“头穴丛刺法"对局灶性脑梗死大鼠可塑性蛋白map-2的影响

目的:探讨"头穴丛刺法"对局灶性脑梗死大鼠神经可塑性影响的物质基础和可能机制.方法:采用线栓法制备大脑中动脉急性脑梗死大鼠模型,将132只雄性Wistar大鼠随机分为假手术组(A组)、模型组(B组)、头穴透刺组(C组)及头穴丛刺组(D组).C组采用针刺"百会"透"曲鬓"穴;D组采用"头穴丛刺"("百会"及"百会"左右侧各旁开4 mm处).均快速捻转1 min后留针30 min,每日1次,6 d为一疗程,共治疗4个疗程.A组与B组不予治疗.采用Bederson评分评价神经功能变化;免疫组织化学染色(S-P)法观察缺血半暗带微管相关蛋白2(MAP-2)阳性信号的表达.结果:7 d时,D组与B组比较,大鼠神经功能评分降低(P<0.05);14 d、28 d时,C组、D组分别与B组比较,神经功能评分均降低(均P<0.05);28 d时D组与C组比较,D组神经功能评分降低(P<0.05).7 d、14 d、28 d时,D组、C组与B组比较,缺血皮层MAP-2阳性信号的表达均上升(均P<0.05),14 d和28 d时D组与C组比较,皮层MAP-2阳性信号的表达升高(P<0.05).结论:"头穴丛刺"能改善脑梗死大鼠的神经功能,增加缺血皮层MAP-2阳性信号的表达.     

电刺激小脑顶核后脑外伤患者脑血流和脑损害变化

目的　探讨小脑顶核电刺激 (FNS)对脑外伤患者脑血流速度 (Vm)和血清髓鞘碱性蛋白 (MBP)的影响。方法　30名健康者为正常对照组 (A)。 6 0例脑外伤患者 ,随机均分为B(外伤对照组 )和C(刺激治疗组 )两组。用FNS对C组实施治疗。应用经颅多普勒超声动态监测A、B和C三组患者ACA、MCA的Vm。分别于外伤后第 1、3、5天检测B、C两组血清MBP。结果　ACA和MCA的Vm正常值分别为 ( 4 5 .4± 6 .1)cm/s和 ( 5 4.3± 5 .7)cm/s ;B组外伤后呈现持续性低Vm ,ACA和MCA的Vm分别为 ( 35 .9± 5 .6 )cm/s和 ( 4 5 .5± 6 .5 )cm/s ;C组FNS后Vm明显升高 ,分别为 ( 4 2 .8± 6 .8)cm/s和 ( 5 1.9± 6 .2 )cm/s。MBP正常值为 ( 1.0 2± 0 .46 ) μg/L。外伤后第 1天 ,B、C两组MBP明显升高 ,B组于第 5天达高峰 ,而C组MBP于第 5天则明显下降。结论　外伤后Vm降低 ,血清MBP升高。FNS可明显提高脑外伤后Vm ,改善脑循环 ,降低MBP ,减轻脑损害     

Neurophysiological adaptations to spaceflight and simulated microgravity

Changes in physiological functions after spaceflight and simulated spaceflight involve several mechanisms. Microgravity is one of them and it can be partially reproduced with models, such as head down bed rest (HDBR). Yet, only a few studies have investigated in detail the complexity of neurophysiological systems and their integration to maintain homeostasis. Central nervous system changes have been studied both in their structural and functional component with advanced techniques, such as functional magnetic resonance (fMRI), showing the main involvement of the cerebellum, cortical sensorimotor, and somatosensory areas, as well as vestibular-related pathways. Analysis of electroencephalography (EEG) led to contrasting results, mainly due to the different factors affecting brain activity. The study of corticospinal excitability may enable a deeper understanding of countermeasures' effect, since greater excitability has been shown being correlated with better preservation of functions. Less is known about somatosensory evoked potentials and peripheral nerve function, yet they may be involved in a homeostatic mechanism fundamental to thermoregulation. Extending the knowledge of such alterations during simulated microgravity may be useful not only for space exploration, but for its application in clinical conditions and for life on Earth, as well.     

Thalamic deep brain stimulation for Tourette Syndrome: A naturalistic trial with brief randomized,double-blinded sham-controlled periods

BackgroundThere is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.ObjectivesIn this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared to sham stimulation.MethodsWe included eight adult patients with medically refractory Tourette's syndrome. Bilateral electrodes were implanted in the centromedian-parafascicular-complex and the nucleus ventro-oralis internus. Tic severity, quality of life and comorbidities were assessed before surgery as well as six and twelve months after. Short randomized, double-blinded sham-controlled crossover sequences with either active or sham stimulation were implemented at both six- and twelve-months’ assessments. The primary outcome measurement was the difference in the Yale Global Tic Severity Scale tic score between active and sham stimulation. Adverse events were systematically surveyed for all patients to evaluate safety.ResultsActive stimulation resulted in significantly higher tic reductions than sham stimulation (F = 79.5; p = 0.001). Overall quality of life and comorbidities improved significantly in the open-label-phase. Over the course of the trial two severe adverse events occurred that were resolved without sequelae.ConclusionOur results provide evidence that thalamic stimulation is effective in improving tic severity and overall quality of life. Crucially, the reduction of tic severity was primarily driven by active stimulation. Further research may focus on improving stimulation protocols and refining patient selection to improve efficacy and safety of deep brain stimulation for Tourette's Syndrome.     

弹力绷带与医用棉两种衬垫在电动气压止血带中的应用比较

目的通过比较医用棉纸与弹力绷带作为电动气压止血带衬垫的方法,观察不同衬垫材料在电动气压止血带中的应用效果。方法将2018年1月至12月镇江市中西医结合医院骨科收治的100例患者采用随机数字表分为弹力绷带组(50例)和棉纸组(50例),分别采用弹力绷带和医用棉纸作为电动气压止血带衬垫材料,观察比较两组的止血效果、皮肤损伤发生率以及对电动气压止血带袖带的保护情况。结果弹力绷带组患者的皮肤压痕、瘀斑、水泡等皮肤损伤发生率低于棉纸组,差异有统计学意义(P<0.05);两组止血效果比较差异无统计学意义;弹力绷带组的袖带污染发生率(4%)明显少于棉纸组(16%),差异有统计学意义(P<0.05)。结论弹力绷带作为止血带衬垫材料止血效果明显,而且能有效降低患者受压处皮肤的损伤率,同时减少了止血带袖带的污染,有利于袖带的清洁消毒。     

Efficacy of Random-start Controlled Ovarian Stimulation in Cancer Patients

This study aimed to evaluate the efficacy of random-start controlled ovarian stimulation (COS) in cancer patients for emergency fertility preservation. In this retrospective comparative study, 22 patients diagnosed with cancer and 44 infertile women undergoing conventional in vitro fertilization (IVF) were included. In cancer patients, ovarian stimulation was started on the day of referral, irrespective of their menstrual cycle date. The control group was selected by age matching among women undergoing conventional IVF. COS outcomes were compared between groups. The number of total and mature oocytes retrieved and the oocyte maturity rate were higher in the random-start group than in the conventional-start group. However, duration of ovarian stimulation was longer in the random-start group (11.4 vs. 10.3 days, P = 0.004). The addition of letrozole to lower the estradiol level during COS did not adversely affect total oocytes retrieved. However, oocyte maturity rate was lower in cycles with letrozole than in cycles without letrozole (71.6% vs. 58.2%, P = 0.019). Our study confirms the feasibility and effectiveness of random-start COS in cancer patients.

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Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study

Objective

To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.

Platelet Adenylyl Cyclase Activity in Alcoholics and Subtypes of Alcoholics

Adenylyl cyclase (AC) activity was measured in membrane preparations of platelets from control and alcoholic subjects. The sample consisted of 51 alcoholics who were categorized as type I or type II using the criteria of Gilligan et al. ( Genet. Epidemiol. 4:395–414, 1987) and 54 normal controls. Alcoholic males exhibited significantly lower values than controls in basal and fluoride-stimulated platelet AC activity. When male alcoholics were segregated into type I and type II categories, the platelet AC activity did not differ between subtypes, and both subtypes had AC activity that was below control values. Western blot analysis of the quantity of G_sα and G_iα proteins in a subset of male controls and alcoholic subjects demonstrated no significant relationship between quantity of G proteins and AC activity. The results confirm lower platelet AC activity in male alcoholics, compared with controls. Given the lack of quantitative relations between G_sα and G_iα proteins and AC activity, the results support the contention that individual differences in platelet AC activity in the alcoholic subjects may reflect quantitative or qualitative differences in the AC catalytic units.     

无创心输出量监测在危重病监护中的应用

目的 探讨电阻抗无创心输出量监测在危重病患者中的应用。方法 选择2001-02～2003-09ICU收治的38例患者用电阻抗无创心输出量监测系统与多谱勒心脏超声,同时测定38例患者心输出量,并对结果进行对比分析。结果 两种方法的测定值有显著的相关性(r=0.908)。结论 电阻抗元创心输出量监测与多谱勒心脏超声测定结果是一致的,它不仅能准确地测定心输出量,而且还具有无创、连续、简便、价廉的优点。     

Pelvic Nerve Stimulation Evokes Nitric Oxide Mediated Distal Rectal Relaxation in Pigs

Purpose  Pelvic nerve stimulation evokes a complex motility response in the pig rectum with a proximal decrease and a distal increase in cross-sectional area. This study investigated whether the distal increase in the cross-sectional area is because of smooth muscle relaxation mediated by nitric oxide. Methods  The pelvic nerves were stimulated with cuff electrodes in ten chloralose-anesthetized minipigs. Pressure, volume, and cross-sectional areas at five positions in the rectum were obtained during stimulation to examine the effect of N^G-nitro-L-arginine (an inhibitor of nitric oxide synthase) injection. Results  Stimulation evoked a median pressure decrease of 13 cm H₂O (range, 0–27; P < 0.05; n = 10) in the anal canal, a pressure increase of 6 cm H₂O (range,-15 to 30; P < 0.05; n = 10) in the rectum and a decrease of 39 mL (range, 30–63; P < 0.05; n = 6) in rectal volume. Rectal cross-sectional areas decreased 33 percent (range, 5–56; P < 0.02; n = 7) in the proximal part and increased 32 percent (range, 9–67; P < 0.02; n = 8) in the distal part. N^G-nitro-L-arginine eliminated the increase in the distal rectal cross-sectional area (n = 5) and the decrease in anal canal pressure (n = 9) in all tested animals. Conclusion  Pelvic nerve stimulation evokes distal rectal relaxation in pigs, sensitive to N^G-nitro-L-arginine, which suggests that this smooth muscle response is mediated by nitric oxide. This work was supported by grants from the Institute of Experimental Clinical Research, Aarhus University Hospital, Aarhus, Denmark Reprints are not available.