两种剂量静脉用丙种球蛋白后对感染早产儿血清免疫球蛋白G水平影响及效果观察

目的:探讨应用两种剂量静脉用丙种球蛋白(IVIG)后,感染早产儿血清免疫球蛋白G(IgG)水平变化及临床效果.方法:选取2013年6月～2014年11月在该院新生儿病房治疗的感染早产儿60例,随机分为A组(IVIG剂量为400 mg/kg)和B组(IVIG剂量为600 mg/kg)各30例,观察两组血清IgG水平变化以及临床疗效.结果:A组治疗总有效率为93.33％,B组治疗总有效率为96.67％,差异无统计学意义(P＞0.05);A组和B组治疗后血清lgG水平较治疗前有所升高,差异有统计学意义(P＜0.05),但B组治疗后血清lgG水平明显高于A组,差异有统计学意义(P＜0.05),两组血清免疫球蛋白M(lgM)和免疫球蛋白A(lgA)水平在治疗前后变化较小,差异无统计学意义(P＞0.05);B组感染征象缓解天数为(3.01±0.98)天,低于A组的(4.12±1.01)天,差异有统计学意义(P＜0.05),而两组住院天数比较差异无统计学意义(P＞0.05).结论:应用不同剂量IVIG均可提高血清感染早产儿血清lgG水平,但600mg/kg剂量的改善效果更为显著.     

针对性护理对脑肿瘤患者伽马刀术后颅内压的影响

目的:探究针对性护理对脑肿瘤患者伽马刀术后颅内压等不良反应指标的影响。方法:选取2011年1月至2013年12月来我院就诊的需行伽马刀治疗的脑肿瘤患者88例,依据分层随机分组法将患者分为治疗组及对照组,对照组44例术后给予常规护理方案及治疗策略进行治疗;治疗组44例术后给予针对性个体化护理方案进行治疗;观察比较两组患者治疗满意度、不良反应情况及治疗效果。结果:治疗前两组患者的颅内压比较差异无统计学意义(P>0.05);治疗后治疗组患者颅内压(196.75±37.14)mm H2O、住院时间(13.27±3.18)d、出现癫痫发病0(0.00%)例、头皮破溃5(11.63%)例及头皮感染例数2(4.65%)例明显低于对照组(217.68±42.59)mm H2O,(15.46±3.53)d,5例(11.36%),13例(29.55%),9例(20.45%),差异有统计学意义(P<0.05);治疗组患者治疗满意度高于对照组,差异有统计学意义(P<0.05);治疗组患者出现头痛、呕吐及视乳头水肿等脑水肿症状例数明显低于对照组,差异有统计学意义(P<0.05)。结论:针对性个体化护理可有效降低患者不良反应出现率及严重程度,提高患者生活质量并促进患者的早日康复。     

Effect of Gamma Knife Radiosurgery on a Pituitary Gonadotroph Adenoma: A Histologic,Immunohistochemical and Electron Microscopic Study

The morphologic findings in a pituitary macroadenoma removed from a 65-year old man by the transsphenoidal approach 9 months after gamma knife surgery are reported. The tumor was immunoreactive for FSH and showed ultrastractural features consistent with an oncocytic gonadotroph adenoma. Accumulation of connective tissue separating small groups of adenoma cells was evident. Several dilated vessels and numerous vascular endothelial growth factor immunopositive adenoma cell were noted. By electron microscopy the endothelial linings frequently showed discontinuities with platelet accumulation attached to the gaps. Several vessels were severely injured showing necrosis of endothelial cells. It can be concluded that gamma knife surgery caused severe alterations in pituitary adenoma microcirculation indicating that vascular injury plays a crucial role in tumor shrinkage.     

Resting-state beta and gamma activity in Internet addiction

Internet addiction is the inability to control one's use of the Internet and is related to impulsivity. Although a few studies have examined neurophysiological activity as individuals with Internet addiction engage in cognitive processing, no information on spontaneous EEG activity in the eyes-closed resting-state is available. We investigated resting-state EEG activities in beta and gamma bands and examined their relationships with impulsivity among individuals with Internet addiction and healthy controls. Twenty-one drug-naïve patients with Internet addiction (age: 23.33 ± 3.50 years) and 20 age-, sex-, and IQ-matched healthy controls (age: 22.40 ± 2.33 years) were enrolled in this study. Severity of Internet addiction was identified by the total score on Young's Internet Addiction Test. Impulsivity was measured with the Barratt Impulsiveness Scale-11 and a stop-signal task. Resting-state EEG during eyes closed was recorded, and the absolute/relative power of beta and gamma bands was analyzed. The Internet addiction group showed high impulsivity and impaired inhibitory control. The generalized estimating equation showed that the Internet-addiction group showed lower absolute power on the beta band than did the control group (estimate = − 3.370, p < 0.01). On the other hand, the Internet-addiction group showed higher absolute power on the gamma band than did the control group (estimate = 0.434, p < 0.01). These EEG activities were significantly associated with the severity of Internet addiction as well as with the extent of impulsivity. The present study suggests that resting-state fast-wave brain activity is related to the impulsivity characterizing Internet addiction. These differences may be neurobiological markers for the pathophysiology of Internet addiction.     

The effect of gamma oscillations in boosting primary motor cortex plasticity is greater in young than older adults

ObjectiveIn healthy subjects, the long-term potentiation (LTP)-like plasticity of the primary motor cortex (M1) induced by intermittent theta-burst stimulation (iTBS) can be boosted by modulating gamma (γ) oscillations through transcranial alternating current stimulation (tACS). γ-tACS also reduces short-interval intracortical inhibition (SICI). We tested whether the effects of γ-tACS differ between young (YA) and older adults (OA).MethodsTwenty YA (27.2 ± 2.7 years) and twenty OA (65.3 ± 9.5 years) underwent iTBS-γ tACS and iTBS-sham tACS in randomized sessions. In a separate session, we delivered γ-tACS alone and recorded SICI during stimulation.ResultsiTBS-sham tACS produced comparable motor evoked potential (MEP) facilitation between groups. While iTBS-γ tACS boosted MEP facilitation in both the YA and OA groups, the magnitude of its effect was significantly lower in OA. Similarly, γ-tACS-induced modulation of GABA-A-ergic neurotransmission, as tested by SICI, was reduced in OA. The effect of iTBS-γ tACS negatively correlated with the age of OA subjects.ConclusionsMechanisms underlying the effects of γ oscillations on LTP-like plasticity become less efficient in older adults. This could reflect age-related changes in neural elements of M1 resonant to γ oscillations, including GABA-A-ergic interneurons.SignificanceThe beneficial effect of γ-tACS on iTBS-induced plasticity is reduced in older adults.     

Dichotic listening deficits in amblyaudia are characterized by aberrant neural oscillations in auditory cortex

ObjectiveChildren diagnosed with auditory processing disorder (APD) show deficits in processing complex sounds that are associated with difficulties in higher-order language, learning, cognitive, and communicative functions. Amblyaudia (AMB) is a subcategory of APD characterized by abnormally large ear asymmetries in dichotic listening tasks.MethodsHere, we examined frequency-specific neural oscillations and functional connectivity via high-density electroencephalography (EEG) in children with and without AMB during passive listening of nonspeech stimuli.ResultsTime-frequency maps of these “brain rhythms” revealed stronger phase-locked beta-gamma (~35 Hz) oscillations in AMB participants within bilateral auditory cortex for sounds presented to the right ear, suggesting a hypersynchronization and imbalance of auditory neural activity. Brain-behavior correlations revealed neural asymmetries in cortical responses predicted the larger than normal right-ear advantage seen in participants with AMB. Additionally, we found weaker functional connectivity in the AMB group from right to left auditory cortex, despite their stronger neural responses overall.ConclusionOur results reveal abnormally large auditory sensory encoding and an imbalance in communication between cerebral hemispheres (ipsi- to -contralateral signaling) in AMB.SignificanceThese neurophysiological changes might lead to the functionally poorer behavioral capacity to integrate information between the two ears in children with AMB.     

γ刀照射三叉神经的剂量-效应关系研究

目的 探讨伽玛刀不同剂量照射大鼠三叉神经(感觉根)后对照射范围内三叉神经组织的损伤以及对周围临近脑干组织和脑桥的影响,为优化伽玛刀照射剂量提供理论依据。方法 选用成年雄性SD大鼠65只,分别以不同照射剂量(20、40、80、160 Gy)照射三叉神经,观察照射后1周、2周、4周大鼠行为学变化,取全脑组织进行HE、Nissl、MAPLC3B、53BP1、XRCC1染色观察细胞形态学和自噬以及DNA损伤和修复等变化。结果 所有剂量组照射大鼠均存活。20和40 Gy组均无行为学和病理学改变;80和160 Gy组均出现了照射部位毛发脱落;HE、Nissle、LC3B、53BP1及XRCC1染色发现,受照部位组织在80和160 Gy照射后,可见神经元细胞固缩、膨胀,神经元细胞发生自噬以及DNA损伤明显,160 Gy组DNA损伤明显加重。40 Gy照射后,神经元发生DNA损伤修复的程度较其他剂量增高。结论 伽玛刀照射三叉神经根对神经元有明显的剂量-效应关系。     

丙种球蛋白及干扰素治疗手足口病并发病毒性脑炎疗效观察

目的观察丙种球蛋白及干扰素在治疗小儿手足口病(HFMD)并发病毒性脑炎的临床疗效、症状改善状况及安全性。方法选取我院2012-12—2013-12收治的手足口病并发病毒性脑炎患儿87例为研究对象,随机分为3组,丙种球蛋白组30例,连续5d静滴人血丙种球蛋白,剂量1g/(kg·d);干扰素组27例,采用肌内注射重组人干扰素80μg/(次·d),持续3d;联合组30例,采取丙种球蛋白和干扰素联合治疗。3组患儿在降颅压、退热、预防细菌感染、营养脑细胞等治疗和护理方式上均相同,观察3组患儿1周内临床症状改善情况,对比临床疗效及安全性。结果 3组在生理指标恢复时间上差异无统计学意义(P0.05),在热程、疱疹消失时间和神经系统病理征转阴时间上差异有统计学意义,联用组所需时间显著少于干扰素组和丙种球蛋白组(P0.01),干扰素组和丙种球蛋白组间无显著性差异(P0.05);联用组有效率(93.33%)大于干扰素组(77.78%)和丙种球蛋白组(76.67%),但两两比较差异无统计学意义(P0.05);联用组不良反应发生率高于干扰素组和丙种球蛋白组,但3组间差异无统计学意义(P0.05)。结论小儿手足口病并发病毒性脑炎采用丙种球蛋白联合干扰素治疗的效果较单独使用明显,缩短了病程,且不良反应可耐受,具有一定临床意义。     

Current status and future opportunities for controlling acromegaly

Growth-hormone (GH) secreting adenomas, including acromegaly, account for approximately one-sixth of all pituitary adenomas and are associated with mortality rates at least twice that of the general population. The ultimate goal of therapy for acromegaly is normalization of morbidity and mortality rates achieved through removal or reduction of the tumor mass and normalization of insulin-like growth factor I (IGF-I) levels. Previously published efficacy results of current treatment modalities (surgery, conventional radiation, and medical therapy with dopamine agonists and somatostatin analogs) are often difficult to compare because of the different criteria used to define cure (some of which are now considered inadequate). For each of these modalities, pooled data from a series of acromegaly studies were reviewed for rates of IGF-I normalization, a currently accepted definition of cure. The results showed overall cure rates of approximately 10% for bromocriptine, 34% for cabergoline, 36% for conventional radiation, 50–90% for surgery for microadenomas and less than 50% for macroadenomas, and 54–66% for octreotide. These cure rates based on IGF-I normalization are generally less than those reported for cure based solely on GH levels. Novel new therapies for acromegaly include the somatostatin analog, lanreotide, Gamma Knife radiosurgery, and pegvisomant, the first in its class of new GH receptor antagonists. Although it does not appear that Gamma Knife radiosurgery results in significantly higher cure rates or fewer complications, it does provide a notable improvement in delivery compared with conventional radiation. Early studies have reported IGF-I normalization in 48% of lanreotide-treated patients and up to 97% of pegvisomant-treated.