Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients

ObjectiveConventional deep brain stimulation (DBS) systems with ring-shaped leads generate spherical electrical fields. In contrast, novel directional leads use segmented electrodes. Aim of this study was to quantify the impedance variations over time in subjects with the directional Cartesia-Boston® system.MethodsImpedance records, programming settings, and clinical data of 11 consecutive Parkinsonian patients implanted with DBS directional leads in two Italian centers (Udine and Vicenza) were retrospectively evaluated. Data were collected before starting stimulation (in the operating room and at days 5 and 40) and after switching stimulation on at the successive follow-up visits (1, 6 and 12 months).ResultsDirectional leads have significantly higher impedance than ring leads. Stimulated contacts had always lower impedance compared to non-stimulated contacts. Before DBS-on, all contacts had higher impedance in the operating room, with an initial decrease five days post-surgery and a subsequent increase at day 40, more evident for directional contacts. The impedance of directional leads increased post-implantation at 1 and 6 months with a plateau at 12 months.ConclusionsThere was a significant difference between the directional and ring leads at baseline (before activation of DBS) and during follow-up (chronic DBS).SignificanceOur study reveals new information about the impedance of segmented electrodes that is useful for patient management during the initial test period, as well as during long-term DBS follow-up.     

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.     

新疆拜城县重病区与中病区内外环境无机元素含量的调查

本文于１９９３年４月调查了新疆拜城县重病区查尔齐农场中与中病区赛里木乡的饮水，土壤，粮食，学龄儿童头发中Ｚｎ，Ｃｕ，Ｍｎ，Ｃａ，Ｌｉ，Ｓｅ６种元素无机元素的含量。结果表明，重病区小麦中Ｃａ的含量显著高于中病区（Ｐ〈０．０５），重病区饮水及小麦中Ｍｎ的含量显著低于中病区（Ｐ〈０．０５）。这些结果揭示重病区查尔齐与中病区赛里木乡的病情相比较，除缺碘较为严重这一主要原因之外，高Ｃａ，低Ｍｎ也可能与查尔齐     

An alternative mechanism of actions for neuroleptic and antidepressant drugs

It has earlier been proposed by the author that the aetiology of schizophrenic symptomatology may be due to the presence of abnormally connected interhemispheric fibres which link specialised functions in the brains of schizophrenics that are not connected in normal subjects, and that the neuroleptic drugs may produce their action through a local anaesthetic-like effect in suppression of conduction in these fibres. This line of thought has been extended here to consider the possible mechanism of action of the neuroleptic drugs in more detail, as well as that of the tricyclic antidepressant drugs which are derivatives of the phenothiazine group. Pharmacological similarities with the local anaesthetics both structurally and functionally have been considered, as well as the effects that these drug groups may have in common with the lithium salts. It has been suggested that these drugs all produce their primary effect on cell membranes, though not necessarily at the synapse, that the time course of their clinical effect may correlate with their incorporation into various cell membranes within the CNS, and that they may thus bring about a fundamental alteration in cell membrane microstructure. The possible role of electroconvulsive therapy has also been considered. The corollary of this argument is that the affective disorders may be genetically determined diseases of cell membrane microstructure.     

脑血管意外尿失禁的机制探讨

目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查(包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定)并按Burney分类进行分析,同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中,表现为逼尿肌反射亢进者31例(73.8%):其中外括约肌无抑制性松弛19例(45.2%),逼尿肌-外括约肌不协调3例(7.1%),逼尿肌-外括约肌协调9例(21.4%);逼尿肌反射减低,外括约肌协调者11例(26.2%);无逼尿肌功能正常者。发生膀胱顺应性减低5例(11.9%),发生尿感缺失者11例(26.2%)。初感尿容量(140.00±46.97)ml;膀胱最大容量(293.20±60.71)ml;最大尿道闭合压(65.14±19.83)cmH2O。逼尿肌最大收缩力(Pdetmax)为(60.98±31.11)cmH2O;最大尿流率时逼尿肌压力(Pdet-Qmax)为(35.98±17.46)cmH2O;逼尿肌收缩时间(Tcon)为(86.07±36.09)sec;最大流量(Qmax)为(9.02±5.62)ml/s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶,脑出血与脑梗塞患者的尿动力学表现无明显差异,左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进,部分出现逼尿肌反射减弱,但感觉正常,感觉缺失者较少见;外括约肌功能以无抑制性松弛为主,其次为逼尿肌-外括约肌协调,少数出现不协调;较少出现膀胱顺应性降低。     

小儿疳证源流考

疳作为一个病名，最早见于隋《诸病源候论》。首先将疳证作为儿科专有疾病者，为宋初《太平圣惠方》。本病分类最全面，收集方剂最丰富当推宋《幼幼新书》。南宋出版的《小儿卫生总微论方》首次将疳证归类为五疳。本草文献中对本病贡献最大的为明《本草纲目》。清《温病条辨》首次将本病治法作全面总结。１９９４年国家中医药管理局颁布的《中医病证诊断疗效标准》首次以法规的形式将本病作了统一规范     

5地市720名高中学生睡眠状况相关因素分析

目的了解省级示范高中学生睡眠状况及相关因素对学生睡眠的影响，为相关部门制订针对性改进措施提供依据。方法采用睡眠状况自评量表（self-rating scale of sleep，SRSS）对省级示范高中学生进行睡眠状况问卷调查，用SPSS 10．0 FOR WINDOWS进行数据的统计与分析。结果发现720名省级示范高中学生睡眠状态异常者占65．42％，显著高于全国常模（45．6％）。其中轻度睡眠问题占57．36％，显著高于全国常模（35．6％）。学业负担过重、缺乏良好的学习习惯、住宿条件差、家庭状况不好、家校距离远和心理问题是导致省级示范高中在校学生睡眠状态异常的主要因素。结论应促进高中生身心健康，提高其学习能力，改善其睡眠状况。     

Professional Education in Co-occurring Disorders: Some Considerations towards Practice Development

The aims of this paper are to provide a brief overview of the types of education and training as well as a framework for co-occurring disorders courses at foundation and advanced levels. Mental health nurses encounter substance abuse problems as part of their workload and should be prepared adequately to work with individuals with the co-existence of mental health and substance abuse. However, co-occurring disorders are not often picked up by substance abuse or mental health services, indicating a need for improvement in ongoing professional development. The targeted audience for education and training in core competencies should be staff working in community mental health teams, inpatient services, assertive outreach teams, early intervention teams, crisis resolution teams, primary care, mental health services for older people, independent mental health projects, accommodation services, day care services, statutory drug and alcohol services, independent drug and alcohol service providers, and those working in hostel accommodations, housing, prison health care probation, and others in the criminal justice system. The theoretical and skills-based training will need to adopt a two-tiered approach as individuals working within mental health services will by definition need a higher emphasis on training around substance misuse and vice versa for individuals working in substance misuse services. One of the agenda items for interagency training is to challenge negative attitudes and prejudices around both mental health problems and substance misuse.     

Vergleichende Untersuchung von niedermolekularem Dextranoder Hydroxyäthylstärkelösungen als Volumenersatzmittel bei Hämodilutionstherapie

Summary Rheological therapy, as an immediate treatment in conjunction with physical therapy and the removal of risc factors, plays a significant role in the management of patients with peripheral vascular disease experiencing reduced walking tolerance. An essential element of rheological therapy is hemodilution. Currently, is still uncertain which plasma substitute solution would be the most appropriate in such cases. This study compared the effectiveness of low molecular hydroxyethyl starch to low molecular dextran during a 16-day hemodilution in combination to physical therapy. The clinical improvement observed with both plasma substitute solutions was comparable, yet in view of the cardiac volume overload, dextran demonstrates greater circulatory stress due to the transient pressure increase and more side effects. For this reason, we prefer to administer low or middle molecular hydroxyethyl starch in the dilution treatment of peripheral arterial occlusive disease as a chronic degenerative vascular disease.

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Abkürzungen A2M Alpha-2-Makroglobulin - D0 Meßzeitpunkt 0 der später mit Dextran behandelten Gruppe - D1 Meßzeitpunkt 1 der Dextran-Gruppe - D2 Meßzeitpunkt 2 der Dextran-Gruppe - Dextran 40 kleinmolekulares Dextran (mittleres Molekulargewicht 40000 Dalton) - ETA Plasmaviskosität - Fib Fibrinogen - Geh Gehstrecke - H0 Meßzeitpunkt 0 der später mit Hydroxyäthylstärke behandelten Gruppe - H1 Meßzeitpunkt 1 der HAES-Gruppe - H2 Meßzeitpunkt 2 der HAES-Gruppe - HAES 40 kleinmolekulare Hydroxyäthylstärke (mittleres Molekulargewicht 40000 Dalton) - Hkt Hämatokrit - LZ Leukozyten-Zahl - Pro Gesamteiweiß - SEA Erythrozyten-Aggregationsindex - SER Erythrozyten-Rigiditätsindex - TY Fließschubspannung - TZ Thrombozyten-Zahl