中青年缺血性卒中脑动脉狭窄分布及危险因素分析

目的探讨中青年缺血性卒中患者脑动脉狭窄分布规律及相关危险因素。方法对50例青年缺血性卒中患者及68例中年患者行DSA检查,收集患者的临床资料,并进行比较。结果与青年组比较,中年组前循环血管狭窄率显著降低,后循环及联合病变率显著升高(P0.05~0.01)。青年组颅内血管狭窄率显著高于颅外及颅内-外联合病变率(均P0.01),中年组颅内-外联合病变显著高于颅内及颅外病变(均P0.05)。与青年组比较,中年组颅内血管狭窄率显著降低,颅外及颅内-外联合病变率显著升高(P0.05~0.01)。与青年组比较,中年组颅外动脉轻度狭窄的比率显著降低,中度狭窄及重度狭窄的比率显著增高(均P0.01)。与青年组比较,中年组颅内动脉轻度狭窄的比率显著降低,重度狭窄的比率显著增高(均P0.05)。与中年组比较,青年组高同型半胱氨酸血症比率显著增高(P0.01),糖尿病、冠心病、高血压比率显著降低(P0.05~0.01)。结论青年缺血性脑血管病的脑动脉狭窄以前循环病变为主,单纯大脑中动脉狭窄及高同型半胱氨酸血症发生率较高,伴发的动脉粥样硬化性疾病相对偏少。中年缺血性卒中患者后循环病变增多,串联及联合病变更多见,动脉狭窄程度更重,伴发的动脉粥样硬化性相关疾病更多。     

影响青年人自发性脑出血预后的相关因素分析

目的研究影响青年自发性脑出血患者预后的相关因素,指导青年自发性脑出血的治疗。方法回顾性分析2012年1月~2014年12月镇江市第一人民医院神经外科收治的53例青年自发性脑出血手术治疗患者的临床资料。根据发病后3个月时的格拉斯哥预后量表(GOS)评分,将患者分为预后良好组(GOS评分≥4分)和预后不良组(GOS评分≤3分)。比较两组患者的格拉斯哥昏迷量表(GCS)评分、收缩压、平均动脉压、出血量、血脂水平、发病时随机血糖水平、血肿是否破入脑室、凝血功能、肝功能及肾功能,分析其是否与预后有关。结果预后良好组与预后不良组的GCS评分、收缩压、平均动脉压、出血量、血脂水平、发病时随机血糖水平比较,差异有统计学意义(均P0.05);而凝血功能、肝功能及肾功能的差异无统计学意义(均P0.05)。结论影响青年人自发性脑出血预后的有关因素较多,GCS评分、收缩压、平均动脉压、出血量、血脂水平、发病时随机血糖水平与其预后有显著的关系,可用于预测青年自发性脑出血的预后。     

运动员维生素E营养水平初探

采用荧光分光光度法对４０名北京体院竞技体校运动员和３０名普通大学生维生素Ｅ（ＶＥ）营养水平作了调查，结果表明：①运动员组与大学生组平均血清ＶＥ含量分别为１．２０±０．２８ｍｇ／ｄｌ和１．３３±０．３３ｍｇ／ｄｌ，运动员明显低于大学生组（Ｐ＜０．０５）。②竞走及中长跑组与短跑组平均血清ＶＥ含量分别为１．２４±０．２６ｍｇ／ｄｌ和１．１８±０．２９ｍｇ／ｄｌ，二者无明显差异（Ｐ＞０．０５）。而将这两组与大学生组比，则短跑组表现的差异大（Ｐ＜０．０５），竞走及中长跑组与大学生组没有显著性差异（Ｐ＞０．０５）。③从血中ＶＥ／ＴＣ（胆固醇）比值看，运动员组虽有低于大学生组的趋势，但两者无显著性差异（Ｐ＞０．０５）。运动员的ＶＥ营养状况是否存在不同于普通大学生的现象仍有待进一步的研究。     

The implication of frontostriatal circuits in young smokers: A resting‐state study

The critical roles of frontostriatal circuits had been revealed in addiction. With regard to young smokers, the implication of frontostriatal circuits resting‐state functional connectivity (RSFC) in smoking behaviors and cognitive control deficits remains unclear. In this study, the volume of striatum subsets, i.e., caudate, putamen, and nucleus accumbens, and corresponding RSFC differences were investigated between young smokers (n₁ = 60) and nonsmokers (n₂ = 60), which were then correlated with cigarette smoking measures, such as pack_years‐cumulative effect of smoking, Fagerström Test for Nicotine Dependence (FTND)‐severity of nicotine addiction, Questionnaire on Smoking Urges (QSU)‐craving state, and Stroop task performances. Additionally, mediation analysis was carried out to test whether the frontostriatal RSFC mediates the relationship between striatum morphometry and cognitive control behaviors in young smokers when applicable. We revealed increased volume of right caudate and reduced RSFC between caudate and dorsolateral prefrontal cortex (DLPFC), orbitofrontal cortex in young smokers. Significant positive correlation between right caudate volume and QSU as well as negative correlation between anterior cingulate cortex‐right caudate RSFC and FTND were detected in young smokers. More importantly, DLPFC‐caudate RSFC strength mediated the relationship between caudate volume and incongruent errors during Stroop task in young smokers. Our results demonstrated that young smokers showed abnormal interactions within frontostriatal circuits, which were associated with smoking behaviors and cognitive control impairments. It is hoped that our study focusing on frontostriatal circuits could provide new insights into the neural correlates and potential novel therapeutic targets for treatment of young smokers. Hum Brain Mapp 37:2013–2026, 2016. © 2016 Wiley Periodicals, Inc .     

Health status and use of medications by adults with intellectual disability in Western Australia

Background Evidence suggests that adults with intellectual disability (ID) are vulnerable to poor health outcomes. This paper describes the health status and medication use of adults with ID in Western Australia.

Method We conducted a cross-sectional survey by interview of 328 adults with ID (M age?=?37 years, range: 18–82) and their families/support persons (79% proxy or joint informants).

Results Although 90% of participants reported long-term health conditions (M?=?2.6, range: 0–10), including epilepsy, allergies, eczema, asthma, and mental health problems, three quarters of the participants (77%) described their health as good or very good. Younger participants (18–44 years) reported osteoporosis and stroke, conditions commonly associated with ageing, more often than the general population at those ages. Medication use was high, with 70% taking one or more medications (Mdn?=?3 medications, range: 0–21).

Conclusions Many participants reported that health problems affected their daily lives, yet the majority reported good health. Long-term health conditions were common and many people used several types of medications. Participants had poorer health than the Western Australian population overall. Careful monitoring of health conditions and regular review of medications are recommended to improve health outcomes for adults with ID.     

Postural control in response to unilateral and bilateral external perturbations in older adults

BackgroundBalance is an important determinant of physical function and falls risk. The ability to withstand external perturbations is important when walking on icy or uneven surfaces, whether the perturbations are bilateral or unilateral.Research questionThis study sought to determine the effect of unilateral and bilateral standing perturbations on leg muscle activity in healthy older adults.MethodsParticipants experienced unilateral and bilateral standing perturbations of the treadmill. Surface electromyography (EMG) from lower limb muscles was recorded unilaterally. EMG onset latency and root mean square (RMS) amplitude of the muscle bursts were calculated.ResultsOlder adults demonstrated a combined ankle/hip strategy, along with pre-activation and co-contraction of muscles in response to unilateral and bilateral stance perturbations. As well, older adults demonstrated higher levels of EMG, but no difference in the latency of burst onset, in bilateral than unilateral perturbation types.SignificanceWhen the stance limb was perturbed in the bilateral condition, the older adults responded with a Gastrocs EMG burst nearly 100% of the maximum EMG. The high level of EMG used, especially in the Gastrocs, during the bilateral perturbations may reduce the safety factor for falls in older adults. Older adults responded to the different perturbation demands by modulating EMG amplitude as opposed to the onset timing of EMG.     

微创外科治疗成人漏斗胸疗效观察

目的通过比较手术前后漏斗胸患者心功能和心脏形态,探讨前胸壁凹陷畸形对心脏影响及微创外科治疗疗效。方法 2009年8月-2010年12月,采用微创外科矫治102例成人漏斗胸患者。男84例,女18例;年龄18～57岁,平均23.4岁。初次手术95例,二次手术7例。漏斗胸分型:Ⅰ型59例,Ⅱ型43例。漏斗胸指数(hallerindex,HI)为4.59±1.51。42例出现临床症状,19例出现心脏体征。术前胸部CT检查示,患者心脏均受压,心脏移位74例。超声心动图检查左室射血分数(left ventricular ejection fraction,LVEF)为68.9%±6.2%。结果患者矫治手术均顺利完成,无死亡及严重并发症发生。102例均获随访,随访时间12～28个月,平均21个月。术后患者临床症状及心脏体征均消失。术后12个月HI为2.70±0.33,与术前比较差异有统计学意义(t=5.83,P=0.00)。参照Nuss等的方法评定胸廓形状,获优99例,良3例。术后12个月胸部CT检查示101例完全解除心脏压迫,1例心脏仍轻度受压;心脏位置恢复正常。心电图检查示4例术前异常患者恢复正常。超声心动图检查示LVEF为70.5%±4.8%,与术前比较差异无统计学意义(t=1.08,P=0.30)。结论成人漏斗胸前胸壁凹陷畸形对心脏的影响主要是压迫和推移,微创外科治疗可有效解除心脏压迫,消除临床症状。     

Determination of normal value of glomerular size in Chinese adults by different measurement methods

Aim: Identification of glomerulomegaly is a prerequisite for diagnosis of obesity‐related glomerulopathy, so measurement of glomerular size is of critical importance. Methods: A total 100 cases pathologically diagnosed as minor glomerular abnormalities or thin basement membrane nephropathy with normal body mass index and blood glucose level were selected as the normal value measurement group of glomerular size. The mean value of diameters of capillary tuft on the glomerular maximum profile was determined using the direct method and indirect method with the Motic Med 6.0 digital medical image analysis system. Meanwhile, 80 cases of different glomerular disease with normal body mass index and blood glucose level were also collected. Their glomerular diameters were measured and compared with those in the normal value measurement group. Results: The measurement results showed that gender and age had no effects on glomerular diameter. The normal value ranges of the diameter on glomerular maximum profile were as follows. (i) Pole‐containing glomerulus (the glomerulus with vascular pole or/and urinary pole): direct method, 101.3–184.9 µm; indirect method, 100.3–183.5 µm. (ii) Pole‐containing glomerulus plus non‐pole glomerulus (the glomerulus without poles, the maximum profile of which was larger than that in the smallest pole‐containing glomerulus): direct method, 108.3–185.9 µm; indirect method, 107.4–185.4 µm. The glomerular diameters of the 80 cases with different glomerular disease were all within the aforementioned normal value ranges. Conclusions: Both methods used in the present study are feasible to measure the glomerular diameter and the normal value range of glomerular diameter in Chinese adults is established.