糖尿病脑内胰岛移植临床初步研究(附三例报告)

本文报告胰岛细胞脑内移植治疗I型糖尿病共3例,分别经过3个月、4个月、6个月的临床观察,其临床症状明显改善或消失,空腹血糖由移植前平均12.38mmol/L下降至7.77mmol/L;3例患者普通胰岛素用量平均每日62.3~u,移植后第21～30天均完全停用胰岛素,其中1例已持续撤离胰岛素治疗达5个月。观察结果提示:胰岛移植物在患者的脑内成活,并具有良好的内分泌功能。     

Neurophysiological aspects of chronic motor cortex stimulation

Chronic motor cortex stimulation is a treatment option for neuropathic drug-resistant pain and possibly associated movement disorders. Preliminary studies suggest the possibility to treat symptoms of Parkinson disease in selected patients. Recently, MCS has been suggested to enhance motor recovery in patients with poststroke hemiparesis. One or more electrodes are placed extradurally over the motor cortex through a burr hole or a small craniotomy, and then connected to a totally implantable neurostimulator. The accurate positioning of the stimulating electrodes over the motor cortex is the key point of the surgical procedure. Motor cortex identification results from the integration of anatomical, neuroradiological, functional, and neurophysiological data, taking into account the huge population variability. Intraoperative neurophysiological mapping of the motor cortex is of paramount importance, in spite of very sophisticated neuroradiological mathematical reconstructions of the motor area. We discuss and compare the different techniques that are utilized by different authors. Moreover, clinical neurophysiology is also helpful in evaluating the results of this neuromodulation procedure and in hypothesizing the mechanisms that are put in play by MCS.     

Bases anatomiques de la mémoire

Résumé Les données cliniques et anatomo-pathologiques ont permis de suggérer le rôle du circuit hippocampo-mamillo-thalamique dans certains processus mnésiques. Récemment des critiques ont été apportées mettant en cause le rôle même de ce circuit et impliquant d'autres formations: hile du lobe temporal; noyau médio-dorsal du thalamus, amygdale. L'étude des relations anatomiques précises du circuit hippocampo-mamillo-thalamique permet de montrer l'importance dans le circuit lui-même de certaines formations comme le subiculum et l'aire entorhinale. Par ailleurs, ce circuit s'intègre totalement au sein du système limbique au sens large, tel que l'a défini Nauta (1961) et par là à des structures comme l'amygdale, le noyau médio-dorsal du thalamus, le cortex orbito-frontal, le septum et la réticulée mésencéphalique.Mais au sein même de ce système limbique, il semble exister une spécificité de relation des éléments en rapport avec le circuit hippocampo-mamillo-thalamique.Enfin, le circuit HMT ne peut pas se concevoir comme restreint au système limbique. Il est en relation étroite avec l'ensemble du cortex et particulièrement avec le cortex frontal, ce que rappellent les désordres mnésiques entraînés par les lésions de cette région.Le circuit HMT n'est donc pas la mémoire mais reste un modèle et un point de départ utile sinon indispensable dans son étude.     

椎间盘退变的腰椎活动节段力学模型

椎间盘是人体组织中最早发生退行性改变的部位。本文报告采用三维有限元方法建立的椎间盘退变腰椎活动节段的力学模型,着重分析其在直立时的应力分布与载荷传递情况。模型共有388个节点,组成293个单元,所得结构较为合理可靠。作者认为,本模型具有其独特的优点。可望用于进一步的研究。     

EEG mapping investigations of psychomotor and music perception brain dysfunction in untreated schizophrenic patients

Twenty-six untreated schizophrenic inpatients and 34 control persons were investigated using 16-channel EEG mapping during resting, manumotor and music perception tasks. Power values of activation tasks were each referenced to a separate, immediately preceding resting condition, using conventional delta, theta, alpha and 2 beta frequency bands. Results in delta and alpha bands, which maximally separated the two groups, are reported only for space reasons. Results indicated a “nonreactivity” (in all frequency bands) on the two activation paradigms in schizophrenic patients as a group. Major gender effects were obtained in normal persons, but not signs of nonreactivity comparable to patients. Subdividing patients exclusively by means of their EEG changes on activation produced meaningful clinical subgroups of “positive/negative” schizophrenics. This latter finding could contribute towards clinical utility of EEG mapping in psychiatry.

Résumé

Vingt-six malades schizophrènes non traités par des médicaments étaient étudiés par l'EEG topographique à 16 voies pendant des tâches psychomotrices et de la perception musicale. Ils étaient comparés à 34 personnes contrôles. Les valeurs de la puissance étaient calculées dans les états de repos et d'activation dans les bandes de fréquences (conventionnelles) delta, theta, alpha et bêta 1 et 2. Seules les bandes delta et alpha, qui séparaient au maximum les deux groupes, sont montrées dans l'article en raison de l'espace. Tandis que les sujets normaux montraient des changements majeurs de l'EEG pendant les deux types de tâches — modifié par le sexe, les malades schizophrènes montraient au contraire des signes de « non-réactivité . L'essai de grouper les malades exclusivement par leurs changements de l'EEG pendant l'activation cérébrale qu'effectuait un groupe était cliniquement significative, en séparant les malades portant des symptomes « positivesde ceux avec des symptomes « négatives . Le résultat final pourrait indiquer une valeur clinique de l'EEG quantifié pour la psychiatrie.     

Accident vasculaire cérébral ischémique : une complication rare du kyste hydatique du foie

Hydatid cyst of the liver (HCL) is a widespread disease in North African countries. We report the case of a 39-year-old patient who was admitted in our intensive care unit because of anaphylactic shock due to a cracked HCL fortuitously discovered. This accident was also complicated by an ischemic stroke witch underline mechanisms are discussed.     

Pression tissulaire cérébrale en oxygène : pour quoi faire et pour qui ?

The main purpose of neurointensive care is to fight against cerebral ischaemia. Ischaemia is the cell energy failure following inadequacy between supply of glucose and oxygen and demand. Ischemia monitoring starts with a global approach, especially with cerebral perfusion pressure (CPP) determined by mean arterial pressure and intracranial pressure (ICP). However, global monitoring is insufficient to detect “regional” ischaemia, leading to development of local monitoring such as brain oxygen partial pressure (PtiO₂). PtiO₂ is measured on a volume of a few mm³ from a probe implanted in the cerebral tissue. The normal value is classically included between 25 and 35 mmHg and critical ischemic threshold is 10 mmHg. Understanding what exactly is PtiO₂ is still a matter of debate. PtiO₂ is more an indicator of oxygen diffusion depending of oxygen arterial pressure (PaO₂) and local cerebral blood flow (CBF). Increase PaO₂ to treat PtiO₂ would hide information about local CBF. PtiO₂ is useful for the detection of low local CBF even when ICP is low as in hypocapnia-induced vasoconstriction. PtiO₂-guided management could lead to a continuous optimization of arterial oxygen transport for an optimal cerebral tissue oxygenation. Finally, PtiO₂ has probably a global prognostic value because studies showed that hypoxic values for a long period of time lead to an unfavourable neurologic outcome. In conclusion, PtiO₂ provides additional information for regional monitoring of cerebral ischaemia and deserves more intensive use to better understand it and probably improve neurointensive care management.     

Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.