目的:为脑损伤后肩关节半脱位的防治设计一款新型矫形器.方法:利用3D打印技术设计和打印一套防治肩关节半脱位的新型矫形器——肘前臂托,并将此肘前臂托与传统的肩吊带应用于脑卒中后伴有肩关节半脱位的患者.采用自身对照的设计方法,对患者分别佩戴肘前臂托与传统的肩吊带,并分别在佩戴前、佩戴后即刻以及佩戴后30min拍摄半脱位肩关节坐位下的正位X线片,测量X线片肩峰下缘至肱骨头中心的垂直距离和水平距离,比较这2种矫形器对肩关节半脱位的复位效果.结果:对于脑卒中后出现肩关节半脱位患者,佩戴这2种矫形器后的即刻均可以达到复位目的,30min后传统肩吊带的复位作用明显减弱,佩戴肘前臂托的复位仍然有效.肘前臂托支撑稳定,持续时间长,佩戴舒适.结论:基于3D打印技术研制的此款肘前臂托设计可行,测试效果好,为脑卒中后肩关节半脱位的临床治疗提供了新的思路.

Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.

目的 分析MR扩散加权成像(DWI)对多系统萎缩(MSA)、进行性核上性麻痹(PSP)及帕金森病(PD)的鉴别诊断价值.方法 选取广东三九脑科医院2019年1月至2020年1月收治的100例MSA患者作为甲组,100例PSP患者作为乙组,100例PD患者作为丙组,另外选取同期100例健康受试者作为丁组.四组受检者均接受DWI检查,分别比较其额叶白质、桥脑、壳核的表观扩散系数(ADC)值.结果 四组患者间的额叶白质、桥脑、壳核ADC值比较差异均具有统计学意义(P<0.05),其中乙组患者的额叶白质、桥脑、壳核ADC值明显高于甲组,甲组患者的额叶白质、桥脑、壳核ADC值明显高于丙组,乙组患者的额叶白质、桥脑、壳核ADC值明显高于丙组,差异均有统计学意义(P<0.05);而丙组患者的额叶白质、桥脑、壳核ADC值与丁组比较差异均无统计学意义(P>0.05).结论 MSA、PSP、PD患者的额叶白质、桥脑、壳核DWI表观扩散系数值有明显差异,可作为临床鉴别MSA、PSP、PD的依据.

目的 对临床帕金森病(PD)患者的颅脑影像学检查的具体改变情况进行一个观察,从而分析有关改变与临床表现之间是否存在着一个较为明显关联性.方法 在本院所有所收治PD患者中随机抽取35例作为研究群体,对所有研究群体都采取CT检查,如伴有CT显像不明显或不清晰患者,则联合应用MRI检查,分析相关影像学改变特点与特征,结合具体特点来分析与临床表现之间是否存在一定联系.结果 在最终结果 中能明显看得出来,有4例患者CT显像并不清晰合并应用MRI检查,其中31例CT检查患者中,有20例存在不同程度脑萎缩,而4例MRI检查中,存在基底节萎缩者2例,出现颞叶萎缩者2例.结合相关变化可以分为三组,即明显异常组、异常组和非异常组,三组患者之间能够明显发现,越是出现明显影像学异常,临床表现和症状就越重.结论 帕金森病临床影像学检查的过程中,可以较为突出地发现,影像学改变越明显的患者相关症状也相对较为明显,因此影像学可以为相关治疗与诊断提供针对性的支持,可参考价值也相对较高一些.

Background Accurate identification of Parkinson’s disease (PD) and Parkinsonism-Plus syndrome (PPS), especially in the early stage of the disease, is very important. The purpose of this study was to investigate the discriminative spatial pattern of cerebral blood flow (CBF) between patients with PD and PPS. Methods Arterial spin labeling (ASL) perfusion-weighted imaging was performed in 20 patients with PD (mean age 56.35 ± 7.56 years), 16 patients with PPS (mean age 59.62 ± 6.89 years), and 17 healthy controls (HCs, mean age 54.17 ± 6.58 years). Voxel-wise comparison of the CBF was performed among PD, PPS, and HC groups. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CBF in discriminating between PD and PPS. The relationship between CBF and non-motor neuropsychological scores was assessed by correlation analysis. Results PD group showed a significantly decreased CBF in the right cerebelum_crus2, the left middle frontal gyrus (MFG), the triangle inferior frontal gyrus (IFG_Tri), the left frontal medial orbital gyrus (FG_Med_Orb) and the left caudate nucleus (CN) compared with the HC group ( P < 0.05). Besides the above regions, the left supplementary motor area (SMA), the right thalamus had decreased CBF in the PPS group compared with the HC group ( P < 0.05). PPS group had lower CBF value in the left MFG, the left IFG_Tri, the left CN, the left SMA, and the right thalamus compared with the PD group ( P < 0.05). CBFs in left IFG_Tri, the left CN, the left SMA, and the right thalamus had moderate to high capacity in discriminating between PD and PPS patients (AUC 0.719–0.831). The CBF was positively correlated with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores in PD patients, while positively correlated with the MMSE, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) scores in PPS patients ( P < 0.05). Conclusion PD and PPS patients have certain discriminative patterns of reduced CBFs, which can be used as a surrogate marker for differential diagnosis.

Objective To investigate the effect of transcranial direct current stimulation (tDCS) on the amplitude of low-frequency fluctuation (ALFF) of the resting brain function network in patients in a minimal conscious state (MCS) so as to explore the mechanism.Methods Eleven MCS patients were selected.Among them,there were 9 males and 2 females,10 with cerebral trauma and 1 with cerebral hemorrhage,with an average age of (37.3±8.4) and an average course of disease of (3.4±0.1) months.All subjects were given a resting-state functional magnetic resonance imaging (rs-fMRI) assessment prior to the single tDCS treatment,followed by a 20-minute single sham tDCS treatment at a time.After single-sham stimulation,a second time rs-fMRI assessment test will be conducted,followed by a real tDCS treatment for 20 minutes.Eventually,a third time rs-fMRI assessment test will be implemented.Results No significant statistical difference was shown in terms of all the parameters after single shamtDCS as compared to those before the treatment (P＞0.05).After single real-tDCS,no significant change was observed with CRS-R score,ALFF of default network (left anterior wedge),the frontal-parietal network (left fróntal lobe,right superior gyms),sensory motor network (left auxiliary motor area),subcortical network (right thalamus,bilateral caudate nuclei) was significantly higher than that before treatment,while the ALFF of the frontal network (frontal lobe) and auditory network (bilateral temporal lobes) was significantly decreased (P＜0.05).After single real-tDCS,the ALFF of default network (right frontal lobe) was significantly enhanced compared to that after single sham-tDCS (P＜0.05),while that of the salient network (left insula) and sensorimotor network (right central frontal) was significantly decreased (P＜0.05).Conclusion The enhancement of ALFF activity in the resting state brain function network is a possible neural mechanism for tDCS to promote the recovery of consciousness level in pa tients with minimal conscious state.

Objective To explore the value of 3D-ASL parameters for predicting glioma grade before operation and the relationship between the expression of Ki-67 and microvessel density(MVD).Methods 3DASL images of 50 patients with pathologically proven gliomas (high grade:n=20,1ow grade:n 30) were analyzed retrospectively.The mean maximum relative cerebral blood flow was obtained by the hot spot method.The Ki-67 labeling index and MVD of surgical specimen were measured.The results were analyzed statistically.Results The mean rCBF,Ki-67 and MVD of low grade gliomas (n=30) were 1.69±1.27,3.73％±3.01％,25.43±13.03,while the high grade gliomas (n=20) were 3.18± 1.46,49.25％ ±20.15％,58.69±20.39 respectively.The difference between the two groups was statistically significant (P＜0.01),which was positively correlated with the grade(r=0.620,0.871,0.698,P＜0.01).rCBF was positively correlated with Ki-67 and MVD (r =0.535,0.723,P ＜0.01).Ki 67 labeling index was positively correlated with MVD (r=0.629,P＜0.01).Conclusion The rCBF value is useful for predicting glioma grade before operation and related to tumor MVD and cell proliferation.The biologic behavior of glioma can be predicted to a certain extent.

Objective:To explore the rCBFmaxvalue for predicting glioma grading before operation and the relationship with MVD expression.Materials and Methods: 3D-ASL images from 50 patients with pathologically proven gliomas(high grade: n=20,low grade: n=30)were analyzed retrospectively.The mean maximum relative cerebral blood flow was obtained by the hot spot method.The MVD of surgical specimen were measured.The results were analyzed statistically.Results: The mean rCBFmax,and MVD of low grade gliomas(n=30)were 1.69±1.27,25.43±13.03,while the high grade gliomas(n=20)were 3.18±1.46,58.69±20.39,the difference between the two groups was statistically significant(P＜0.01)and was positively correlated with the grade(r=0.620,0.698,P＜0.01).rCBFmaxwas positively correlated with MVD(r=0.723,P＜0.01).Conclusions: The rCBFmaxvalue is useful for predicting glioma grade before operation and is related to tumor microvessel density.The biologic behavior of glioma can be predicted to a certain extent.

Objective:To investigate the effect of transcranial direct current stimulation (tDCS) on the functional connectivity strength (FCS) of rest brain function network in patients with minimal conscious state (MCS) so as to explore the mechanism of this treatment.Method:Eleven MCS-compliant patients were involved.Subjects were given an rs-fMRI assessment prior to the single tDCS treatment,followed by a 20-minute min single sham-tDCS treatment at a time.After singlesham stimulation,a second time rs-fMRI assessment test will be given to subjects,followed by a real-tDCS treatment for 20-minute min.Eventually,a third time rs-fMRI assessment test will be given to subjects.Result:Before treatment and after single sham-tDCS,no significant statistical difference was shown (P＞0.05).After single real-tDCS,FCS of auditory network (right inferior temporal gyrus) and the frontal-parietal network was significantly higher than that before treatment (P＜0.05).After single real-tDCS,the default network (right precuneus),the frontal-parietal network (right angular gyrus and right postcentral gyrus central back),sensory motor network (bilateral supplementary motor area) FCS was significantly enhanced compared to that after single sham-tDCS (P＜0.05).Conclusion:tDCS has a significant effect on MCS brain function network FCS by synchronous and non-synchronous regulatory effect (distant effect) to MCS brain function network.Single real-tDCS treatment can adjust the left side of the top of the network to enhance the FCS and can adjust key nodes of consciousness level related to the role in the recovery of consciousness.

Abstract Background: Although hand motor cortex (HMC) has been constantly used for identification of primary motor cortex in magnetic resonance spectroscopy (MRS) studies of amyotrophic lateral sclerosis (ALS), neurochemical profiles of HMC have never been assessed independently. As HMC has a constant location and the clinic–anatomic correlation between hand motor function and HMC has been established, we hypothesize that HMC may serve as a promising region of interest in diagnosing ALS. Patients and methods: Fourteen ALS patients and 14 age- and gender-matched healthy controls (HC) were recruited in this study. An optimized magnetic resonance spectroscopic imaging (MRSI) method was developed and for each subject bilateral HMC areas were scanned separately (two-dimensional multi-voxel MRSI, voxel size 0.56 cm3). N-acetyl aspartate (NAA)–creatine (Cr) ratio was measured from HMC and the adjacent postcentral gyrus. Results: Compared with HC, NAA/Cr ratios from HMC and the postcentral gyrus were significantly reduced in ALS. However, in each group the difference of NAA/Cr ratios between HMC and the postcentral gyrus was not significant. Limb predominance of HMC was not found in either ALS or HC. In ALS, there was a significant difference in NAA/Cr ratio between the most affected HMC and the less affected HMC. A positive relationship between NAA/Cr ratio of HMC and the severity of hand strength (assessed by finger tapping speed) was demonstrated. Conclusion: Neuronal dysfunction of HMC can differentiate ALS patients from HC when represented as reduced NAA/Cr ratio. Postcentral gyrus could not serve as normal internal reference tissue in diagnosing ALS. Asymmetrical NAA/Cr ratios from bilateral HMC may serve as a promising diagnostic biomarker of ALS at the individual level.

Objective To explore whether proton magnetic resonance spectroscopy( MRS),a newer radiographic technology,would be useful in the evaluation of the patients in persistent vegetative state. Methods 28 patients who were in the vegetative state before being treatment and 30 healthy volunteer both had proton MRS studies. NAA / Cr and Cho / Cr and NAA / Cho ratios were obtained for each patient in the dorsal thalamus and basal ganglia,and then statistical analysis was performed. Results There was significant difference between PVS group and the control group of MRS in Thalamus,basal ganglia visible damage zone( P < 0. 05). Also there was the same result in apparent normal zone( P < 0. 05). Differences in NAA / Cr,NAA / Cho ratio of hypothalamic and NAA / Cr ratio of basal ganglia were positively correlated with PVS efficacy score grading. Conclusion For attempting to predict PVS prognosis,MRS has a very good value and potential. The apparent normal zone of hypothalamus and NAA / Cr ratio may be a good choice of VOI and evaluation index.