基于听觉刺激的意识障碍患者脑功能连通性研究

目的 目前对意识障碍（DOC）患者的分级评估仍是相关领域的重点和难点。因效性网络可以通过时间序列间的因果关系直观地反映信息传递方向,帮助人们更好地理解患者大脑不同区域之间的信息交互作用。本文结合脑电图和因效性网络探讨听觉刺激下无反应觉醒综合征（VS）患者与最低意识状态（MCS）患者的脑功能连通性差异。方法 共纳入23例DOC患者,采集并分析唤名刺激下的脑电信号,通过多元格兰杰因果方法构建脑功能网络,利用脑网络节点度、聚类系数、全局效率以及因果流向性等参量从脑区之间协同工作的角度对比研究听觉刺激下不同意识水平患者的网络特征。结果 唤名刺激下MCS患者的脑功能连通性强于VS患者,且呈现出因果流向差异,MCS与VS患者四个脑区的信息传递方向均不相同。结论 唤名听觉刺激下MCS患者的信息传递能力强于VS患者;与VS患者相比MCS患者为因果源的电极通道数增多,对其他脑区的信息输出增多。本研究可为DOC患者意识水平的分级评估提供一定的理论依据。     

Ganoderma lucidum total triterpenes prevent γ-radiation induced oxidative stress in Swiss albino mice in vivo

Objectives: The in vivo radio-protective effect of total triterpenes isolated from Ganoderma lucidum (Fr.) P. Karst was evaluated using Swiss albino mice, by pre-treatment with total triterpenes for 14 days, followed by a whole body exposure to γ-radiation.

Methods: The activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), and the level of reduced glutathione (GSH) were analysed in liver and brain homogenates. The extent of lipid and protein peroxidation was also estimated in liver and brain homogenates after irradiation. Protection of radiation-induced DNA strand breaks in peripheral blood lymphocytes and bone marrow cells was assessed using the comet assay.

Results: Total triterpenes were highly effective in reducing the levels of lipid peroxidation and protein oxidation to near normal values in both liver and brain tissues. Total triterpenes, when administered in vivo, were also found to be successful in restoring the antioxidant enzyme activities and GSH level in liver and brain of irradiated mice. Administration of total triterpenes, prior to radiation exposure, significantly decreased the DNA strand breaks.

Discussion: The results of the present study thus revealed the potential therapeutic use of Ganoderma total triterpenes as an adjuvant in radiation therapy.     

Comparison of β2-microglobulin serum level between Alzheimer’s patients,cognitive healthy and mild cognitive impaired individuals

Background: Several studies performed in the last years on the brain, showed that beta2-microglobulin (β2m) and MHC can act independently of their canonical immune function to regulate normal brain development, synaptic plasticity and behaviour. Increased systemic levels of soluble β2m have been implicated in cognitive impairments like that associated with chronic haemodialysis, or aortic valve replacement. Increased soluble β2m has also been detected in the cerebral spinal fluid (CSF) of patients with HIV-associated dementia and Alzheimer’s disease (AD).

Objective: To compare plasma β2m levels in healthy subjects and subjects with dementia or cognitive impairment.

Methods: We measured the concentration of β2m in a cohort of 245 individuals and compared sex matched, cognitive healthy individuals.

Results: We found higher levels of β2m in AD patients compared to non-AD MCI and healthy controls (2063?ng/mL ±852 versus 1613?±?503 and 1832?±?382?ng/mL, pp?>?0.05).

Conclusions: Our data confirm that β2m could play a role in AD. However, a replication study in an independent cohort would be necessary to confirm our preliminary results.     

可分流长期护理机构的住院病人筛选方法与实证研究

准确测算大型医院住院患者可下沉至护理机构的数量,为合理推进分级诊疗和基层卫生资源配置提供科学性依据。方法 结合前期研究成果和专家咨询,基于住院天数、病种和转归情况,建立住院病人下沉的筛选方法,并计算可下沉的床日数。结果 样本城市2016年可下沉之护理机构的病人为5 775人次,床日为51.6万。结论 为推进住院病人下沉,建议引入评估机制完善病人转诊规则,针对下沉病人的高发病种,加强基层卫生机构相应的资源配置。同时借助长期护理保险实施,进一步促进护理病人的下沉。     

Endpiece: It works in every country

ObjectivesTo determine whether any vital signs can be used to quickly identify brain lesions in patients with impaired consciousness. DesignCross sectional observational study.SettingEmergency department of an urban hospital, Japan.Participants529 consecutive patients (mean age 65 years) presenting with impaired consciousness (score <15 on the Glasgow coma scale) during 2000.Results312 (59%) had a brain lesion which accounted for the impaired consciousness. The area under the receiver operating curve for systolic blood pressure was 0.90 (SE 0.01), indicating significantly higher accuracy (P<0.01) in the identification of a brain lesion than using diastolic pressure 0.82 (0.02) or pulse rate 0.63 (0.03). Likelihood ratios for systolic blood pressure lower than 90 mm Hg were less than 0.04, and those for systolic pressure higher than 170 mm Hg were greater than 6.09.ConclusionsSystolic blood pressure is useful for diagnosing brain lesions in patients with impaired consciousness.

What is already known on this topic

Brain imaging and neurological examination of patients with impaired consciousness are often a waste of time and resources and can delay correct diagnosis

What this paper adds

Systolic blood pressure distinguishes patients with impaired consciousness who are at high risk from those who are at low risk of an organic brain lesionGeneral use of systolic blood pressure in the diagnosis of impaired consciousness may have clinical and economic benefits     

蜱传脑炎病毒跨过血脑屏障的体外实验

【目的】构建蜱传脑炎病毒(Tick-borne encephalitis virus,TBEV)跨血脑屏障研究的体外细胞模型,研究2种不同细胞的TBEV培养物在病毒跨过血脑屏障中的主要差异,从而为进一步TBEV跨血脑屏障的分子机制研究奠定基础。【方法】利用人脑微血管内皮细胞(Human brain microvascular endothelial cells,hCMEC/D3)构建体外血脑屏障的细胞模型。用BHK-21细胞中培养的蜱传脑炎病毒感染人脑微血管内皮细胞,检测TBEV在hCMEC/D3中的复制增殖情况;将TBEV加入体外血脑屏障模型的上层微孔中,用实时荧光定量PCR和噬斑测定的方法检测跨过血脑屏障的病毒量;将感染TBEV的人单核细胞加入血脑屏障模型的上层微孔中,观察渗漏进下层孔中的淋巴细胞,并用实时荧光定量PCR和噬斑测定的方法检测跨过血脑屏障的病毒量。利用伊文思蓝标记的白蛋白确定血脑屏障细胞的渗透率变化。【结果】实时荧光定量PCR和病毒滴度测定结果表明,TBEV不能在hCMEC/D3细胞中复制增殖,也不能直接跨过血脑屏障;然而,人单核细胞THP-1感染TBEV后,尽管单核细胞不能直接携带TBEV跨过血脑屏障,但THP-1中产生的病毒却能跨过血脑屏障模型进入下层孔中,并引起血脑屏障渗透率的增高。【结论】单核细胞有助于TBEV跨过血脑屏障。     

Neuroglobin and Nogo-a as biomarkers for the severity and prognosis of traumatic brain injury

Abstract

Objective: To identify the early changes of serum neuroglobin and Nogo-A concentrations and the relations to traumatic brain injury (TBI) severity and prognosis.

Methods: Serum samples were obtained and analyzed from 34 patients with TBI within the first 96?h after injury. Comparative analysis combined with Glasgow Coma Scale (GCS) scores and the 6-month prognosis of these patients was performed.

Results: Significant correlations were found between peak serum neuroglobin and Nogo-A concentrations and a patient’s GCS score on admission (p?<?0.001). The mean peak serum neuroglobin and Nogo-A concentrations were both significantly higher in patients with an unfavorable outcome at 6 months after injury (p?<?0.05).

Conclusions: Serum neuroglobin and Nogo-A levels could be suggested as biomarkers for predicting TBI severity and prognosis.

Trial registration: ClinicalTrials.gov identifier: NCT02229643.     

Predictive biochemical-markers for the development of brain metastases from lung cancer: Clinical evidence and future directions

BackgroundBrain metastases are a common complication of patients with lung cancer and lung cancer is one of the most common causes of brain metastases. The occurrence of brain metastases is associated with poor prognosis and high morbidity, even after intensive multimodal therapy. Therefore, identifying lung cancer patients with who are at high risk of developing brain metastases and applying effect intervention is important to reduce or delay the incidence of brain metastases. Biochemical-markers may meet an unmet need for following patients’ mechanisms of brain metastases.MethodsData for this review were identified by searches of Pubmed and Cochrane databases, and references from relevant articles using the search terms “lung cancer” and “brain metastasis”. Meeting abstracts, unpublished reports and review articles were not considered.ResultsClinical results for pathological and circulating markers including cancer molecular subtypes, miRNA, single nucleotide polymorphisms, and other markers are presented. However, these biochemical-markers are not yet established surrogate assessments for prediction of brain metastases.ConclusionsBiochemical-markers reported allowed physicians to identify which patients with lung cancer are at high risk for brain metastases. Prospective randomized clinical studies are needed to further assess the utility of these biochemical-markers.     

脑卒中患者连续性护理的应用及效果评价

目的 探讨对脑卒中患者应用连续性护理的效果。方法 构建连续性护理模式,从入院开始进行连续性护理干预,通过患者住院天数、住院费用、再入院率、护理服务满意度、BI指数等指标评价应用效果。结果 连续性护理干预减少了患者住院天数、住院费用、再入院率（P<0.01,P<0.01,P<0.05）,提高了患者对护理服务的满意度及BI指数（P<0.05）。结论 连续性护理是脑卒中患者护理的有效途径,值得推广应用。     

P300 values in patients diagnosed with primary Sjogren syndrome

Purpose: Primary Sjogren syndrome (PSS) is an autoimmune disease characterized by symptoms of a dry mouth and eyes, in which other organs and systems are widely involved. Central nervous system (CNS) involvement in PSS is reported in a wide range between 2.5–60%. The reason is that the clinical picture can remain asymptomatic despite the presence of CNS involvement in the disease process. In this study, our aim was to evaluate subclinical cognitive impairment in patients with PSS by investigating P300 potential parameters.

Method: Forty-three female patients with PSS (mean age: 52.6?±?11.4 years) and 35 healthy female controls (mean age: 54.5?±?8.09 years) were included in the study. Mini-Mental State evaluations (MMSE) and brain MRI were performed in the patient and control groups. An event-related evoked potentials test (P300) was applied to those with normal MMSE.

Results: The P300 latencies of patients with PSS were significantly longer compared with the control group (p?=?.019). In patients with PSS, there was no difference in P300 parameters between ANA, Anti-SSA, Anti-SSB-positive and negative patients, and patients with or without sedimentation and CRP elevation. In addition, brain MRI revealed no statistically significant difference between patients with PSS with and without ischemic gliotic lesions (p=.48).

Conclusion: In our study, P300 latency was also found to be significantly longer in patients who had no white matter change. We believe that prolonged P300 potential latencies without associated white matter lesions in brain imaging may be associated with subclinical CNS involvement.     

手术病例住院打包收费政策可行性研究

目的 分析手术病例住院打包收费政策的可行性和患者满意度,为该政策在公立医院的实施提供临床依据。方法 回顾性分析2016年2月－6月在香港大学深圳医院接受打包收费的手术患者。入院时由临床专科医师填写打包收费筛查表,患者出院时填写满意度调查问卷。采用SPSS软件分析患者打包收费的入组情况和满意度。结果 共有336例患者参与打包收费筛查,最常见的手术病种是腹腔镜胆囊切除（161例,47.9％）和单／双侧甲状腺切除（78例,23.2%）。共有240例患者纳入打包收费,入组率71.4%。有231位参与打包收费的患者术后接受调查。分别有89%和88%的患者认为打包收费可以有效控制“过度用药”和“过度检查”。91％的患者赞同或非常赞同手术打包收费的政策推广。结论 打包收费作为一次创新性的尝试,其在公立医院中是可行的,在一定程度上减少了医疗资源的浪费,患者满意度高,值得进一步推广。

     

上海市某综合性医院心内科大额费用病人的费用分析

目的 分析大额费用病人的费用情况,以探讨对病人的费用控制。方法 分析比较2008年心内科大额费用病人、非大额费用病人的平均住院费用、平均住院日、病种结构以及费用构成。结果 扣除大额费用病人使心内科全年病人的平均住院费用有所下降。结论 通过加强对大额费用病人的管理可控制平均住院费用。

     

What are the determinants of explicit and implicit motor imagery ability in stroke patients?: a controlled study

Abstract

Purpose: The purposes of the study were to (a) investigate both explicit and implicit motor imagery ability (MIA) impairment after stroke, (b) examine predictive effects of clinical characteristics for MIA after stroke.

Materials and Methods: Forty one patients with stroke (PwS) (mean age 59.41?±?10.19?years; %41 female) and 36 healthy participants (mean age 62.47?±?9.29?years; %47 female) completed Chaotic Motor Imagery Assessment-Hand Rotation for implicit MIA and Movement Imagery Questionnaire-3 (MIQ-3) and Box and Block Test (BBT) for explicit MIA. The severity of motor and sensory impairments were determined by the Fugl-Meyer Assessment-Upper Extremity (FMAUE) scores. The Turkish version of Motor Activity Log-28 was used to assess amount of use (AUS) and quality of movement in daily life.

Results: Our results indicated that both implicit and explicit MIA (except kinaesthetic imagery of MIQ-3) in PwS were statistically impaired compared to controls (p?<?0.05). The sensorimotor impairment level, amount of use and movement quality of the affected upper limb were found to be correlated with MIA in various degrees. Total motor scores in FMAUE and AUS were significant predictors of explicit MIA (p?<?0.01). Additionally, explicit MIA scores of stroke subgroups were statistically different between severely and mildly impaired patients, in favour of mildly impaired group (p?<?0.05).

Conclusion: In conclusion, both motor impairment level and amount of daily use of upper extremity were found to be predictive factors for explicit MIA. Further investigation with brain imaging techniques is needed to explore the validity of these findings in establishing MIA.     

Investigating the effects of subthalamic Nucleus–Deep brain stimulation on the voice quality

Abstract

Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson’s patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.

Materials/methods: A total of 12 patients, (8 male–4 female) with an age average of 58.8?±?9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6?months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients’ voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.

Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.

Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.     

磁休克治疗对重度抑郁症患者脑功能网络的影响

目的 磁休克治疗(MST)是一种新兴的神经调节干预技术,在重度抑郁症(MDD)治疗中得到广泛应用,然而其抗抑郁机制尚不清楚。探索MST对不同疗效MDD患者脑功能网络的调控作用,对MST治疗的抗抑郁作用机制研究具有重要意义。方法 本文对18例MDD患者MST作用前后的静息态脑电进行记录,基于皮尔逊相关方法构建脑功能网络;应用复杂网络理论对比分析脑功能网络拓扑结构的改变;根据HDRS-17评分变化率进一步区分治疗有效组和无效组,对网络特征进行二次比较。结果 MST后,MDD患者的脑功能网络平均节点度、平均聚类系数和平均全局效率值均比治疗前显著升高,平均路径长度值显著降低,小世界属性显著增大;相比于治疗无效组,治疗有效组的脑功能网络特征参数变化量更大。结论 MST显著改变了MDD患者脑功能网络拓扑结构,对患者的脑功能网络具有一定的调制作用,这些结果为MST治疗的抗抑郁机制研究提供了实验支持和理论依据。     

Onion extract structural changes during in vitro digestion and its potential antioxidant effect on brain lipids obtained from low- and high-fat-fed mice

Abstract

This study investigated the effects of onion (Allium cepa, L.) extract on the antioxidant activity of lipids in low-and high-fat-fed mouse brain lipids and its structural change during in vitro human digestion. The onion extracts were passed through an in vitro human digestion model that simulated the composition of the mouth, stomach, and small intestine juice. The brain lipids were collected from low- and high-fat-fed mouse brain and then incubated with the in vitro-digested onion extracts to determine the lipid oxidation. The results confirmed that the main phenolics of onion extract were kaempferol, myricetin, quercetin, and quercitrin. The quercetin content increased with digestion of the onion extract. Antioxidant activity was strongly influenced by in vitro human digestion of both onion extract and quercetin standard. After digestion by the small intestine, the antioxidant activity values were dramatically increased, whereas the antioxidant activity was less influenced by digestion in the stomach for both onion extract and quercetin standard. The inhibitory effect of lipid oxidation of onion extract in mouse brain lipids increased after digestion in the stomach. The inhibitory effect of lipid oxidation of onion extract was higher in the high-fat-fed mouse brain lipids than that in the low-fat-fed mouse brain lipids. The major study finding is that the antioxidative effect of onion extract may be higher in high-fat-fed mouse brain lipids than that in low-fat-fed mouse brain lipids. Thus, dietary onion may have important applications as a natural antioxidant agent in a high-fat diet.     

Association of galectin-3 with changes in left ventricular function in recent-onset dilated cardiomyopathy

Abstract

Background: The course of newly diagnosed dilated cardiomyopathy (DCM) varies from persistent reduction of left ventricular ejection fraction (LVEF) to recovery or even worsening. The aim of the present study was to examine the prognostic value of selected biomarkers with regard to changes in LVEF.

Methods: Main inclusion criterion was LVEF ≤45% with exclusion of coronary artery or valvular heart disease. The primary endpoint was LVEF ≤35% in the follow-up echocardiogram. Galectin-3, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) were related to the endpoint.

Results: Data from 80 DCM patients (55 male, mean age 53 years) were analyzed. Median LVEF was 25% (IQR 25–30). The endpoint was met for 24 patients (30%). These had higher baseline levels of galectin-3 (median 20.3?ng/mL [IQR 14.3–26.9] vs. 14.7?ng/mL [IQR 10.9–17.7], p?=?0.007) and NT-proBNP (3089?pg/mL [IQR 1731–6694] vs. 1498?pg/mL [IQR 775–3890]; p?=?0.004) in univariate Cox regression analysis. ROC analysis revealed that CRP (median 0.4?mg/dL [IQR 0.2–1.2]) was also related to the endpoint (p?=?0.043).

Conclusion: Higher levels of galectin-3, NT-proBNP, and CRP were associated with LVEF ≤35% in our cohort. An approach utilizing a combination of biomarkers for patient management should be assessed in further studies.     

Oxidative stress is associated with decreased heart rate variability in patients with chronic kidney disease

Objectives: Elevated oxidative stress and reduced heart rate variability (HRV) is prevalent in patients with chronic kidney disease (CKD) and is associated with increased morbidity and mortality. Previous studies have identified a positive association between elevated oxidative stress and autonomic dysfunction, however this relationship has not yet been investigated in the CKD population.

Methods: Plasma was collected from 78 patients with stage 3–4 CKD (estimated glomerular filtration rate 25–60?ml/min/1.73?m²) for the assessment of oxidative stress, including plasma total F2-isoprostanes, glutathione peroxidase activity and total antioxidant capacity. Time and frequency HRV parameters were measured from a three lead electrocardiogram.

Results: Participants with elevated F2-isoprostanes had reduced HRV compared to patients with normal levels of F2-isoprostanes. A number of HRV parameters were found to be inversely correlated with F2-isoprostanes in all CKD patients, including SDNN (r?=??0.337; P?r?=??0.281, P?=?0.01), LF (r?=??0.315, P?r?=??0.288, P?=?0.01). Multiple linear regression found F2-isoprostanes to be an independent predictor of SDNN (r²?=?0.287, β?=??0.272, P?=?0.01).

Discussion: Oxidative stress is significantly and independently associated with HRV in patients with CKD. Identifying oxidative stress in the pathogenesis of autonomic dysfunction may help target therapeutic strategies.     

Long-term survival results after treatment for oligometastatic brain disease

AimThe aim of this study was to characterize the survival results of patients with up to four brain metastases after intense local therapy (primary surgery or stereotactic radiotherapy) if extracranial metastases were absent or limited to one site, e.g. the lungs.BackgroundOligometastatic disease has repeatedly been reported to convey a favorable prognosis.Material and methodsThis retrospective study included 198 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. Uni- and multivariate tests were performed.ResultsMedian survival was 16.5 months (single brain metastasis) and 9.8 months (2–4, comparable survival for 2, 3 and 4), respectively (p = 0.001). After 5 years, 15 and 2% of the patients were still alive. In patients alive after 2 years, added median survival was 23 months and the probability of being alive 5 years after treatment was 26%. In multivariate analysis, extracranial metastases were not significantly associated with survival, while primary tumor control was.ConclusionLong-term survival beyond 5 years is possible in a minority of patients with oligometastatic brain disease, in particular those with a single brain metastasis. The presence of extracranial metastases to one site should not be regarded a barrier towards maximum brain-directed therapy.     

Metabolic Changes in Rat Brain After Prolonged Ethanol Consumption Measured by 1H and 31P MRS Experiments

SUMMARY 1. In vivo ¹H and ³¹P magnetic resonance spectroscopy techniques were applied to reveal biochemical changes in the rat brain caused by prolonged ethanol consumption.2. Three models of ethanol intoxication were used.3. ¹H MRS showed a significant decrease in the concentration of myo-inositol in the brain of rats fed with 20% ethanol for 8 weeks. This change is consistent with perturbances in astrocytes. On the other hand, N-acetyl aspartate and choline content did not differ from controls.4. ³¹P MRS did not reveal any significant changes in the high-energy phosphates or intracellular free Mg²⁺ content in the brain of rats after 14 weeks of 20% ethanol drinking. The intracellular pH was diminished.5. By means of a ³¹P saturation transfer technique, a significant decrease was observed for the pseudo first-order rate constant k _for of the creatine kinase reaction in the brain of rats administered 30% ethanol for 3 weeks using a gastric tube.6. The ¹H MRS results may indicate that myo-inositol loss, reflecting a disorder in astrocytes, might be one of the first changes associated with alcoholism, which could be detected in the brain by means of in vivo ¹H MRS.7. The results from ³¹P MRS experiments suggest that alcoholism is associated with decreased brain energy metabolism.8. ³¹P saturation transfer, which provides insight into the turnover of high-energy phosphates, could be a more suitable technique for studying the brain energetics in chronic pathological states than conventional ³¹P MRS.