组大鼠的神经元特异性烯醇化酶（neuron-specific enolase，NSE）、中枢神经特异性蛋白（central nervous specific protein，S100β）、细胞死亡受体Fas 水平、逃逸潜伏期、游泳速度、穿过原平台次数，对NSE、S100β、Fas 病理切片进行分析。结果：与对照组和右美托咪定组相比，咪达唑仑组 NSE、S100β、Fas 水平较高，逃逸潜伏期较长，穿过原平台次较少（P<0.05）。结论：咪达唑仑对神经功能损伤以及学习记忆功能影响较大。     

Explicit and implicit stigma towards peers with mental health problems in childhood and adolescence

Background: Children and adolescents with mental health problems are widely reported to have problems with peer relationships; however, few studies have explored the way in which these children are regarded by their peers. For example, little is known about the nature of peer stigmatisation, and no published research has investigated implicit attitudes thus ensuring that stigma is not well understood. To address this issue, the current study explored patterns of explicit and implicit stigmatisation of peers with depression and attention deficit hyperactivity disorder (ADHD). Methods: The sample was 385 children (M = 10.21 years) and adolescents (M = 15.36 years). Participants completed a questionnaire assessing explicit stigma towards an age‐ and gender‐matched peer with ADHD or depression and another peer with ‘normal issues’ who were described in vignettes. They also completed a modified version of the Implicit Association Test (IAT) that explored implicit attitudes towards the target peers. Results: Questionnaire data indicated that the peer with ADHD was perceived more negatively than the peer with depression on all dimensions of stigma, except perceived dangerousness and fear. In contrast, the IAT findings suggest that some participants had more negative views of the peer with depression than the peer with ADHD. Specifically, the findings demonstrate that adolescent males demonstrated significantly stronger negative implicit evaluations of depression compared with younger males and adolescent females. Conclusions: Children and adolescents demonstrate stigmatising responses to peers with common mental health problems. The nature and extent of these responses depends on the type of problem and the type of measurement used. The findings highlight the importance of using both explicit and implicit measures of stigma.     

Blepharoptosis in association with ipsilateral adduction and elevation palsy A form of fascicular oculomotor palsy

A 16-year-old girl hospitalized with a sudden onset of blepharoptosis and diplopia revealed a combined paresis of the elevator palpebrae, the superior rectus, and the medial rectus muscles of the left eye as quantitatively demonstrated by the Hess chart and levator action test. A small midbrain lesion confined to the left cerebral peduncle and tegmentum, presumably by an ischemic or demyelinative process, was identified on magnetic resonance imaging. Despite uncertainty in its pathology, the incomplete oculomotor palsy of this case is certainly a consequence of oculomotor fascicular involvement in the intra-axial nerve root which initially fans out and then converges into the peripheral compact bundle. We speculate on the revised version of the oculomotor fascicular arrangements by which the neurophthalmologic features of the current case are better explained.     

Disrupted resting-state EEG alpha-band interactions as a novel marker for the severity of visual field deficits after brain lesion

ObjectiveHomonymous visual field deficits (HFVDs) are frequent following brain lesions. Current restoration treatments aim at activating areas of residual vision through numerous stimuli, but show limited effect. Recent findings suggest that spontaneous neural α-band coupling is more efficient for enabling visual perception in healthy humans than task-induced activations. Here, we evaluated whether it is also associated with the severity of HFVD.MethodsTen patients with HFVDs after brain damage in the subacute to chronic stage and ten matched healthy controls underwent visual stimulation with alternating checkerboards and electroencephalography recordings of stimulation-induced power changes and of spontaneous neural interactions during rest.ResultsVisual areas of the affected hemisphere showed reduced event-related power decrease in α and β frequency bands, but also reduced spontaneous α-band interactions during rest, as compared to contralesional areas and healthy controls. A multivariate stepwise regression retained the degree of disruption of spontaneous interactions, but not the reduced task-induced power changes as predictor for the severity of the visual deficit.ConclusionsSpontaneous α-band interactions of visual areas appear as a better marker for the severity of HFVDs than task-induced activations.SignificanceTreatment attempts of HFVDs should try to enhance spontaneous α-band coupling of structurally intact ipsilesional areas.     

去大骨瓣减压颞肌贴敷术治疗大面积脑梗死患者几种护理模式的临床应用效果

目的:对比研究不同护理模式在去大骨瓣减压颞肌贴敷术治疗大面积脑梗死患者临床护理中的应用价值。方法:将襄阳市中心医院收治的120例大面积脑梗死患者随机分为A组、B组、C组,各组40例。A组进行常规护理,B组进行临床护理路径表护理,C组进行循证护理。于3组患者护理干预前后,根据美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分标准评价患者神经功能缺损程度,并根据格拉斯哥预后分级(Glasgow outcome scale,GOS)评价3组患者预后情况。结果:护理3个月、6个月后,C组患者NIHSS评分低于A组、B组(P<0.05),A组、 B组比较,差异无统计学意义(P> 0.0 5)。在预后良好率,A组、 B组、 C组依次为5 0%、6 2.5%、 8 2.5%, C组高于A组、 B组(P <0.0 5), A组、 B组比较,差异无统计学意义(P> 0.0 5)。结论:于大面积脑梗死患者行去大骨瓣减压颞肌贴敷术治疗中行循证护理能有效提高护理效果,改善患者神经功能缺损程度及预后。     

Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review

Background contextVertebral hemangiomas (VHs) are called benign tumors but are actually just vascular malformations. The diagnosis and treatment for aggressive VHs is still controversial, due to their rarity.PurposeTo evaluate the safety and efficiency of the present diagnostic methods and treatment choices.Study designA retrospective study of aggressive VHs with neurologic deficit.Patients sampleA total of 29 consecutive aggressive VH cases were diagnosed and treated in our department since 2001.Outcome measuresWe routinely took anteroposterior and lateral spinal roentgenograms, computed tomography, and magnetic resonance images.MethodsTrocar biopsy is indicated in suspected malignant cases. Radiotherapy was usually our first choice if the neurologic deficit was mild or developed slowly. Surgery was indicated if the neurologic deficit was severe or developed quickly or if the radiotherapy was not effective.ResultsThis series included 12 males and 17 females, and the mean age at diagnosis was 44.0 years (range, 21–72 years). Ten patients had radiculopathy, 1 had cauda equina syndrome, and 18 cases had myelopathy. Twenty-one cases had lesions in the thoracic spine, 5 in the lumbar, and 3 in the cervical region. Eleven cases had untypical image findings, including five cases with pathologic vertebral fracture. The neurologic compression came from only epidural soft tumor mass in 18 cases, whereas it came from both bony compression and soft lesion in the other 11 cases. Ten cases had radiotherapy alone, but two failed and had surgery later. Twenty-one cases had surgery. In the 12 cases having surgical decompression without vertebroplasty, the average estimated blood loss was 1900 mL, and it was 1093 mL for the eight cases having decompression with vertebroplasty. The average follow-up was 51.1 months (range, 24–133 months). There was no recurrence in those cases with radiotherapy, whereas three had local recurrence in those six cases treated by surgical decompression alone without radiotherapy.ConclusionsIn aggressive VHs, epidural soft-tissue compression was usually the main reason for neurologic deficit. In cases with rapid progressive and/or severe myelopathy, posterior decompression and stabilization could be combined with intraoperative vertebroplasty to reduce blood loss.     

Antibody therapeutics targeting ion channels: are we there yet?

The combination of technological advances, genomic sequences and market success is catalyzing rapid development of antibody-based therapeutics. Cell surface receptors and ion channel proteins are well known drug targets, but the latter has seen less success. The availability of crystal structures, better understanding of gating biophysics and validation of physiological roles now form an excellent foundation to pursue antibody-based therapeutics targeting ion channels to treat a variety of diseases.     

Diagnostic de l’acidose métabolique à la naissance par la détermination du pH eucapnique

The identification of a metabolic acidosis is a key criterion for establishing a causal relationship between fetal perpartum asphyxia and neonatal encephalopathy and/or cerebral palsy. The diagnostic criteria currently used (pH and base deficit or lactatemia) are imprecise and non-specific.ObjectiveThe study aimed to determine among a low-risk cohort of infants born at term (n = 867), the best diagnostic tool of metabolic acidosis in the cordonal from the following parameters: pH, blood gases and lactate values at birth.Materials and methodsThe data were obtained from arterial blood of the umbilical cord by a blood gas analyser. The parameter best predicting metabolic analysis was estimated from the partial correlations established between the most relevant parameters.ResultsThe results showed a slight change in all parameters compared to adult values: acidemia (pH: 7.28 ± 0.01), hypercapnia (56.5 ± 1.59 mmHg) and hyperlactatemia (3.4 ± 0.05 mmol/L). From partial correlation analysis, pCO₂ emerged to be the main contributor of acidemia, while lactatemia was shown to be non-specific for metabolic acidosis. Seven cases (0.81 %) showed a pH less than 7.00 with marked hypercapnia. The correction of this respiratory component by EISENBERG's method led to the eucapnic pH, classifying six out of seven cases as exclusive respiratory acidosis.Discussion and conclusionIt has been demonstrated that the criteria from ACOG-AAP for defining a metabolic acidosis are incomplete, imprecise and generating errors in excess. The same is true for lactatemia, whose physiological significance has been completely revised, challenging the misconception of lactic acidosis as a specific marker of hypoxia. It appeared that eucapnic pH was the best way for obtaining a reliable diagnosis of metabolic acidosis. We proposed to adopt a simple decision scheme for determining whether a metabolic acidosis has occurred in case of acidemia less than 7.00.