急性脑梗死与左心室功能的相关性研究

目的：探讨急性脑梗死患者对左心室功能改变的关系,以及与病变部位、病灶大小及颈动脉硬化的关系。方法：选择100例急性脑梗死患者（ACI组）和100例短暂性脑缺血发作或后循环缺血患者（对照组）。采用彩色多普勒超声诊断仪,检测左心室结构和功能及颈动脉斑块,经统计学处理,进行相关性分析。结果：ACI组二尖瓣舒张早期血流速度/舒张晚期血流速度（0.82±0.31）低于对照组（1.05±0.44）,两组比较差异统计学意义（t=3.525,P〈0.05）,不同部位、不同大小脑梗死左心室射血分数和E峰/A峰比值差异无统计学意义。ACI组颈动脉闭塞比例（4%）高于对照组（0）,两组差异有统计学意义（χ2=5.627,P〈0.05）。脑梗死组颈动脉斑块、狭窄比例与对照组比较差异无统计学意义（P〉0.05）。结论：急性脑梗死可引起左心室功能改变,对舒张功能影响更明显,颈动脉狭窄与脑梗死密切相关,脑梗死不同病变部位、病灶大小对左心室功能没有影响。     

National compliance to an evidence-based multidisciplinary guideline on pancreatic and periampullary carcinoma

BackgroundWe evaluated national compliance to selected quality indicators from the Dutch multidisciplinary evidence-based guideline on pancreatic and periampullary carcinoma and identified areas for improvement.MethodsCompliance to 3 selected quality indicators from the guideline was evaluated before and after implementation of the guideline in 2011: 1) adjuvant chemotherapy after tumor resection for pancreatic carcinoma, 2) discussion of the patient within a multidisciplinary team (MDT) meeting and 3) a maximum 3-week interval between final MDT meeting and start of treatment.ResultsIn total 5086 patients with pancreatic or periampullary carcinoma were included. In 2010, 2522 patients were included and in 2012, 2564 patients. 1) Use of adjuvant chemotherapy following resection for pancreatic carcinoma increased significantly from 45% (120 out of 268) in 2010 to 54% (182 out of 336) in 2012 which was mainly caused by an increase in patients aged <75 years. 2) In 2012, 64% (896 of 1396) of patients suspected of a pancreatic or periampullary carcinoma was discussed within a MDT meeting which was higher in patients aged <75 years and patients starting treatment with curative intent. 3) In 2012, the recommended 3 weeks between final MDT meeting and start of treatment was met in 39% (141 of 363) of patients which was not influenced by patient and tumor characteristics.ConclusionCompliance to three selected quality indicators in pancreatic cancer care was low in 2012. Areas for improvement were identified. Future compliance will be investigated through structured audit and feedback from the Dutch Pancreatic Cancer Audit.     

双源CT低剂量技术在疑是胸部病变患者CT检查中的应用

目的研究双源CT低剂量技术在疑是胸部病变患者CT检查中的应用价值。方法选取2013年11月至2014年11月来我院接受检查的161例疑是胸部病变患者,按照患者前来就诊的先后顺序将患者分为7组,每组23例,对7组患者分别采用常规管电流量110m As和低管电流量105,100,95,90,85,80 m As进行测量,比较各组患者肺动脉分叉平面肺动脉信噪比、肺动脉-竖脊肌对比噪声比、降主动脉信噪比、降主动脉-竖脊肌对比噪声比、图像主观质量评分及病变检出情况。结果随着放射剂量的降低,肺动脉和降主动脉的信噪比逐渐降低(P0.05);各组图像质量评分随着球管电流量的减小而降低(P0.05);80m As低管电流量组病变检出率为81.25%较其余各组显著较低(P0.05)。结论双源CT低剂量技术能在疑是胸部病变患者CT检查中给予准确判断,能有效降低放射对人体造成的伤害,建议行双源CT检查时采用85m As的参考管电流量,既能获得准确清晰的诊断图像又能明显降低患者所受辐射剂量。     

Abdominal tumors in patients with neurofibromatosis type I: Genotype-phenotype relationships

BackgroundGastrointestinal stromal tumors have been detected in 25% of the necropsies performed on NF1 patients, but have been reported only in 7% of NF1 patients in the largest series. Such data imply an important gap between the true presence of tumors and those diagnosed. Few genotype-phenotype relationships have been described but to date none referring to abdominal tumors.ObjectivesEvaluate retrospectively the efficacy of a regular and proactive follow-up of NF1 patients to early diagnose abdominal tumors and report their mutations.MethodsCohort study performed between 2010 and 2020, with 43 NF1 adult patients followed at our Dermatology department.ResultsEight abdominal tumors were diagnosed in six patients, meaning that 14% of the followed patients developed an abdominal tumor. Five patients (83%) were asymptomatic. Five (83.3%) had a family history of NF1 with abdominal tumors (patients 1,2 and 3,4,5 were relatives).ConclusionsAlthough currently gastrointestinal routine screening investigations for asymptomatic patients are not recommended in the guidelines, the family aggregation in our series suggests it should be considered a close follow-up of the relatives of a patient with an NF1-related abdominal tumor. Also, for the first time, two mutations [c.2041C > T (p.Arg681Ter) and c.4537C > T (p.Arg1513*)] have been associated with family aggregation of abdominal tumors in NF1 patients.     

Interaction between Albuminuria and Treatment Group Outcomes for Patients with Renal Artery Stenosis: The NITER Study

Purpose

To perform a post-hoc analysis of the Nephropathy Ischemic Therapy (NITER) trial, which enrolled patients with atherosclerotic renal artery stenosis, to evaluate whether medical therapy plus stent placement is superior to medical therapy alone in patients without elevated albuminuria.

Deficits in the control of food intake after hypothalamic paraventricular nucleus lesions

Noradrenergic mechanisms of the hypothalamic paraventricular nucleus (PVN) have been shown to play an important role in the stimulation of feeding To determine the influence of this nucleus in monitoring and controlling responses to physiological and pharmacological challenges, PVN electrolytic lesion rats were tested for their behavioral responsiveness to agents known to affect the alpha-2 noradrenergic system as well as release of corticosterone, and to short- and long-term periods of food deprivation. Discrete lesions of the PVN produced enhanced feeding, particularly of carbohydrate, in freely-feeding rats maintained on a macronutrient self-selection paradigm. Lesion rats demonstrated a behavioral deficit in food intake regulation (a decrease in carbohydrate ingestion) in response to 5-hr and 24-hr fasts, showed a disturbance in circadian feeding, and exhibited a dramatic decrease in circulating corticosterone. However, feeding in response to 2-deoxy-D-glucose and insulin remained intact, suggesting that noradrenergic receptors within the PVN are not involved in the mediation of glucoprivic-induced feeding.     

Influences of bilateral hippocampal lesions upon kindled amygdaloid convulsive seizure in rats

In this study, rat hippocampus was lesioned bilaterally after completion of amygdaloid kindling, to examine how hippocampus affects the kindling permanency. The ventral hippocampal lesions of the kindled rats inhibited reappearance of any kindled seizures. The other rats with the same lesions showed the regression of generalized convulsion. These results suggest that hippocampus, especially ventral parts of hippocampus, would have rather facilitatory or maintaining influence on the kindled neural circuits, relating to the catecholaminergic system in rat forebrain.     

Taste reactivity in rats following lesions of the zona incerta or amygdala

Rats with amygdala lesions (n=12) and rats with zona incerta lesions (n=12) were compared to normal rats (n=12) in their response to various taste stimuli. Five concentrations each of sucrose, sodium chloride, quinine hydrochooride, and hydrochloric acid were presented to all animals in single bottle tests during a schedule of restricted fluid access. Results indicated that both groups of rats with lesions had significantly lower baseline water consumption than normal rats. Using taste consumption measures expressed as a percent of water baseline, it was found that zona incerta lesions did not significantly alter normal taste reactivity. Animals with zona incerta lesions did fail to show normal habituation to a 0.0001 M quinine solution over repeated presentations. Lesions of the amygdala resulted in an increase in consumption of the acid solutions; consumption of sucrose, quinine, and sodium chloride was normal across concentrations. Amygdala damaged rats failed to show normal neophobia when first presented with the 0.0001 M quinine solution. It was concluded that taste response functions of rats with lesions of the zona incerta or amygdala remain essentially normal following surgery but that subtle changes in reactivity do occur, particularly with regard to neophobia.     

The organization of descending tectofugal pathways underlying orienting in the frog,Rana pipiens

Summary In the frog, identical orienting deficits, involving a failure to turn toward stimuli in the ipsilateral hemifield, can be produced by small white matter lesions either in the caudal mesencephalon (Kostyk and Grobstein, 1987a) or in the caudal medulla (Masino and Grobstein, 1989). These findings suggest that descending turn signals may run uninterrupted from the midbrain to the spinal cord, and that something other than tectospinal axons may carry such signals. We here report studies to determine whether there is a tecto-recipient structure whose axons pass through the known critical lesion sites in the caudal mesencephalon and medulla, and whether damage to such a structure, sparing tectospinal pathways, produces an orienting deficit. Horseradish peroxidase (HRP) was applied to behaviorally effective lesions in the caudal medulla and the resulting labelling patterns compared with those resulting from application of HRP to nearby but behaviorally ineffective lesions at the same rostrocaudal level. A column of large cells in the ventrolateral midbrain tegmentum (including nMLF as well as parts of AV and PV) was robustly labelled in all effective lesion cases, and less frequently labelled in ineffective cases. A quantitative analysis showed labelling in this region to be more highly correlated with the existence of a behavioral deficit than that in any other brain region. Reconstructions of single retrogradely labelled cells in the rostral part of the column (nMLF) showed that they have dendrites in a position to receive tectal input and axons which pass through the critical lesion sites in both the caudal mesencephalon and the caudal medulla. Tegmental lesions, sparing the tectospinal tracts, produced ipsilateral turning deficits in cases where the large cell column was completely removed but did not when the column was spared. The findings support the hypothesis that tectofugal signals involved in orienting turns descend uninterrupted to the spinal cord on something other than tectospinal axons, and suggest that the critical projections derive from the large cell column of the ventral tegmentum.Abbreviations A Anterior Thalamic nucleus - AD Anterodorsal nucleus - AV Anteroventral nucleus - B Neuropil Bellonci - BO Basal Optic nucleus - CbN Cerebellar nucleus - Cb Cerebellum - CG Central Grey - CPG Corpus Geniculatum Thalamicum - DH Dorsal Horn - Ent Entopeduncular nucleus - Hb Habenular nucleus - IP Interpeduncular nucleus - LA Lateral Anterior Thalamic nucleus - LCC Tegmental Large Cell Column - LP nucleus Lateralis Profundus - LPD Lateral Posterodorsal nucleus - LPV Lateral Posteroventral nucleus - Mg Magnocellular Thalamic nucleus - NB Nucleus Bellonci - nMLF Nu. Medial Longitudinal Fasciculus - NLM Nu. Lentiformis Mesencephalicus - NPC Nucleus of the Posterior Commissure - OT Optic Tectum - PD Posterodorsal Tegmental nucleus - P Posterior Thalamic nucleus - PTG Pretectal Grey - PV Posteroventral Tegmental nucleus - Ris Isthmic Reticular nucleus - Rinf Inferior Reticular nucleus - Rmed Medial Reticular nucleus - Rsup Superior Reticular nucleus - SC Suprachiasmatic nucleus - SF Solitary fasciculus - SO Superior olivary nucleus - SV Secondary visceral nucleus - T6 Tectal layer 6 - T8 Tectal layer 8 - Tel Telencephalon - TP Posterior tubercle - TSL Torus semicircularis laminaris - TSmg Torus semicircularis magnocellular - TSp Torus semicircularis principalis - VH Ventral horn - VLD Ventrolateral dorsal nucleus - VLV Ventrolateral ventral nucleus - VM Ventromedial nucleus - 2V Secondary visceral nucleus - 3 Oculomotor nucleus - 4 Trochlear nucleus - 5me Mesencephalic trigeminal nucleus - 5m Trigeminal motor nucleus - 7m Facial motor nucleus - 8V Ventral vestibular nucleus - 8d Dorsal vestibular nucleus - n8 Vestibular nerve - 9m Glossopharyngeal motor nucleus     

Effect of selective hippocampal lesions in the rat on acquisition,performance, and extinction of bar pressing on a fixed ratio schedule

Summary Rats with bilateral anterior and posterior hippocampal lesions (APH), anterior hippocampal lesions (AH), and controls were trained on CRF for water, and then switched to FR-20. Both hippocampal groups adapted more readily than controls to the FR-20 schedule and maintained significantly higher rates for 45 days. There were no significant differences on FR-20 between the lesion groups. Following FR-20, the rates of all groups were equalized by training on FR-30. During subsequent extinction, the APH group made significantly more responses than both the AH and control groups, while AH and control groups were indistinguishable. The acquisition results were interpreted as indicating increased emotional reactivity to delay of anticipated reward in both hippocampally lesioned groups. The extinction results suggested that APH, but not AH, lesions also result in increased perseveration.