肺叶切除术后肋间神经冷冻止痛与静脉自控镇痛效果比较

目的比较肺叶切除术后肋间神经冷冻止痛与静脉自控镇痛的效果,完善开胸术后的镇痛方法。方法将近年我院肺叶切除术患者178例纳入研究,根据术后镇痛方法的不同分为肋间神经冷冻止痛组（A组）和静脉自控镇痛组（B组）,将2组患者的镇痛效果和不良反应进行比较。结果术后第1周内及术后1个月A组患者的镇痛效果明显优于B组（P〈0.05）;随访6个月,2组患者疼痛均消失,差异无统计学意义（P〉0.05）。并发症比较显示,B组患者肺炎及肺不张、胃肠道不适、嗜睡的发生率均高于A组（P〈0.05）。结论肺叶切除术后肋间神经冷冻止痛效果好、并发症少,与静脉自控镇痛相比具有优势。     

膨体聚四氟乙烯用于肺切除后的残腔填塞

背景：肺切除后由于处理不当产生的胸内残腔是导致胸腔内感染和支气管胸膜瘘的主要原因,目前对残腔的处理尚无行之有效的预防方法。 目的：探讨应用膨体聚四氟乙烯肺模型消除肺切除后残腔的可行性。 设计、时间及地点：随机对照动物实验,于2007-07/2009-03在西安交通大学医学院动物实验中心完成。 材料：健康杂种犬12只,随机分成模型组、填塞组,6只/组。膨体聚四氟乙烯肺模型由上海塑料研究所提供,该肺模型为预先消毒好的医用海绵及膨体聚四氟乙烯,根据胸腔三维结构进行设计制作,模型质量500~700 g。 方法：2组犬均进行肺叶切除和全肺切除。填塞组将预先设计的膨体聚四氟乙烯模型直接置入胸腔,胸顶和隔肌缝针疏松固定防止移位;模型组按肺切除手术常规处理,未置入任何材料。 主要观察指标：检测并发症的发生;分别于肺切除后6,12,24周处死解剖,行动脉血气分析,取胸膜组织进行光镜和电镜观察。 结果：模型组1只犬因发生支气管胸膜瘘于术后10 d死亡,气管纵隔有移位;填塞组未发生支气管胸膜瘘,无纵隔移位,置入体内的膨体聚四氟乙烯肺模型保持原状,表面覆盖纤维结缔组织,剖面内无积液。与肺切除前比较,肺切除后两组均出现氧分压下降(P < 0.05)、二氧化碳分压升高(P < 0.05);肺切除后2组间比较,pH、氧分压、二氧化碳分压、HCO3-浓度均无明显差异(P > 0.05)。肺切除后6,12,24周,两组动物胸膜组织病理变化及超微结构变化基本相似,均未见明显炎症反应。 结论：肺切除后人工材料填塞消除残腔是可行的,膨体聚四氟乙烯是现阶段理想的填塞材料。     

3D-slicer软件辅助神经内镜手术治疗高血压性脑出血的疗效

目的 探讨3D-slicer软件辅助神经内镜手术治疗高血压性脑出血的疗效。方法 2015年5月至2017年1月手术治疗高血压性脑出血60例,其中30例采用3D-slicer软件辅助神经内镜手术（A组）,30例小骨窗开颅在显微镜下清除血肿（B组）。结果 A组手术时间、血肿消失时间、术中出血量均明显少于B组（P<0.05）;A组血肿清除率明显高于B组（P<0.05）。A组术后发生肺部感染1例、急性肾损伤1例;B组术后发生再出血4例、消化道出血1例、肺部感染4例、急性肾损伤3例、颅内感染2例。A组并发症总发生率（6.7%,2/30）明显低于B组（33.3%,10/30;P<0.05）。结论 在3D-slicer软件辅助下,神经内镜手术治疗高血压性脑出血定位精确,可提高血肿清除率。     

神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的临床疗效对比分析

目的探讨神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的临床疗效及优缺点。方法将54例垂体腺瘤病人随机分两组,其中30例病人行神经内镜下单鼻孔蝶窦入路垂体腺瘤切除术(神经内镜组),24例病人行神经导航辅助显微镜下单鼻孔蝶窦入路垂体腺瘤切除术(导航显微镜组)。分析两组病人的术后并发症发生率、住院时间、手术时间和肿瘤全切率。结果神经内镜组与导航显微镜组在术后并发症发生率、肿瘤全切率方面差异无统计学意义(P0.05)。导航显微镜组手术时间短于神经内镜组,而神经内镜组术后住院时间明显短于导航显微镜组(P0.05)。结论神经内镜与神经导航辅助显微镜下经鼻蝶入路垂体腺瘤切除术的临床疗效相当,需结合病人情况实施治疗。     

不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效比较

目的分析不同来源神经供体进行臂丛神经根性撕脱伤移位修复的疗效,并探讨手术效果影响因素。方法选取2011-01—2017-12平顶山市第五人民医院骨科收治的行神经移位修复术治疗臂丛神经根性撕脱伤患者94例作为研究对象,分别行健侧颈7神经移位术(32例)、肋间神经移位术(30例)及膈神经移位术(32例),收集患者基本资料,并对患者术后患肢肘关节功能及肌力恢复情况进行评估。结果3组患者肘关节恢复达到良以上分别为膈神经组21例(65.6%),肋间神经组20例(66.7%),C7神经组23例(71.9%),3组患者术后肘关节功能恢复情况比较,差异无统计学意义(P>0.05)。术后膈神经组、肋间神经组,C7神经组肌力≥Ⅲ级的例数分别为25例(78.1%)、22例(73.3%)、25例(78.1%),3组患者术后患肢肌力恢复情况无显著性差异(P>0.05)。3组术后肘关节功能恢复的影响因素存在差异。(1)膈神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P<0.05);(2)肋间神经组术后肘关节功能恢复情况与功能锻炼时间、损伤部位和神经移植长度等因素有关(P均<0.05);(3)C7神经组术后肘关节功能恢复情况与年龄、损伤-手术时间、神经移植长度等因素有关(P<0.05)。与3组患者术后肘关节功能恢复情况均有关的影响因素为神经移植长度。3组患者术后肌力恢复的影响因素存在差异。(1)膈神经组肌力恢复情况与患者年龄、损伤-手术时间、神经移植长度和功能锻炼时间等因素有关(P均<0.01);(2)肋间神经组肌力恢复情况与年龄、功能锻炼时间和神经移植长度等因素有关(P均<0.01);(3)颈7神经组肌力恢复情况与年龄、功能锻炼时间及损伤-手术时间等因素有关(P均<0.01)。结论3种供体神经移植修复臂丛神经根性撕脱伤效果相当,但术后效果的影响因素不尽相同,因此根据患者具体情况选择最优的治疗方式,有利于提高手术有效率。     

神经内镜下经鼻经蝶垂体瘤切除术后并发症的观察及护理

目的：探讨神经内镜下经鼻经蝶切除垂体瘤术后并发症发生原因及护理对策。方法收集2012‐01—2013‐12我院接受神经内镜下经鼻经蝶切除术治疗的垂体瘤患者62例,随机分为观察组与对照组各31例。对照组行常规护理,观察组行针对性护理,比较2组手术效果及并发症发生情况。结果观察组术后肛门排气时间、肠鸣音恢复时间以及住院时间均较对照组显著缩短（P＜0.05）;观察组并发症发生率为6.5％,显著低于对照组的35.5％（P＜0.05）;观察组护理满意度为96.8％,显著低于对照组的83.9％（P＜0.05）。结论严密的护理干预有利于降低神经内镜下经鼻经蝶垂体瘤切除术后并发症发生率,促进术后康复,提高患者的满意度,值得推广应用。     

循证护理对额叶胶质瘤患者术后精神障碍的影响

目的探讨循证护理对额叶胶质瘤患者术后精神障碍方面的影响,提出规范、个性化的护理措施。方法选取2014-01—12在我院接受治疗的60例额叶胶质瘤术后存在精神障碍患者,随机分为观察组(30例)和对照组(30例)。对照组给予手术常规护理措施,观察组在此基础上给予循证护理干预。分别术后第1天、第3天、第30天及第90天使用日常生活能力量表(ADL)、神经精神症状问卷(NPI)、常识-记忆力-注重力测验(IMCT)对患者的精神状况进行定量评估。结果 2组术后第1天和第3天ADL评分比较差异无统计学意义(P0.05),观察组术后第30天和第90天时ADL评分明显高于对照组(P0.05);2组术后第1天和第3天NPI评分比较差异无统计学意义(P0.05),而观察组术后第30天和第90天的NPI评分明显低于对照组(P0.05);2组术后第1天和第3天的IMCT评分比较差异无统计学意义(P0.05),而观察组术后第30天和第90天时IMCT评分明显低于对照组(P0.05)。结论循证护理可更好地提高患者的日常生活能力,并有效改善了患者的神经精神症状和认知障碍。     

实验性自身免疫性脑脊髓炎大鼠脑组织Nogo-A和NgR的变化

背景：Nogo-A蛋白是一种中枢神经系统髓鞘相关轴突再生抑制因子,与其受体作用可抑制轴突再生。 目的：观察实验性自身免疫性脑脊髓炎（Experimental Autoimmune Encephalomyelitis,EAE）大鼠侧脑室周围Nogo-A和NgR蛋白的动态变化,探讨Nogo-A和NgR蛋白在EAE发生发展中的可能作用机制。 设计、单位、时间：随机对照动物研究。试验于2008年9月至11月在湖南省人民医院临床研究所进行。 材料：6~8周龄清洁级雌性Wistar大鼠60只,体重（180±10）g,由湖南农业大学动物科技学院实验动物养殖场提供。 方法：60只大鼠随机分为EAE组和对照组各30只,各组再分为6个亚组,每组5只大鼠,分别于免疫后11天、13天、15天、18天、24天、30天处死各亚组大鼠取脑。采用免疫组化方法测定2组大鼠侧脑室周围白质Nogo-A和NgR蛋白在不同时间点表达情况。 主要观察指标：通过免疫组化后阳性细胞数计数观察侧脑室周围Nogo-A和NgR表达水平。 结果：EAE组在免疫第11天Nogo-A蛋白表达升高,第13天下降,后又升高,第30天仍高于对照组;EAE组NgR蛋白在第13、15、18表达升高。 结论：Nogo-A和NgR蛋白可能在EAE的发生发展中起重要作用     

颅内肿瘤切除术后帕瑞昔布钠的镇痛效果

目的 观察帕瑞昔布钠用于颅内肿瘤切除术后镇痛的效果。方法 选择择期行切除术的颅内肿瘤60例,术后应用帕瑞昔布钠镇痛30例（观察组）,应用生理盐水30例（对照组）;采用视觉模拟量表（VAS）评分评估疼痛程度,记录术后需要追加镇痛药的时间和例数。结果 观察组追加镇痛药的发生率（53.5%,16/30）明显低于对照组（100%;P<0.05）,而且需要追加镇痛药的时间[（6±2）h]较对照组[（2±1）h]也明显延长（P<0.05）。观察组术后6、12、24 h VAS评分均明显低于对照组（P<0.05）。结论 帕瑞昔布钠应用于颅内肿瘤切除术后镇痛效果良好。     

大鼠胸主动脉损伤后基质金属蛋白酶组织抑制因子1，2的表达与血管内膜增生

背景：已有研究发现,基质金属蛋白酶及其组织特异性抑制因子通过影响血管平滑肌细胞迁移以及细胞外基质的代谢参与再狭窄过程。 目的：观察基质金属蛋白酶组织抑制因子1,2在大鼠胸主动脉损伤后不同时间的表达情况。 设计、时间及地点：随机对照动物实验,于2008-07在辽宁医学院动物实验中心完成。 材料：选用SD雄性大鼠60只,按随机数字表法分为2组,单纯球囊损伤组及对照组各30只。 方法：单纯球囊损伤组大鼠采用2F Fogarty导管损伤胸主动脉;对照组行左颈总动脉结扎术,不插入2F Fogarty导管。 主要观察指标：2组于术后第1,3,7,10,14,28天分别处死5只大鼠,取完整的血管内膜,应用蛋白印迹法检测动脉损伤后不同时间点基质金属蛋白酶组织抑制因子1,2表达水平,并进行比较。 结果：基质金属蛋白酶组织抑制因子1于大鼠动脉损伤后第1天开始表达增加,第7天达到高峰,第28天几乎无表达。基质金属蛋白酶组织抑制因子2于大鼠动脉损伤后第1,3天仅有较弱的表达,第7,10天表达明显增加,第14天达到高峰,第28天仍有较强表达。对照组中各时间点基质金属蛋白酶组织抑制因子1,2的表达均无明显变化(P > 0.01)。术后各时间点基质金属蛋白酶组织抑制因子1,2的表达水平单纯球囊损伤组均显著高于对照组(P < 0.01)。 结论：大鼠胸主动脉球囊损伤后基质金属蛋白酶组织抑制因子1,2的表达均明显增加。 关键词：基质金属蛋白酶组织抑制因子1,2;动脉损伤;再狭窄     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Effects of NMD A- and AMPA-Receptor Antagonists on Different Forms of Epileptiform Activity in Rat Temporal Cortex Slices

Summary: Lowering extracellular magnesium induces different patterns of epileptiform activity in rat hippocampus and entorhinal cortex. Short recurrent epileptiform discharges in the hippocampus are stable over time, whereas seizurelike events (SLEs) in the entorhinal cortex, the subiculum, and the neighboring neocortex develop into late recurrent discharges which are not blocked by clinically employed antiepileptic drugs. We tested the sensitivity of the different epileptiform discharge patterns to. /V-methyl-D-aspartate (NMDA)- and non-NMDA-receptor antagonists. As NMDA-receptor antagonist we used dextrorphan, ket-amine, and 2-aminophosphonovalerate (2APV); as α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)-receptor antagonist we employed the quinoxaline derivative glutamate 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX). The findings show that the different patterns of epileptiform activity, including the late recurrent discharges, are sensitive to all NMDA-receptor antagonists. However, when dextrorphan was employed to suppress seizure-like events, later recurrent discharges did not develop during the remaining time course of the experiment. CNQX reversibly suppressed recurrent discharges in the hippocampus and SLEs in the entorhinal cortex. However, late recurrent discharges become insensitive to CNQX, even at a high concentration of 60 μM m. This finding suggests a prominent role for NMDA receptors in the generation of late recurrent discharges.