PURPOSE:Brain development is accompanied by gradual refinement of large-scale functional communication. Recent work indicates that functional connectivity can be characterized by both linear and nonlinear dependencies, raising the possibility that maturation involves a shift toward more linearly organized coupling. Whether this developmental trajectory differs in autism spectrum disorder (ASD) is not yet clear. METHODS:We analyzed resting-state fMRI data from the ABIDE cohort, including 188 males with ASD and 216 age-matched typically developing (TD) males. The ASD group had a mean age of 15.66 ± 66.13 years (range = 6-35), and the TD group had a mean age of 15.71 ± 5.97 years (range = 7-35). After standard preprocessing, we estimated linear and nonlinear connectivity for each participant and derived an index reflecting the extent to which nonlinear interactions were accounted for by linear coupling. This index was examined at the whole-brain scale and within canonical large-scale networks defined by the Yeo 7-network framework. Group differences and age-related effects were assessed, with multiple-comparison correction applied to network-level analyses. RESULTS:At the whole-brain level, ASD participants showed significantly lower R² values than TD participants. At the network level, significant between-group differences were observed in the visual, somatomotor, dorsal attention, ventral attention, and default mode networks. Across the typically developing group, the index increased significantly with age, suggesting a gradual strengthening of linear structure in functional interactions during maturation. In contrast, the ASD group showed only a weak relationship with age. At the network level, age-related associations were more widespread in the TD group than in the ASD group. In TD, significant positive age associations were observed in multiple networks, whereas in ASD they were limited to fewer systems. The clearest between-group inconsistency in age-related pattern was observed in the limbic network. CONCLUSION:These findings support the idea that normative brain development is associated with increasing linear organization of functional interactions, and suggest that this pattern is attenuated or altered in males with ASD. The proposed index quantifying the goodness of fit of the linear model predicting distance-correlation-based functional connectivity (FC) from Pearson-correlation-based FC and may provide an operational summary for characterizing atypical maturation of large-scale FC patterns.

脑性瘫痪(cerebral palsy,CP)简称脑瘫,是儿童时期最常见的引起运动功能障碍的疾病[1].我国于2013年完成的12省市自治区32万余名1-6岁儿童脑瘫流行病学调查结果显示,我国脑瘫患病率为2.46‰[2].在全球范围内,估计有1700万人患有脑瘫[3].虽然导致脑瘫的神经损伤是非进行性的,但是脑瘫儿童肌肉继发的病理变化会随着年龄的增长而进展[4].传统观点认为脑瘫儿童的骨骼肌只是脑损伤的终末器官,脑损伤引起的肌张力增高及长时间的姿势固定导致挛缩发生,但最新研究挑战了这一观点.脑瘫儿童肌肉病理形态的变化如结缔组织和脂肪增多、肌节形成异常、卫星细胞数量的减少和功能的下降等都与挛缩的发生有关[5].

脑性瘫痪(cerebral palsy,CP)简称脑瘫,是由一组持续存在的、导致活动受限的、中枢性运动和姿势发育障碍的症候群,这种症候群是由于发育中的胎儿或婴幼儿脑部非进行性损伤所致.CP的运动功能障碍常伴有感觉、知觉、认知、交流和行为障碍,以及癫痫和继发性肌肉、骨骼问题[1-3].据流行病学调查显示,脑瘫的发病率为0.2％-0.6％[4],目前治疗方法也多是采用综合康复治疗.而运动障碍是脑瘫患儿的主要表现形式,患有CP的儿童由于肌肉过度无力、关节运动学异常和姿势反应异常而表现出功能限制[5-6].脑瘫患儿的足部问题也是康复治疗过程中的重点和难点,研究表明,足部功能异常将直接影响到膝关节和髋关节受力、脊柱曲度以及相关部位的肌肉、韧带等软组织[7],会严重影响到患儿的平衡功能及步行能力.

目的:观察头针联合综合康复训练对脑性瘫痪合并智力障碍患者粗大运动功能及日常生活能力的影响.方法:选取河南中医药大学第一附属医院收治的脑性瘫痪合并智力障碍患者144例,按1:1的比例分为两组.对照组给予综合康复训练[运动疗法(推荐强度A级)、推拿按摩(推荐强度B级)、认知训练言语康复训练(推荐强度B级)];治疗组在对照组治疗基础上给予头针(百会、运动区、四神聪、智三针、平衡区)治疗,留针40 min,1次/d.两组均以治疗20 d为1个疗程,共3个疗程后判定疗效.结果:治疗组显效29例,好转32例,无效11例,有效率为84.72％(61/72).对照组显效15例,好转35例,无效22例,有效率为69.44％(50/72).两组疗效对比,差异有统计学意义(P<0.01).治疗1、2、3个疗程,两组之间在下肢肌群肌张力、粗大运动功能量表88项(GMFM-88)及日常生活能力量表(ADL)评分,均有统计学差异(P<0.01).智力水平在治疗1个疗程时两组之间无明显统计学差异(P>0.05),但上升趋势治疗组优于对照组(P<0.01);第2、3个疗程两组之间有明显的统计学差异(P<0.01).结论:头针联合综合康复训练治疗脑性瘫痪合并智力障碍疗效确切.

目的 探讨蒲金口服液对缺氧缺血性脑损伤(Hypoxic-ischemic brain damage,HIBD)幼鼠的神经保护机制.方法 单侧颈总动脉结扎联合缺氧环境制备HIBD幼鼠模型.动物分为中药组、西药组、模型组、假手术组、空白组.中药组蒲金口服液0.1 mL/(kg·d)灌胃;西药组单唾液酸四己糖神经节苷脂钠注射液3 mL/(kg·d)腹腔注射;余组生理盐水0.1 mL/(kg·d)灌胃,均每日1次,连续14 do Morris水迷宫测试学习与记忆行为能力,尼氏染色观察脑组织神经元,透射电镜观察突触超微结构,Western Blot检测脑组织PSD-95、NMDAR-2B表达.结果 蒲金口服液可改善HIBD幼鼠神经损伤,上调脑组织突触后密度蛋白95(PSD-95)、谷氨酸受体2B抗体(NMDAR-2B)表达(P＜0.05).结论 蒲金口服液改善HIBD幼鼠神经行为学表现,可能与其调控PSD-95、NMDAR-2B表达,维护突触稳态有关.

The incidence of cerebral palsy (CP) is high in China, which brings huge economic burden to patients, families and society. Foot deformities such as scissors gait, flat foot, varus or valgus are the main manifestations of lower limb spasm in patients with spastic cerebral palsy. Cerebral palsy is a kind of non-progressive brain injury and nerve damage. At present, there is no effective treatment. If the foot deformity was not corrected for a long time, the muscles, fascia and ligament will change and contracture will occur, which can lead to secondary skeletal deformity, osteoarthritis of talocalcaneal, talonavicular and phalangeal joints, bony deformities of talocalcaneal joints and talonavicular joints, and miss the opportunity for passive traction correction. Patients with flat feet are prone to limb fatigue and pain when standing, walking, running and jumping for a long time, so it is necessary to screen and diagnose as soon as possible and implement rehabilitation training. Currently, there is no unified standard for the evaluation of foot deformity in children with CP. This review summarizes the evaluation methods for foot deformity in children with CP, mainly inclu-ding the principles, evaluation methods, advantages, disadvantages and scope of application of related evaluation tools for static analysis (footprint analysis, imaging evaluation, angle of standing calcaneus rest position, subtalar joint hardness, surface electromyography, etc.) and dynamic analysis (gross motor function grading system, Berg balance scale, plantar pressure system, etc.). The purpose is to provide reference for the diagnosis, rehabilitation treatment and rehabilitation outcomes evaluation of foot deformities in children with CP. The review found that the static analysis and evaluation method was mainly used for structure evaluation, while the dynamic analysis and evaluation method was mainly used for the evaluation of balance and motor function.

Objective . To evaluate the efficacy of psychotherapy in children with tic disorder and to provide basis for the application of psychotherapy in the treatment of children with tic disorder. Methods . A detailed search was conducted based on PubMed, Cochrane library database, CNKI, Wanfang Data, and VIP database to determine the randomized controlled trial (RCT) of psychotherapy combined with drugs and oral drugs in the treatment of tic disorder. The search time was from the establishment of the database to August 20, 2021. All kinds of extracted data are meta analyzed, and the statistical software used is Review Manager 5.3 software. Results . According to the inclusion and exclusion criteria, 14 clinical trials were finally included, including 513 TD children, including 267 in the psychological intervention group and 246 in the control group. All trials were conducted in China and published from 2013 to 2021. In terms of clinical efficacy, compared with the control group, the psychotherapy combined with drugs group had more advantages in improving the effective rate (RR = 3.25, 95% CI: 2.17~4.85, Z = 5.74, P < 0.00001) and improving the clinical symptoms of children with TD (WM = −5.36, 95% CI: -6.41 ~ -4.30, Z = 9.97, P < 0.00000 1). Conclusion . Psychotherapy as an adjuvant therapy for clinical treatment of TD can improve the clinical efficacy, but due to the low methodological quality of the existing trials, the research may have potential bias. In the future, large sample, multicenter, and double-blind randomized controlled trials need to be carried out to provide further support.

AbstractBackgroundThe EVEN‐plus syndrome (epiphyseal–vertebral–ear–nose dysplasia plus associated findings) is an extremely rare autosomal recessive inherited disease characterised by specific facial features and skeletal dysplasia. It has a prenatal onset due to defects in the HSPA9 gene. The syndrome has not been reported previously in China.MethodsThis study reported the characteristics, examination results, diagnosis and treatment of a female case aged 3 years and 3 months.ResultsThe patient had global developmental delay and specific facial features, including a prominent forehead, a bilateral auricle deformity, a collapsed nose, a high palatine arch, a short neck and other appearance abnormalities. Her hip joint magnetic resonance imaging (MRI) results showed bilateral femoral head epiphyseal dysplasia with a fork‐shaped malformation at the distal end, and her brain MRI showed white matter myelin dysplasia. HSPA9 compound heterozygous variants c.882_c.883delAG and c.613A>G were identified by exome sequencing.ConclusionsThis finding expands the spectra of EVEN‐plus syndrome phenotype and pathogenic variants and suggests that c.882_c.883delAG may have a higher distribution frequency in East Asian populations.

目的:观察基于"脾肾-脑相通"理论之脏腑经穴推拿联合康复训练治疗孤独症谱系障碍(ASD)的临床疗效.方法:选取104例ASD患儿,按随机数字表法分为推拿组及康复组各52例.康复组行常规康复训练,推拿组在常规康复训练的基础上联合脏腑经穴推拿进行治疗,4周为1个疗程,2组共治疗6个疗程.比较2组治疗前后孤独症儿童行为量表(ABC)评分、孤独症治疗评估量表(ATEC)评分变化,观察2组临床疗效.结果:治疗后,2组ABC评分均较治疗前下降,推拿组ABC评分低于康复组,差异均有统计学意义(P＜0.05).治疗后,2组ATEC中各分量表(Ⅰ言语/语言/交流、Ⅱ社交、Ⅲ感觉/知觉、Ⅳ健康/身体/行为)评分及其总分均较治疗前降低,推拿组上述各项评分均低于康复组,差异均有统计学意义(P＜0.05).推拿组临床疗效总有效率为86.54％,康复组临床疗效总有效率为74.51％,2组比较,差异有统计学意义(P＜0.05).结论:脏腑经穴推拿联合康复训练能有效提升ASD患儿的行为、语言、社交、感知觉等功能,改善患儿的临床症状.

背景:推拿振法治疗周围神经损伤疗效明确,但其作用机制的相关研究较少.目的:探讨推拿振法对周围神经损伤后再生的作用机制.方法:将28只SD大鼠随机分成假手术组(8只)和模型组(20只).模型组大鼠给予坐骨神经钳夹损伤建立坐骨神经损伤模型,再随机取4只进行模型鉴定后,将剩余大鼠随机分为假干预组(8只)与推拿振法组(8只);假手术组仅开皮后缝合.分别于造模7d后进行干预,推拿振法组用振动仪笔尖接触右下肢皮肤进行治疗,频率为8 Hz,1次/d,2 min/次,连续4周;假干预组振动仪仅接触皮肤,不给予推拿振法治疗;假手术组不做治疗.于干预后7,14,28 d行斜板试验及坐骨神经功能指数行为学指标检测,治疗28 d后取材行肌卫星细胞、胰岛素样生长因子1、MyoD生化指标检测.实验方案经上海中医药大学附属岳阳中西医结合医院动物实验伦理委员会批准.结果 与结论:①治疗7,14,28 d,假干预组和推拿振法组斜扳试验角度显著小于假手术组(均P＜0.05);假干预组与推拿振法组的斜板试验角度整体呈上升趋势,但两组之间差异不明显(P＞0.05);②治疗14,28 d推拿振法组坐骨神经功能指数明显优于假干预组;③治疗28 d后推拿振法组肌卫星细胞、胰岛素样生长因子1、Myod的吸光度值均显著高于假干预组,假干预组高于假手术组(均P＜0.05);④结果提示:推拿振法能促进大鼠运动功能的恢复,加速胰岛素样生长因子1、MyoD的表达及肌卫星细胞的增殖与分化,缓解骨骼肌肌萎缩状态,加速坐骨神经损伤后再生.

孤独症谱系障碍(austim spectrum disorder,ASD)是一种以社交和沟通障碍以及重复和限制性行为为特征的神经发育障碍.ASD的表型异质性使得确定核心症状涉及的确切病因和病理生理机制困难重重,且这些症状通常伴有注意缺陷多动障碍、癫痫发作和感觉运动异常等共患病.动物模型提供了阐明疾病的病因和发病机制的重要平台.越来越多的研究利用如环境暴露、母体免疫激活(maternal immune activation,MIA)等诱导的动物模型进行孤独症谱系障碍病因病机的探讨以及药物治疗靶点的筛选.该文综述常见动物模型的不同神经网络机制、脑组织及相关因子变化、症状表型等方面,为今后进行精准动物实验研究提供针对性的动物模型选择,也可为阐明疾病神经生物学、开发潜在的治疗药物提供参考.

手势先于语言产生,促进语言的发展.孤独症谱系障碍(ASD)儿童手势的类型和功能存在非典型使用及发展,手势-语言轨迹发展缓慢,可以成为ASD儿童的一个关键早期行为标记.手势的发展与后期语言、认知、社交和ASD诊断显著相关,应对ASD儿童的早期手势功能进行评估和监测.针对手势特点进行个性化训练,增加儿童社会参与和学习潜能,以手势为中介促进语言、认知及社交发展,提高康复效果.

孤独症谱系障碍(autism spectrum disorder,ASD)是一种起病于儿童早期的严重神经发育障碍性疾病,致残率极高,因此及时诊断和尽早治疗至关重要.ASD诊断方法的异质性和量表评估固有的主观性是ASD早期识别的障碍.弥散张量成像(diffusion tensor imaging,DTI)可通过相关参数量化呈现白质微观结构变化和脑发育情况,在ASD早期识别诊断中具有重要价值.本文围绕DTI技术及其在ASD诊疗方面的临床应用,提出DTI技术未来研究方向是探索ASD白质纤维束连接机制、归纳不同神经发育障碍性疾病的共同发育途径、分析全年龄组ASD患儿脑发育与行为学的纵向关联性,旨在阐明潜在神经病理学机制,为今后利用可视化技术寻求ASD生物标志物提供重要参考.

思想政治建设是近几年高等院校实施教育改革的重要举措,在新型冠状病毒肺炎疫情大规模暴发的突发性公共卫生事件面前,医生们逆向而行,为迅速控制疫情提供了条件.思政建设在临床儿科规培带教工作中较薄弱,加强临床规培的思政建设对为临床输送优质的儿科医生具有重要意义.此文就后疫情时代思政建设融入儿科规培医生临床带教方法进行探讨,可为儿科规培医生临床带教方案的制定提供参考.

Autism spectrum disorder (ASD) is a complex disorder of neuropsychiatric development in children (American Psychiatric Association D S, 2013). The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) is a 14-year revision that uses a large number of clinical studies as evidence-based to make leapfrog adjustments to many psychiatric disorders, including autism spectrum disorder. DSM-5 argues that autism spectrum disorder is characterized by social and communication disorders, repetitive stereotypes, and narrow interests. The prevalence of the disease is one in 54 in the United States, and the upward trend is obvious, placing a heavy burden on families and society (Persico et al., 2021). Due to the large base of Chinese population and the prevalence rate is still unclear, the China Colorful Deer Children ’ s Behavior Correction Center has found that by 2017, there were about three million children with autism spectrum disorder aged 0 – 14 in China, and the incidence is still growing, which means that patients with autism spectrum in China have become a huge medical group (Wucailu children ’ s behavior correction center, 2015). According to the statistics of the census of disabled persons in China, childhood autism has accounted for the fi rst place in China ’ s mental disabilities, but unfortunately there is no explicit report on the epidemi-ological investigation of the prevalence of autism spectrum disorder in China from 2017 to 2021. Early detection and early intervention are key to the clinical treatment of children with autism spectrum disorder (Siu A L et al., 2016). It is conducive to improving the core symptoms of children with ASD, helping children to integrate into society as soon as possible, and

全身振动训练(Whole-body vibration training,WBV)是一种神经肌肉训练方法,主要包含振动频率、振动强度和振动方式三个参数调控.训练过程中训练者站立、坐或半蹲在振动平台上,平台通过对人体施加振动波(通常使用5～60 Hz频率),刺激肌肉纺锤体和a运动神经元等感受器,使神经系统、肌肉-骨骼系统以及心血管系统产生适应性反应进而提高部分身体功能[1].早在1965年,Hagbarth等[2]就发现机械振动刺激会引起肌腹和肌腱的收缩性反应,并推广应用成为运动员训练的常用方法.随着研究的深入,学者们发现WBV还与骨密度、肌肉力量、平衡能力、步行速度、代谢和激素水平等生理参数有关[3],当躯体进行WBV时,可激活骨骼肌肉、调动神经反射通路、增加机体合成激素分泌[4-5],近年来WBV已单独或与其他干预措施联合应用于儿童,特别是运动障碍儿童康复,然而支持这种方法的证据有限.本文针对国内外研究现状,主要介绍了WBV在儿童康复中的作用及作用机制,以期为WBV相关研究与临床应用提供参考.

周围神经损伤动物模型的复制方法包括手术器械损伤、物理因素损伤及其他损伤,目前被普遍认可及广泛应用的模型有横断伤、钳夹伤、卡压伤等.动物实验的关键是,根据实验目的及临床研究需求,选择合适的动物模型,并对动物模型进行优化总结.该文通过对周围神经损伤动物实验研究的相关文献进行检索,对现阶段模型复制的研究进展作出综述.

药对是中药复方配伍中最基础的一种形式.中药石菖蒲为涤痰开窍常用药,临床上多配伍使用,以扩大疗效.本文重点综述临床中常用的石菖蒲药对物质基础、药理作用及临床应用的研究进展,包括石菖蒲—远志、石菖蒲—郁金、石菖蒲—人参、石菖蒲—西洋参、石菖蒲—川芎、石菖蒲—白芷、石菖蒲—萆薢、石菖蒲—黄连、石菖蒲—甘松、石菖蒲—胆南星.目前石菖蒲相关药对治疗神经系统疾病可能通过调节神经递质、抑制炎症反应、抗氧化应激、保护神经细胞等方面,同时具有保护心肌细胞、降脂、舒张血管等作用,临床应用于循环系统疾病,但对作用于消化系统、呼吸系统的研究相对不足.中药配伍后具有多成分—多靶点—多通路协同作用,化学成分及作用机制较复杂,今后有必要多方面、多角度、深层次、全面系统研究药对配伍的作用靶点及途径,以指导临床科学合理用药.

目的 探讨生物力学(ICB)矫形鞋垫对痉挛型脑性瘫痪足外翻患儿下肢功能及步态的影响,为治疗痉挛型脑性瘫痪足外翻患儿提供有效的治疗方法及临床依据.方法 将2017年1月—2019年12月收治的80例痉挛型脑瘫患儿采用随机数字表法分为对照组和观察组,对照组(40例)行常规康复训练,观察组(40例)在常规康复训练的基础上联合ICB矫形鞋垫康复治疗,分别于治疗6月后进行内侧纵弓(MLA)、支撑相各分期、足弓指数(AI)、步长、步频、步速、88项粗大运动功能评定量表(GMFM-88)、Berg平衡量表(BBS)指标检测.结果 1)对照组与观察组组内治疗前后相比MLA、支撑相各分期、AI、步长、步频、步速、GMFM-88、BBS均呈明显的下降趋势,差异有统计学意义(P＜0.01);2)治疗后对照组右MLA、支撑相早、中、末期、AI、步长、步频、步速、BBS、GMFM-88的D能区和E能区与观察组之间有明显的统计学差异(t=2.571、0.827、1.449、1.670、3.512、3.202、5.828.5.585、2.675、4.721、2.345,P＜0.05);3)治疗后对照组左足内弓角与观察组之间无明显的统计学差异(P＞0.05),但观察组下降趋势优于对照组.结论 ICB矫形鞋垫联合康复训练能够改善痉挛型脑瘫患儿外翻足,提高双下肢运动功能及步行能力,可作为临床治疗痉挛型脑瘫患儿外翻足的辅助方法推广应用.

目的:对SD大鼠坐骨神经钳夹伤模型进行量化研究,确定不同压力对坐骨神经造成的损伤程度,建立符合SunderlandⅤ度分类法中坐骨神经损伤模型.方法:对JZ06Cr 14 cm止血钳进行压力测定,采用JZ06Cr 14 cm止血钳进行造模,将32只4周龄健康清洁级雄性SD大鼠随机分为4组,正常对照组(8只)及压力组(1扣压力亚组、2扣压力亚组、3扣压力亚组各8只),分别于造模后30 min检测各组神经传导速度(NCV),并取神经进行HE染色观察.结果:止血钳压力测定显示止血钳1扣压力约16 N,2扣压力约为31 N,3扣压力约为46 N.1扣压力亚组的坐骨神经传导速度与正常对照组相比差异有统计学意义(P<0.05),形态学显示神经纤维平行排列,结构致密,轴突、髓鞘、神经内膜束膜都完好无破裂;2扣压力亚组的NCV与正常对照组、1扣压力亚组之间相比差异均有统计学意义(P<0.05),形态学可见神经纤维断裂,神经内膜发生部分损害,结构紊乱;3扣压力亚组的部分NCV无法测出,并与其他各组之间差异均有统计学意义(P<0.05),形态学可见神经纤维断裂,神经外膜与束膜均保持完整.结论:约16 N压力坐骨神经钳夹伤模型符合SunderlandⅠ度损伤;约31 N压力坐骨神经钳夹伤模型符合SunderlandⅡ或Ⅲ度损伤;约46 N压力坐骨神经钳夹伤模型符合SunderlandⅢ度损伤.