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find Keyword "全面性" 10 results
  • Lennox Gastaut综合征和表型——继发性脑网络癫痫

    Lennox-Gastaut综合征(Lennox-Gastautsyndrome, LGS)是一种严重的多病因且具有特征性电生理特征的癫痫表型。前驱研究发现常见的脑网络与特征性的发作间期放电:慢棘慢复合波(Slow spike-and-wave, SSW)和阵发性快活动(Paroxysmal fast activity, PFA)。一些患者有Lennox-Gastaut样表型和皮质病灶。现旨在探讨脑网络和病灶的相互作用。选取6例具有Lennox-Gastaut表型和结构病灶的患者为研究对象, 采用3T脑电图-功能磁共振(Electroencephalography-functional magnetic resonance imaging, EEG-fMRI)进行检测。SSW和PFA时间监测用于事件相关fMRI分析, 以分析关键区域的血流动力学时间进程。结果:①PFA发生时, 额叶和顶叶的联合皮层区、丘脑和脑桥的fMRI信号增强, 且注意和静息态脑网络均同时增强, 这是一个少见的模式; ②SSW发生时, 表现为混合性的fMRI信号增强和减弱, 联合皮质区和丘脑在放电发生前信号增强, 而在放电后显著减弱, 在初级皮层区fMRI信号减弱; ③在PFA和SSW放电期间, 病灶区表现为不同的fMRI信号增强。3例患者在病灶切除术后1年无痫性发作。研究认为Lennox-Gastaut表型是一种网络癫痫, 且主要的脑网络自发不稳。Lennox-Gastaut表型和LGS的癫痫样活动, 似乎通过联合皮质区放大和表达, 这可能是由于基本的脑网络, 注意和静息态网络广泛地相互作用。接受病灶切除术后癫痫患者无癫痫发作表明皮质损伤能建立并保持这种非正常的不稳定脑网络。LGS可能是继发性脑网络癫痫, 因为其统一的癫痫临床表现, 包括PFA和SSW, 反映出脑网络功能异常而非特定的触发过程

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  • Highfrequency stimulation of mediodorsal thalamic nucleus inhibits pentylenetetrazole-induced seizures in rats

    ObjectiveThe optimal target of deep brain stimulation (DBS) for treating intractable epilepsy is still undefined. Cumulative studies suggest that the mediodorsal thalamic nucleus (MD) is involved in seizure activity, the purpose of this study was to investigate the effect of high frequency stimulation in MD on pentylenetetrazole (PTZ)-induced seizures in rats. MethodsThe experimental rats (Male Sprague-Dawley rats 280-350 g) were all provided by Experimental Animal Center, Zhejiang Academy of Medical Science, Hangzhou, China. The rats were given unilateral or bilateral stimulation of the MD at 100 Hz (HFS group) and sham stimulation, others were given unilateral stimulation of the MD at 1 Hz (LFS group). EEGs in the cortex and seizure behavior were recorded with the Neuroscan system at the same time. ResultsNeither LFS nor HFS of the MD changed the latency to the first spikes or EEG manifestations for stage 3 and stage 5 seizures; animals receiving unilateral or bilateral HFS of the MD decreased the number of stage 5 EEG seizure synchronized with the convulsive episodes; LFS and sham stimulation showed multiple periods of continuous spikes which accompanied stage 5 or stage 4 seizures. HFS of unilateral or bilateral MD, but not LFS, decreased the seizure stage, the number of clonic movement episodes, and the duration of acute PTZ-induced seizures. The average latency to onset of myoclonic jerks did not differ among groups. Unilateral and bilateral HFS of the MD had a similar antiepileptic effect. ConclusionHFS of the MD may be of value as a new antiepileptic approach for patients with generalized epilepsy, besides, the seizure model, should be fully considered in clinical application.

    Release date:2016-10-02 06:51 Export PDF Favorites Scan
  • 青少年肌阵挛癫痫的社会心理长期结局

    青少年肌阵挛癫痫(Juvenile myoclonic epilepsy,JME)是一种定义明确的特发性全面性/遗传性癫痫综合征。它与特定的人格特征相关,并且与不利的社会结局有相关性。文章旨在分析JME患者的社会心理结局。为了从环境本身固有的神经生物学因素中描绘慢性发作性疾病的结局,对年龄和性别对照匹配的JME患者与失神癫痫(Absence epilepsy,AE)患者的社会结局进行了对比。研究纳入癫痫病程至少20年的患者。所有JME和AE患者(n=41)回答关于癫痫发作、治疗和社会心理变量的结构化问卷。除此以外,JME患者进行了癫痫生活质量量表 31(QOLIE-31)评估。在JME中,癫痫起病后46.3(20~69)年,总体社会心理长期结局是有利的(80.5%的患者从未失业超过1年,90.2%能够良好融入社会环境)。生活质量中所有询问到的方面均显示出高得分。与AE对照组相比,JME患者并未显示出更差的社会心理结局;JME患者的大学入学率和学位获得率甚至更高(70% vs 34%,P=0.001)。JME患者显示出高水平的生活质量,当前或既往精神合并症与较低的总体生活质量得分显著相关(P=0.02)。对于JME患者的长期研究显示出与以往研究不同的有利社会心理结局。这是第一个对JME和另外一个遗传决定形式的癫痫进行对比的研究。JME和AE患者的相似结局对于JME可能引起社会缺陷的特定神经生物学改变提出了质疑。在JME患者中,生活质量降低与精神合并症相关。

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  • Analysis of 598 Cases of Nosocomial Infection in a New Comprehensive Hospital

    ObjectiveTo understand the characteristics of and risk factors for nosocomial infection in a newly built branch of a university teaching hospital, in order to investigate the control measures for prevention and control of nosocomial infection. MethodsA total of 598 cases of nosocomial infection from April 2012 to June 2014 were enrolled in this study. We analyzed statistically such indexes as nosocomial infection rate, infection site, pathogen detection, and use of antibiotics. Meantime, infection point-prevalence survey was introduced by means of medical record checking and bedside visiting. ResultsAmong all the 44 085 discharged patients between April 2012 and June 2014, there were 598 cases of nosocomial infection with an infection rate of 1.36%. Departments with a high nosocomial infection rate included Intensive Care Unit (ICU) (9.79%), Department of Orthopedics (2.98%), Department of Geriatrics (2.62%), and Department of Hematology (1.64%). The top four nosocomial infection sites were lower respiratory tract (45.32%), urinary tract (13.21%), operative incision (8.86%), and blood stream (8.86%). The samples of 570 nosocomial infections were delivered for examination with a sample-delivering rate of 95.32%. The most common pathogens were acinetobacter Baumanii (17.02%), Klebsiella pneumoniae (14.21%), Escherichia coli (13.68%), Pseudomonas aeruginosa (11.93%), and Staphylococcus aureus (9.12%). And urinary tract intubation (42.81%), admission of ICU (28.60%), and application of corticosteroid and immunosuppressive agents (26.42%) were the top three independent risk factors for nosocomial infection. ConclusionGeneral and comprehensive monitoring is an effective method for the hospital to detect high-risk departments, factors and patients for nosocomial infection, providing a theoretical basis for prevention and control of nosocomial infection.

    Release date:2016-10-02 04:54 Export PDF Favorites Scan
  • 特发性全面性癫痫易感基因的研究

    随着生物信息学的飞速发展, 特发性全面性癫痫(Genetic generalized epilepsy, GGE)发病被证实与遗传因素密切相关, 越来越多的易感基因被发现, 同时其发病机制亦陆续被深入研究。大部分的突变基因为编码离子通道蛋白的基因, 但离子通道基因突变仅能解释GGE的少数家系或散发病例, 故对GGE的易感基因与发病机制进行阐明, 有利于GGE的后续遗传学研究。

    Release date:2017-01-22 09:09 Export PDF Favorites Scan
  • 使用表皮肌电监测来检测全面强直-阵挛发作

    该前瞻性多中心Ⅲ期临床试验的目的在于评估在癫痫监测单元(Epilepsy monitoring unit,EMU)中使用可穿戴的表皮肌电图(surface electromyographic,sEMG)监测系统来检测全面强直-阵挛发作(Generalized tonic–clonic seizures,GTCS)的性能和耐受性。199 例有 GTCS 病史的患者被收入 11 个Ⅳ级癫痫中心的 EMU 中,在进行临床视频脑电图(VEEG)监测的同时,也通过在肱二头肌上佩戴可穿戴设备接受了 sEMG 监测。所有 sEMG 数据记录都使用先前开发的检测算法在中心站点处理。将 sEMG 检测到的 GTCS 与 3 名评审专家验证的发作事件进行比较。在所有受试者中,检测算法共检测到了 46 次 GTCS 中的 35 次[76%,95%CI(0.61,0.87)],阳性预测值(Positive predictive value,PPV)为 0.03,平均误报率(False alarm rate,FAR)为 2.52/24 h。对于在肱二头肌中线上方记录到的数据,系统检测到了全部的 29 例 GTCS[100%,95%CI(0.88,1.00)],检测时间平均延迟 7.70 s,PPV 为 6.2%,平均 FAR 为 1.44/24 h。28%(55/199)报告了轻至中度的不良事件,并导致 9% 的研究中止(17/199)。这些不良事件主要是电极贴片引起的皮肤刺激反应,这种情况未经治疗即可缓解。研究中无严重不良事件报告。在肱二头肌上使用 sEMG 监测装置来检测 GTCS 是可行的。正确放置该装置对于检测准确性至关重要,但是对于一些患者而言,减少误报数仍有一定难度。

    Release date:2018-05-22 02:14 Export PDF Favorites Scan
  • 禁忌用药对 Dravet 综合征认知结局的影响及初次非高热性痫性发作年龄对 SCN1A 相关痫性发作表型的临床预测作用

    SCN1A 致病性变异可引起不同严重程度的疾病表型,而这在疾病初期可能难以辨别。研究组致力于探究有助于预测痫性发作分别向 Dravet 综合征演变和预测 Dravet 综合征认知结局的临床特征,分析了禁忌用药对认知减退的可能调节作用。评估由 164 例 SCN1A 相关痫性发作的荷兰患者组成的队列研究。临床数据通过医疗记录和半结构式电话回访获得。认知功能由一名儿童神经科医师、一名神经心理医师和一名临床基因学家测评分类。通过单因素和多因素回归分析多项临床变量(包括在病程前 5 年禁忌用药的持续时间)发现,起病前 5 年内更长时间的禁忌用药与纳入研究时更差的认知结局显著相关,同时与 Dravet 综合征患者第一个 5 年病程后更低的内插智商值和发育智商值有关。多因素线性回归分析提示,禁忌用药是认知结局的一个重要预测因素。此外,初次发现发育迟缓的年龄和初次非高热性痫性发作年龄也是其重要的预测因素。而在完整的队列中,初次非高热性痫性发作年龄是痫性发作向 Dravet 综合征演变最准确的预测因素。比研究数据提示病程前 5 年内更长时间的禁忌用药对 Dravet 综合征患者的认知结局有负面影响。早期诊断对于避免使用这些禁忌药物极为重要。研究还发现初次非高热性痫性发作年龄是痫性发作向 Dravet 综合征演变以及 Dravet 综合征疾病严重程度的重要预测因素,这些都可为 SCN1A 相关痫性发作年幼患者的父母提供建议。

    Release date:2019-11-14 10:46 Export PDF Favorites Scan
  • Ⅲ期临床试验非盲延期阶段联合使用吡仑帕奈的局灶性癫痫患者的四年药物安全性、耐受性及发作结局:307 号研究

    评估 307 号研究(临床试验验证码:NCT00735397)Ⅲ期非盲延期阶段(OLEx)联合使用吡仑帕奈的局灶性癫痫患者的药物安全性、耐受性及痫性发作结局。患者在完成任一 III 期双盲试验后均可进入非盲延期阶段(Open-labelextension,OLEx)。对所有 OLEx 队列中有同样最小吡伦帕奈暴露剂量的局灶性癫痫和继发全面性癫痫(Secondarily generalized seizures,SGS)的患者进行药物安全性及耐受性和痫性发作结局(每 28 d 中位痫性发作减少率、反应率和无发作率)的分析。另外,针对 OLEx 的早期失访进行了额外的敏感性分析。从 1 480 例双盲试验中随机分组的患者共纳入 1 218 例。大部分患者(65.4%~80.9%)仅用吡仑帕奈 12 mg,每日一次,进行治疗,并在相同剂量下完成长期的检测,或是相对基线联合使用少量抗癫痫药物(AEDs)。长期的药物安全性及耐受性结果与双盲研究一致。导致超过 1% 的患者研究中断治疗的紧急不良反应事件(Treatment-emergent adverse events,TEAEs)包括眩晕、易激、疲劳。有临床意义的 TEAEs 稳定期为 4 年。所有队列中患者的痫性发作结局随时间持续改善。对于接受 3 年(n = 436)、4 年(n = 78)药物治疗的患者 28 d 中位痫性发作减少率分别为 62%、70.6%,相应的 50% 反应率为 59.6%、67.9%。最大 28 d 中位痫性发作减少率发生于基线水平的 SGS 患者,接受 3 年(n = 190)、4 年(n = 28)药物治疗分别为 88.0% 和 100.0%。在这些队列中分别有 40.0% 和 53.6% 的患者达到了无 SGS。排除早期失访后的 28 d 中位痫性发作减少率结果类似。长期吡仑帕奈联合用药(≤4 年)不会导致新的药物安全性及耐受性问题,并且可以很大程度地减少痫性发作,特别是基线水平的 SGS 患者。

    Release date:2020-03-20 08:06 Export PDF Favorites Scan
  • Effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay

    Objective To investigate the effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay (GDD). Methods A total of 40 children with GDD admitted to the Department of Rehabilitation Medicine, Children’s Hospital of Nanjing Medical University were selected as the research subjects. By envelope method, the children were randomly and equally divided into experimental group and control group, with 20 cases in each group. The experimental group received children’s crawling-promotion-training-robot combined with conventional rehabilitation therapy, while the control group received manual crawling training combined with conventional rehabilitation therapy. Before and after treatment, the scores of Gross Motor Function Measure Scale-88 (GMFM-88) and Gesell Developmental Scale (GDS) were respectively used to evaluate gross motor function and cognitive function. Results There was no significant difference in gender (χ2=0.100, P=0.752) and age (t=0.053, P=0.962) between the two groups. Before treatment, there was no significant difference in GMFM-88 and GDS scores between the two groups (P>0.05). After treatment, there were statistically significant differences in GMFM-88 and GDS scores between the two groups (P<0.05). The comparison within the group showed that there were statistically significant differences in GMFM-88 and GDS scores between the two groups before and after treatment. Conclusion Children’s crawling-promotion-training-robot is more effective than manual crawling training in improving gross motor function and cognitive function in children with GDD.

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  • Establishment of the cerebral cortex thickness atlas in early Idiopathic Generalized Epilepsy

    ObjectiveTo construct a map of cerebral cortex thickness in Idiopathic Generalized Epilepsy (IGE) diagnosed at the first visit, using T1-weighted brain magnetic resonance imaging and advanced image analysis software. MethodsHigh-resolution three-dimensional T1 images were obtained from 27 IGE patients diagnosed at the first visit and 29 normal controls in Shouguang People's Hospital from January 1, 2022 to December 31, 2021. The location recognition calculation system of the Freesurfer software was used to calculate the values of cortical thickness in each brain region, and the cortical thickness values were transformed into a brain atlas using the image analysis software. A differential brain atlas was generated using the two-sample t-test to analyze the difference in cortical thickness between IGE patients and normal controls. Paired t-test was used for within-group comparison to explore changes of cortical thickness laterality. ResultsIn the IGE brain atlas, the brain regions with higher cortical thickness were the right left temporal pole, the right left entorhinal cortex, the head of the right anterior cingulate gyrus, the right and left insular lobe, the right and left middle temporal gyrus, the right inferior temporal gyrus, the head of the left anterior cingulate gyrus, the left tail of the anterior cingulate gyrus, the left inferior temporal gyrus, the left and right fusiform gyrus, and the left frontal pole. The areas with lower cortical thickness were the right and left paracalcaric gyrus, the right and left cuneiform lobe, the left and right lingual gyrus, the left and right posterior central gyrus, the left lateral occipital gyrus, and the right and left superior parietal gyrus. The distribution of cortical thickness of the IGE group was comparable to the cortical thickness atlas of the normal control. Compared with normal control, the areas with changes of cortical thickness in the IGE group were bilateral superior frontal gyrus, bilateral posterior central gyrus, bilateral anterior central gyri, bilateral lingual gyri, left cuneiform lobe, bilateral entorhinal cortex and temporal pole. The brain areas with laterality of cortical thickness between hemispheres in the IGE group were the tail of anterior cingulate gyrus, cuneiform lobe, inferior parietal gyrus, lateral occipital gyrus, posterior central gyrus, head of anterior cingulate gyrus, and superior marginal gyrus. Compared with normal control, the IGE group has decreased number of brain regions with laterality of cortical thickness. ConclusionThe present study revealed the distribution and laterality of cerebral cortical thickness map in early idiopathic generalized epilepsy, which provides imaging structural basis for brain research in the future.

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