3D-CTA在颅内动脉瘤破裂开颅手术中的应用价值

目的探讨三维血管CT造影（3D-CTA）在颅内动脉瘤破裂开颅手术中的应用价值。方法经手术证实的颅内动脉瘤破裂导致蛛网膜下腔出血（SAH）或颅内血肿患者65例,术前均行3D-CTA检查并进行动脉瘤手术模拟,部分患者术前行DSA检查。将患者术前3D-CTA、术前DSA、术中所见进行比较,分析3D-CTA的临床应用价值。结果 65例患者共有动脉瘤68枚,3D-CTA发现65枚,诊断阳性率为95.59%,特异性为100%。3D-CTA可清晰显示动脉瘤位置、大小、形态、瘤顶指向、瘤颈宽窄、载瘤动脉、动脉瘤与周围血管及骨结构关系,且与术中所见基本一致。结论 3D-CTA是一种准确、快捷、微创的诊断颅内动脉瘤方法,能够提供足够信息指导动脉瘤的外科手术治疗。     

3D-CTA在破裂颅内动脉瘤诊断和手术中的应用

目的探讨三维CT血管造影(3D-CTA)对破裂颅内动脉瘤诊治的价值。方法 21例破裂颅内动脉瘤均行3D-CTA检查,8例同时行常规DSA检查,20例行显微手术动脉瘤夹闭。结果 21例共计发现25个动脉瘤,3D-CTA检查发现24个动脉瘤,在1例多发动脉瘤中3D-CTA遗漏1个大脑中动脉瘤,DSA能显示该动脉瘤,同时发现载瘤动脉存在脑血管痉挛。20例24个动脉瘤直接手术夹闭,术后存活14例(恢复良好12例,差2例),死亡6例,术中探查发现动脉瘤数目、位置、载瘤血管、瘤顶指向、瘤体及瘤顶大小与3D-CTA显示基本吻合,无假阳性。结论 3D-CTA诊断颅内动脉瘤具有微创、快捷、安全、可靠的优点,并可显示动脉瘤立体结构,可作为重症破裂动脉瘤及年老体弱患者的首选影像学诊断方法,术者可依据3D-CTA提供的信息指导手术。     

三维CT血管造影术在急性蛛网膜下腔出血颅内动脉瘤诊断中的应用

目的探讨三维CT血管造影术（3D-CTA）在急性蛛网膜下腔出血（SAH）颅内动脉瘤诊断中的应用。方法采用3D-CTA和DSA对26例非外伤性SAH患者进行检查，3D-CTA通过最大密度投影（MIP）、表面遮盖法重建（SSD）和容积重建术（VRT）方法获得图像．根据3D-CTA和DSA所获得的关于动脉瘤的位置、大小等进行术前评估。结果在26例中24例3D-CTA检测出27个动脉瘤，瘤体直径3-2mm，1例后交通动脉瘤3D-CTA不能证实，1例未检出动脉瘤；14例行DSA检查，其中1例未检出动脉瘤而通过3D-CTA发现，1例右椎动脉梭形动脉瘤因DSA行右椎动脉造影失败而通过3D-CTA发现。12例仅凭3D-CTA手术，3D-CTA在检查动脉瘤的位置、大小、瘤体方向及对载瘤动脉和分支动脉的形态描述均优于DSA，它在诊断颅内动脉瘤的敏感性和特异性分别为96％和100％。结论3D-CTA是一种准确、价廉、非侵袭性的诊断颅内动脉瘤SAH的方法，在动脉瘤的急诊手术时较DSA更具优越性。     

3D-CTA与3D-DSA成像在颅内动脉瘤破裂出血早期诊断中的应用价值

目的探讨3D-CTA和3D-DSA在颅内动脉瘤早期诊断中的应用价值.方法40例蛛网膜下腔出血(SAH)病人均经手术证实为颅内动脉瘤破裂出血,术前分别行3D-CTA及3D-DSA检查,比较两种方法诊断动脉瘤的确诊率及显示瘤颈与载瘤动脉关系的能力.结果3D-DSA对动脉瘤的确诊率为97.5％,3D-CTA为85.0％.3D-DSA对动脉瘤瘤颈及其与载瘤动脉关系的显示能力明显优于3D-CTA,两者差异有统计学意义(P＜0.05).结论3D-DSA成像在早期诊断颅内动脉瘤破裂出血的临床应用价值优于3D-CTA.     

3D-CTA在急性破裂颅内动脉瘤诊断和治疗中的应用

目的探讨三维CT血管造影(3D-CTA)在颅内动脉瘤破裂急性期的临床诊断价值。方法148例疑为颅内动脉瘤破裂的自发性蛛网膜下腔出血患者,进行3D-CTA检查,时间分别在发病后2h到4d;其中6例在3D-CTA之前行数字减影脑血管造影(2D-DSA)检查,142例在3D-CTA之后行DSA检查,扫描图像后经计算机工作站处理。原始图像三维后处理技术采用容积重建(VR)和最大密度投影(MIP),以VR为主。后处理图像与DSA图像分别由两位放射科医生和神经外科医生用双盲法进行分析。对动脉瘤治疗采用夹闭和血管内栓塞两种技术。结果经3D-CTA、DSA和手术或栓塞证实共发现112例130个动脉瘤,大小自1.1～28mm,其中单发动脉瘤97例,多发15例33个动脉瘤。在112例动脉瘤中,3D-CTA发现112例128个动脉瘤,漏诊多发动脉瘤中的2个,敏感度为98.5%,特异度94.7%,准确度97.6%,阳性预测值98.5%,阴性预测值94.7%;而DSA发现动脉瘤109例127个动脉瘤,漏诊3例3个动脉瘤,敏感度为97.7%,特异度100%,准确度98.2%,阳性预测值100%,阴性预测值为92.3%。在3D-CTA上均可清晰或较清晰显示出瘤颈与载瘤动脉的关系,占98.4%;而DSA能清晰显示瘤颈与载瘤动脉关系仅占40.9%,两者有统计学意义(x2= 5.545,P<0.05)。结论3D-CTA对颅内动脉瘤具有极高的敏感性和特异性,并具有快捷、经济和相对无创等优点,对颅内动脉瘤破裂急性期的诊断优于2D-DSA。     

3D-CTA在颅内动脉瘤诊治中的应用

目的探讨3D-CTA在颅内动脉瘤诊断和治疗中的应用价值。方法采用3D-CTA检查疑似颅内动脉瘤病人52例,根据造影结果决定直接手术或进一步行3D-DSA检查。术后均复查3D-CTA。结果共发现58个动脉瘤,6例查3D-CTA及3D-DSA均未发现动脉瘤。3D-CTA对颅内动脉瘤诊断的敏感度、特异度、阴性似然比分别是94.8%、100%、0.052。诊断颅内动脉瘤病人的敏感度、特异度、阴性似然比分别是97.8%、100%、0.022。术前3D-CTA在估计动脉瘤大小及形态方面与术中所见 3D-CTA结果相似。3D-CTA清晰显示了动脉瘤的自身形态和周边的关系。结论3D-CTA是诊治颅内动脉瘤的一种快捷、安全、操作简便的方法,为制定手术方案提供了详细的资料,具有很高的临床实用价值。     

3D-CTA容积重建在诊断颅内动脉瘤中的临床应用研究

目的通过3D-CTA容积重建(VR)图像与DSA结果的对照研究,探讨3D-CTA VR在颅内动脉瘤诊断中的临床应用价值。方法回顾性总结126例115个动脉瘤的3D-CTA和DSA比较影像学资料,分析3D-CTA VR重建表现。影像学分析诊断采用双盲法。结果126例患者共发现115个动脉瘤,102个病人为单发动脉瘤,5例为2个动脉瘤,1例为3个动脉瘤。3D-CTA VR重建漏诊9例,DSA漏诊2例。17例DSA和3D-CTA VR重建均诊断为阴性。经统计分析3D-CTA VR重建在诊断颅内动脉瘤的敏感性、特异性和准确性分别达到92.2%、94.4%和92.5%。结论3D-CTA VR技术在颅内动脉瘤的诊断中具有较好的诊断方法,在颅内动脉瘤的诊断中具有重要的筛检价值。     

3D-CTA诊断和治疗颅内动脉瘤的可行性探讨

目的探讨三维CT血管成像(3D-CTA)取代DSA,作为颅内动脉瘤诊断和治疗依据的可能性。方法42例患者行3D-CTA与DSA检查,两者对照研究并以术中发现为准评估图像质量。结果本组动脉瘤35个,3D-CTA准确检出32个,DSA准确检出34个,两者检出率差异无统计学意义(P>0.05),但在小动脉瘤诊断上3D-CTA尚不及DSA;根据术中发现,3D-CTA在瘤壁钙化、载瘤动脉的显示、瘤周解剖标志等方面,明显优于DSA(P<0.05)。结论随着CT机及软件的更新,3D-CTA可能取代DSA成为颅内动脉瘤诊断和治疗的首选。     

3D-CTA结合DSA在颅内动脉瘤诊断中的应用

目的比较三维螺旋CT血管造影(3D-CTA)和数字减影血管造影(DSA)在颅内动脉瘤诊断中的应用价值。方法对2007-09~2009-08入院的自发性蛛网膜下腔出血(SAH)患者69例,行3D-CTA、DSA检查,研究比较CTA、DSA影像特点。结果69例患者,阴性3例,余66例患者共检出72个动脉瘤。3D-CTA与DSA准确性比较,差异无统计学意义。结论在颅内动脉瘤影像学诊断上,3D-CTA和DSA各有优势。DSA与CTA两种检查方法互补可提高动脉瘤的检出率。     

三维CT血管造影在颅内动脉瘤诊断和治疗中的应用

目的评价三维CT血管造影（3D-CTA）在颅内动脉瘤破裂后蛛网膜下腔出血诊断中的价值及其对手术的指导意义。方法对136例蛛网膜下腔出血患者行螺旋CT检查，将数据输入工作站行图像三维重建。对其中95例行数字减影血管造影术（DSA）检查，41例直接手术证实。结果3D-CTA显示了瘤体的大小、方向，以及与载瘤动脉、邻近血管及骨质结构的相互关系；经手术、DSA证实本组3D-CTA对动脉瘤的诊断准确率为98．4％。假阳性率为1．6％，假阴性率为0。结论3D．CTA对颅内动脉瘤是一种无创、快速、高准确率的诊断技术；3D—CTA可显示各部位动脉瘤与载瘤动脉、邻近动脉分支及邻近颅骨的空间关系，对选择手术入路和手术方式有较大的帮助。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

他汀类药物的使用和颅内动脉瘤破裂相关性分析

目的 探讨他汀类药物对颅内动脉瘤破裂的影响。方法 2010年3月至2014年3月收治颅内囊状动脉瘤67例,其中破裂者32例,未破裂者35例。采用多变量Logistic回归评估他汀类药物的使用和颅内动脉瘤破裂的关系。结果 破裂组术前使用他汀类药物4例（12.5%,4/32）,未破裂组16例（45.7%,16/35）。破裂组服用他汀类药物的百分比显著低于未破裂组（P<0.01）。纠正潜在的混杂干扰后（or值: 0.30,95%可信空间:0.12~="" 0.64）显示,颅内动脉瘤破裂与他汀类药物的使用呈显著负相关,也与高血清总胆固醇浓度有关。结论 本结果提示他汀类药物对颅内动脉瘤破裂有一定的预防效果。     

Impact of our understanding of the genetic aetiology of epilepsy

A genetic contribution to aetiology is estimated to be present in up to 40% of patients with epilepsy. It is useful to categorise genetic epilepsies according to the mechanisms of inheritance into Mendelian disorders, non-mendelian or ‘complex’ disorders, and chromosomal disorders. Over 200 Mendelian diseases include epilepsy as part of the phenotype, and the genes for a number of these have been identified recently. These include autosomal recessive progressive myoclonic epilepsies such as Unverricht-Lundborg disease, Lafora disease and the neuronal ceroid lipofuscinoses, and three autosomal dominant idiopathic epilepsies. The last named have been shown to arise from mutations in ion channel genes. Autosomal dominant nocturnal frontal lobe epilepsy is caused by mutations in CHRNA4, benign familial neonatal convulsions by mutations in KCNQ2 and KCNQ3, and generalised epilepsy with febrile seizures plus by mutations in SCN1B. ‘Complex’, familial epilepsies are more difficult to analyse, but evidence has been obtained for loci predisposing to juvenile myoclonic epilepsy on chromosome 6p and 15q. Lastly, the genes underlying several spike-wave epilepsies in mice have been cloned, and three of these encode sub-units of voltage-gated calcium channels. Received: 29 September 1999/Accepted: 7 December 1999     

肌萎缩侧索硬化三例误诊分析

目的掌握肌萎缩侧索硬化(ALS)的诊断标准,以便早期准确诊断,避免误诊。方法分析3例ALS患者早期被误诊的临床资料。结果 3例患者均以下肢无力发病,逐渐波及上肢或对侧肢体,脊柱MR I示颈部或腰部椎间盘突出压迫硬膜囊,手术治疗后,症状无缓解,病情仍进行性加重,经肌电图检查证实为ALS。结论临床医师应熟知ALS的诊断标准,对患者详细询问病史、认真查体和电生理检查是减少ALS误诊的关键。     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Modelling of movement of the lamprey: Control of oscillators

This article discusses the control methods of the central pattern generator (CPG). First a control model of the CPG is presented using 2 oscillators, and we suggest that phasic modulation to the CPG by means of phasic information is effective for controlling the phase difference between oscillators. Next, two models for controlling the CPG of a lamprey are proposed. One model describes a control system from the brain stem, in which the reticulospinal neurons control the CPG by receiving feedback signals and sending control signals to the neck region of the CPG. The other is a model for learning an localized control system to generate a desired motor pattern. By means of these models, a role of the efference copy is suggested.     

利培酮对精神分裂症患者生活质量的影响

目的：比较利培酮与氟哌啶醇对精神分裂症患者生活质量的影响。方法：对门诊72例服用氟哌啶醇及74例服用利培酮的精神分裂症患者用生活质量综合评定问卷（GQOLI）、阳性与阴性症状量表（PANSS）、副反应量表（TESS）进行评定。结果：利培酮组患者治疗后生活质量有所提高,而氟哌啶醇组患者生活质量有所下降。结论：利培酮治疗有利于患者提高生活质量。