癫痫发作后状态及其临床意义

癫痫发作后状态(PIS)是指癫痫发作停止到恢复至发病前水平的异常状态,包括认知、运动、感觉、自主神经和精神行为等异常,症状多样,严重程度不一,持续数秒至数天不等,对患者的健康和生活质量产生很大影响。然而,目前国内外相关的研究较少,临床医生对此缺乏正确认识,容易误诊误治。本文将从PIS的定义、病理生理机制、临床表现、诊断和鉴别诊断、临床意义以及干预策略等进行综述,以提高临床医生的认识,并为今后临床研究提供参考。     

X-刀治疗靶点定位精确度分析

目的 :研究SRS2 0 0X 刀治疗系统治疗靶点定位的精确度。方法 :应用人体头颅模型内特定标记物测定CT定位的精度 ,用胶片法测定二次等中心系统精度和总的治疗精度。结果 :BRW头环CT定位精度为 0 .65mm ,最大误差为 1 .0 9mm ;SRS2 0 0二次等中心系统误差为 0 .1 9mm ;总治疗误差理论计算值为0 .68mm ,胶片法检测值为 1 .43mm。结论 :X 刀治疗系统精确度已达到放射外科质量控制要求。     

胰岛素瘤10例临床特点分析

目的 分析胰岛素瘤的临床表现特点，为诊断和治疗提供帮助。方法 回顾性分析2000年10月至2006年4月北京大学第一医院住院手术且术后病理诊断的胰岛素瘤10例临床资料。结果 （1）10例患者均表现有晨起或饥饿时发作性出冷汗、心慌等交感神经兴奋及头晕、乏力症状，其中9例进食或喝糖水后可缓解。9例有晕厥、昏迷等意识障碍，6例有惊厥、抽搐或癫痫发作，5例进食多且体重增加超过10kg。（2）8例血糖〈2．8mmol／L，7例胰岛素血糖比值〉0．4，9例胰岛素修正释放指数〉100。（3）B超、CT和术中探查阳性率分别为30％、60％和100％。结论 典型低血糖症状、Whipple三联症和胰岛素血糖比值、胰岛素修正释放指数是胰岛素瘤定性诊断主要依据，术中B超结合术中探查和脾门静脉分段取血是最有效的肿瘤定位手段。临床表现典型而影像学检查阴性病例应考虑剖腹探查术。     

Localization of small intestinal bleeding

The preoperative identification of a bleeding site is not always possible, particularly when bleeding originates in the small intestine. Small vascular abnormalities, such as the telangiectatic lesion described in this report, comprise about 40–60% of such cases. Preoperative location using arteriography, radionuclide bleeding scan, and enteroclysis were nondiagnostic. The lesion was demonstrated by intraoperative endoscopy. A segment of small intestine was resected, and the patient made an uneventful recovery.     

How the lack of visuomotor feedback affects even the early stages of goal-directed pointing movements

Pointing movements made with a hidden cursor from the center of gaze to a stationary, visible target overshot the actual target location. The systematic error decreased when the final cursor location from the previous trial was shown, which likely led to the creation of an internal sensorimotor model of movement. However, the putative model had a short memory, and could not substitute for on-line visuomotor feedback on subsequent trials. Contrary to common belief, the effect of a lack of visuomotor feedback was seen even in the early acceleration stage of the movement trajectory. Unchecked in the absence of visual monitoring, the acceleration stage of the movement lasted longer, as was evidenced by the significantly larger value of the peak cursor speed. Moreover, the speed peaked much later in the course of the movement. Speed declined more rapidly thereafter. Consequently, the delayed deceleration stage lasted far less than the acceleration stage. In the absence of visual feedback, the shift rightward in time of the peak speed position (PSP) in relation to total movement duration and other changes in the trajectory imply that visual feedback must play a significant role in determining when acceleration ceases (d V/d t=0), and argue against the traditional notion that visuomotor feedback is unavailable until the later stages of movement. Moreover, our data suggest that non-visual modalities, e.g., proprioception, may be too slow to make up for the absence of vision.     

The location and distribution of type A and type B atrial endings in cats

Summary In the attempt to explain the difference in discharge pattern of atrial endings, 131 endings were localized by punctate stimulation, 44 were type A, 77 type B and 10 of an intermediate type. All were located on the dorsal wall of the atria with none on the ventral wall or in the appendage. On the right side, 74% of type A were located in the atria and 63% of type B in or near the veins. On the left side, 67% of type A and 94% of type B were located in or near the veins. Thus, there appeared to be some difference in the location of type A and type B endings on the right side, but on the left side both types of endings were for the most part confined to the venous region. Further, on both right and left sides, these endings were present both in the central part of the atria and in or adjacent to veins. This leads to the suggestion that the difference in discharge patterns is not caused by the location but may be due to some other reasons, e. g. difference of arrangement in the atrial wall with respect to the contractile elements.     

额叶脑回的横断层定位

目的:在横切面上利用髓突对成人端脑额叶脑回进行影像学定位.方法:取20例正常成人尸头标本,作层厚6mm之横切脑片,选取其中典型层面,观察分析额上、中、下回所对应髓突的方向、数目等特征形态.结果:各切面.各脑回所对应髓突为1～2支;时针12-12点半方向髓突所对应脑回是额上回;时针12点半-1点(左)及10点半-11点半(右)方向髓突所对应脑回是额中回;时针2-3点(左)及9-11点(右)方向髓突所对应脑回是额下回.结论:额上、中、下回与髓突之间有对应规律可寻,影像学上可以通过髓突定位额上、中、下回.     

The role of the p33:p33/p92 interaction domain in RNA replication and intracellular localization of p33 and p92 proteins of Cucumber necrosis tombusvirus

Replication of plus-stranded RNA viruses is performed by the viral replicase complex, which, together with the viral RNA, must be targeted to intracellular membranes, where replication takes place in membraneous vesicles/spherules. Tombusviruses code for two overlapping replication proteins, the p33 auxiliary protein and the p92 polymerase. Using replication-competent fluorescent protein-tagged p33 of Cucumber necrosis virus (CNV), we determined that two domains affected p33 targeting to peroxisomal membranes in yeast: an N-proximal hydrophobic trans-membrane sequence and the C-proximal p33:p33/p92 interaction domain. On the contrary, only the deletion of the p33:p33/p92 interaction domain, but not the trans-membrane sequence, altered the intracellular targeting of p92 protein in the presence of wt p33 and DI-72(+) RNA. Moreover, unlike p33, p92 lacking the trans-membrane sequence was still functional in supporting the replication of a replicon RNA in yeast, whereas the p33:p33/p92 interaction domain in both p33 and p92 was essential for replication. In addition, p33 was also shown to facilitate the recruitment of the viral RNA to peroxisomal membranes and that p33 is colocalized with (+) and (-)-stranded viral RNAs. Also, FRET and pull-down analyses confirmed that p33 interacts with other p33 molecules in yeast cells. Based on these data, we propose that p33 facilitates the formation of multimolecular complexes, including p33, p92, viral RNA, and unidentified host factors, which are then targeted to the peroxisomal membranes, the sites of CNV replication.     

EEG versus MEG localization accuracy: Theory and experiment

Summary We first review the theoretical and computer modelling studies concerning localization accuracy of EEG and MEG, both separately and together; the source is here a dipole. The results show that, of the three causes of localization errors, noise and head modelling errors have about the same effect on EEG and MEG localization accuracies, while the results for measurement placement errors are inconclusive. Thus, these results to date show no significant superiority of MEG over EEG localization accuracy. Secondly, we review the experimental findings, where there are again localization accuracy studies of EEG and MEG both separately and together. The most significant EEG-only study was due to dipoles implanted in the heads of patients, and produced an average localization error of 20 mm. Various MEG-only studies gave an average error of 2–3 mm in saline spheres and 4–8 mm in saline-filled skulls. In the one study where EEG and MEG localization were directly compared in the same actual head, again using dipoles implanted in patients, the average EEG and MEG errors of localization were 10 and 8 mm respectively. The MEG error was later confirmed by a similar (but MEG-only) experiment in another study, using a more elaborate MEG system. In summary, both theory and experiment suggests that the MEG offers no significant advantage over the EEG in the task of localizing a dipole source. The main use of the MEG, therefore, should be based on the proven feature that the MEG signal from a radial source is highly suppressed, allowing it to complement the EEG in selecting between competing source configurations. A secondary useful feature is that it handles source modelling errors differently than does the EEG, allowing it to help clarify non-dipolar extended sources.This work was supported by grants RO1NS26433, RO1NS19558 and RO1NS22703 from the National Institutes of Health.