河北省0～6岁儿童中枢神经性系统（CNS）缺陷调查及相关因素分析

目的对河北省2003年1月1日至2008年12月31日出生的0～6岁中枢神经系统（CNS）缺陷儿童进行调查和相关因素分析。方法采取整群回顾性调查的方式,详细记录患儿的出生地点、出生日期、性别、孩次、父母年龄及可能的危险因素。结果全省共调查0～6岁儿童4 611 808名,其中发现CNS缺陷儿9498例,总发生率为21.42/万。2003年至2006年CNS缺陷发生率基本保持较高水平,各年份发生率均接近或高于6年平均水平21.42/万（P〉0.01）;2007年至2008年,CNS缺陷发生率呈下降趋势,2年的发生率均明显低于6年平均水平21.42/万（P〈0.001）。从全省CNS缺陷构成看,脑瘫占比最大,达64.59%,其次是先天性智力低下,占24.59%,神经管畸形占比最低,为10.45%。对9498例0～6岁儿童CNS缺陷进行分析显示：与父母一方或双方有遗传病、家族疾病史有关的为934例,占9.83%,与母亲孕期不良因素（包括病毒微生物感染、感冒、接触有毒有害物、污染物、服药、营养、不良妊娠史、年龄因素等）有关的为2164例,占22.78%,与父亲因素（包括污染及毒害物接触史、非遗传性疾病等）有关的为331例,占3.48%,与出生因素（包括早产、缺氧、产伤、溶血、多胎等）有关的共2166例,占22.80%,不明原因或其他因素的病例为3903例,占41.09%。结论河北省出生儿CNS缺陷有下降的趋势。加强孕前、孕期保健、做好优生遗传学咨询与指导、有针对性地开展产前诊断和筛查及提高高危妊娠者检测率是减少CNS缺陷特别是神经管畸形、脑瘫、智力低下患儿出生的有效措施。     

国家级继续医学教育项目[项目编号:2012010302050(国)]神经训导康复治疗系列技术专项第六届培训班招生通知

中枢神经(CN)细胞坏死和运动程序破坏是运动功能障碍的根源,恢复的方法需符合CN可塑性变化的"技巧性使用-依赖"机制并能重建运动程序方可。民政部国家康复辅具研究中心附属康复医院(国康)赵文汝根据上述机制将以调神、调息和调形为基本技术、完全主动运动的我国古老中医导引术改良成六步法以更好开发CN潜能,采用信号接收设备实时检测并以曲线形式显示导引出的运动程序信号的强度和比例,然后通过冲着箭靶圆心反复练习射箭才能提高射箭准确度的生物反馈机制,反复调控该信号的强度和比例使之重建,并在此基础上通过专有设备进行运动模式重塑训练恢复丧失的运动功能。经临床应用证明效果良好,适用于CN损伤和骨关节肌肉病变导致的运动功能障碍的恢复、或经传统康复不能进一步改善功能患者的治疗。     

三维步态分析仪指导下的康复训练对中枢神经损伤患者步行功能的影响

目的观察在三维步态分析仪指导下的康复训练对中枢神经损伤患者步行功能的影响。方法将符合入选标准的中枢神经损伤患者32例采用治疗前后自身对照的方式,评估治疗疗效。所有患者接受步态评估,采用Gait Watch三维步态分析仪(章和电气,广州),根据评估结果针对性的进行综合的康复训练。所有患者疗程开始前、疗程结束后进行三维步态分析。结果治疗后,患者的步频、步幅、步速、步态周期、髋膝关节屈曲伸展角度、步长偏差、左右摆动相偏差与治疗前比较,差异均有有统计学意义(P <0. 05或P <0. 01)。结论三维步态分析仪可客观、有效指导中枢神经患者步行功能的康复训练。     

中枢神经细胞瘤的临床病理观察

目的 探讨中枢神经细胞瘤(CNC)的临床病理特点、肿瘤发生、诊断和鉴别诊断,提高对此瘤的认识,避免误诊.方法 对2例原发脑室、额叶内的CNC进行光镜观察,应用突触素(Syn)、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)等进行免疫组织化学染色分析其本质,并复习文献.结果 2例肿瘤1例发生于侧脑室,1例发生于额叶.组织学特点:肿瘤由密集一致的小圆形细胞组成,胞质透明,有核周空晕,核小而圆,居中,呈菊形团状排列,特征性改变为无核神经元纤维基质岛.免疫组织化学显示Syn、NSE阳性.结论 CNC是伴神经元分化的肿瘤,免疫组织化学对确诊CNC很重要.     

脊髓部位脑室外神经细胞瘤的临床病理及文献复习

目的探讨罕见的脑室外神经细胞瘤(extraventricular neurocytoma,ENC)尤其是脊髓ENC的临床病理特征、诊断及鉴别诊断、治疗及预后。方法应用光镜、电镜及免疫组化染色方法对1例脊髓ENC进行观察,并加上国外文献中仅报道的9例脊髓ENC,对10例脊髓ENC临床病理特点、治疗及预后进行观察分析及讨论。结果 1例27岁男性患者,肿瘤位于颈髓。镜下为典型性ENC,由少突胶质细胞样细胞(oligodendroglia-like cells,OLC)组成,易见神经节样细胞,未见无核纤维岛,无核分裂、坏死及血管内皮增生。免疫组化染色:瘤细胞Syn、Neu-N及NF阳性,少数瘤细胞GFAP阳性,Ki-67增殖指数1%。电镜下部分瘤细胞核仁明显,胞质和突起内富含粗面内质网及游离核糖体,偶见神经内分泌颗粒,少数瘤细胞除上述改变外,并含胶质细丝。10例脊髓ENC中男性多见,年龄8～67岁,多发生于颈髓及颈胸髓区域。镜下7例为典型性ENC,3例非典型性ENC可见坏死、血管内皮增生、核分裂活跃(≥2个/10HPF)或Ki-67增高(2%)。随访4例全切除加典型性者预后良好,2例次全切除加非典型性者术后复发。结论 ENC为2007年WHO新分类肿瘤(WHOⅡ级),与中枢神经细胞瘤相比,组织学形态更加多样,多可见神经节细胞分化,而无核纤维岛常不明显,ENC容易被误诊为其它含OLC的肿瘤,免疫组化和电镜对确诊ENC非常重要。治疗尽可能行肿瘤全切除,全切除加典型性者无需放疗,强调对次全切除、非典型性者、Ki-67增殖指数2%者、进展性和复发的ENC给予放疗。     

Reversibility of central neuronal changes in patients recovering from gallbladder stones or acute cholecystitis

INTRODUCTION Cholecystectomy in patients with gallstone disease usua relieves the symptoms. However, it has repeatedly be demonstrated that 5%-10% of the patients still suff from severe pain, and even more patients (25%-40% have milder symptoms[1,2]. The …     

AI免疫原制备及应用

血管紧张素I(angiotensin,AI)为10肽结构。AI正常生理浓度下没有生理活性,若在血浆浓度很高时,能刺激肾上腺髓质释放儿茶酚胺,作用于脑中枢神经,引起周围血管收缩,使血压升高,还对钠、水的重吸收产生影响[1]。AI分子量为1295.69,属于半抗原,必须与大分子载体蛋白相结合制成免疫     

Changes in the proliferative activity of hippocampal neural stem cells from manganismus mice

BACKGROUND: Manganese neurotoxicity presents in the form of not only extracorticospinal tract injury of central nervous system (CNS), but also learning and memory ability damage. So, the mechanism of manganese neurotoxicity will be further studied from the angle of hippocampus. OBJECTIVE: To observe the effects of manganism on learning and memory ability and the proliferation of neural stem cells (NSCs) in hippocampus of mouse brains, and analyze whether this effect has dose-dependence. DESIGN: Randomized controlled experiment. SETTING: Department of Human Anatomy, and Department of Industrial Hygiene and Occupational Diseases, Guangxi Medical University. MATERIALS: Twenty-eight male Kunming mice, aged 2 weeks, were involved in this experiment. The involved mice were randomized into 4 groups, with 7 in each: control group, low-dose manganism group, middle-dose manganism group and high-dose manganism group. Manganese chloride was purchased from Shantou Chemicals Factory. METHODS: This experiment was carried out in the Experimental Center for Preclinical Medicine, Guangxi Medical University from November 2005 to August 2006. Mice in the low-, middle- and high-dose manganism groups were intraperitoneally injected with 5, 20 and 50 mg/kg per day manganese chloride, once a day, for 2 weeks successively. Mice in the control group were injected with the same amount of stroke-physiological saline solution. Neurobehavioral detection of all the animals was performed in Morris water maze constantly from the 7th day after the first injection of manganese chloride solution. Learning ability was detected in the place navigation test. Mice were trained for 5 consecutive days with four trials per day. The time to find the platform was latency. Memory ability was detected in spatial probe test. Platform was withdrawn on the following day of place navigation. The mice were placed in the water from a random start in the edge of the pool. The number of times they traversed the plateform's region was recorded as the performance of spatial memory. At the final two days of the water maze tests, all the animals were daily intraperitoneally injected with 50 mg/kg BrdU three times successively, once every 4 hours. At 24 hours after the final BrdU injection, all the animals were sacrificed and perfused, and their brains were harvested, fixed and successively sliced at coronary plane on a freezing microtome. Distribution and number of BrdU-positive cells in the subgranular zone of hippocampus of brains of experimental animas were detected respectively by immunohistochemistry for reflecting the proliferation of NSCs. Single-factor analysis of variance was used for comparing the difference of measurement data. Linear correlation analysis was used among the performance record in Morris water maze test, the number of BrdU-immunopositive cells and the dose of manganism. MAIN OUTCOME MEASURES: Learning and memory ability and the number of hippocampal NSCs of mice in each group. RESULTS: ①Performance of mice in Morris water maze: In the place navigation test, there was a significant retarded learning in mice of high-dose manganism group from the 3rd day as compared with control group (P < 0.01). Till the 5th day, escape latency of mice in each manganism group was prolonged, and learning performance was significantly decreased (P < 0.05), while swimming speed did not affect above results. In the spatial probe test, the average frequency of middle- and high-dose manganism groups was 1.17±1.60 and 0.80±1.10, respectively, and decreased remarkably than that of control group which was 4.86±1.35 (P < 0.01), indicating memory ability was decreased; while the average frequency of low-dose manganism group did not differ obviously from that of control group (P =0.066) although it was 2.67±3.27. The difference of swimming speed in each group was still of no statistic significance (P > 0.05). ②Effect of manganism on the number of NSCs: After counting, the average number of BrdU- immunopositive cells of one side in the control group, low-, middle- and high-dose manganism groups was 69.20±4.48, 36.63±4.50, 31.00±6.87, 26.76±4.83, individually (P < 0.01). ③Results of linear correlation analysis: The ability of spatial memory was significantly in positive correlation with the number of BrdU-labeled cells ( r =0.734, P < 0.01), and in negative correlation with the intensity of manganese poisoning (r =–0.598,P < 0.01).Meanwhile, there was a significant negative correlation between the number of BrdU-labeled cells and the intensity of manganese poisoning(r =–0.666, P < 0.01). CONCLUSION: Manganese exposure in mice can affect the ability of learning and memory, which is probably caused by the inhibition of manganese to the neurogenesis of NSCs in hippocampus in dose-dependent manner.     

氯诺昔康超前镇痛用于腹腔镜胆囊切除术的临床观察

超前镇痛（preemptive analgesia）,是在伤害性应激作用于机体之前采取措施,防止外周和中枢神经的敏感化,达到减少或消除伤害性刺激引起的疼痛。本文旨在观察单次静注氯诺昔康对腹腔镜胆囊切除术病人切口痛的防治效果,为腹部小切口手术寻找简便、有效的术后镇痛手段。现报告如下。     

Nogo与中枢神经再生

Nogo基因编码三种蛋白质:NogoA、NogoB、NogoC,它们对损伤后中枢神经系统(CNS)的再生具有抑制作用,Nogo受体(NgR)是一种糖基醇磷脂结合蛋白,是Nogo的一种功能性细胞表面受体,神经营养因子受体p75NTR是NgR的共受体,三者的相互作用介导了Nogo的中枢神经抑制活性。本文概述了Nogo、NgR和p75NTR在CNS再生抑制中的作用机制,各自的重要性,抑制的调节机制,以及目前研究的突破和疑点,并展望了未来研究和应用的前景。