Objective To observe the clinical effect of acupuncture combined with Epley repositioning maneuver in the treatment of benign paroxysmal positional vertigo( BPPV). Methods 120 cases of BBPV patients were randomly divided into treatment group and control group, and each group had 60 cases. The patients in the control group were given only Epley repositioning maneuver, and patients in the treatment group were given acupuncture combined with Epley repositioning maneuver. Results After one course of treatment, the treatment for BPPV of the two groups had certain therapeutic effect, and the effect of the treatment group was obviously better than that of the control group(P0.05). Conclusion Acupuncture combined with Epley repositioning maneuver in the treatment of BPPV can improve the clinically curative effect, reduce the times of manual reduction treatment, and is worthy of clinical promotion.

<正>1基本原理1.1 BOLD-fMRI成像原理功能磁共振成像(functional magnetic resonance imaging,fMRI)是以血氧水平依赖效应(blood oxygenation level dependent,BOLD)为核心检测和定位脑功能的一种成像技术。它是利用内源性血红蛋白作为对比剂,通过血氧饱和度的变化实现的成像方法,反映了神

<正>1背景知识颅内动脉粥样硬化是导致缺血性脑卒中的主要病因,随着粥样硬化斑块的发展,除了对管腔形成占位效应,引起管腔狭窄外,更为重要的是斑块

Objective: To explore the clinical effect of intra-aneurysmal embolization combined with cerebrospinal fluid(CSF) replacement on patients with subarachnoid hemorrhage(SAH).Methods: Eighty-four SAH patients were divided into three groups.Patients in group A(n=26) were treated with intra-aneurysmal embolization combined with CSF replacement;patients in group B(n=28) with embolization alone;and patients in group C(n=30) with conventional medication only.The recovery time of CSF,duration of neck rigidity and headache,rate of hydrocephalus and death rate were analyzed and compared.Results: The recovery time of CSF,duration of neck rigidity and headache in group A were significantly shorter than those in group C(P<0.01) and group B(P<0.05).The incidence rate of hydrocephalus in group A were lower than that in group C(P<0.05).No patients died in group A and B,but six patients died in group C.Conclusion: Intra-aneurysmal embolization combined with CSF replacement is a safe and effective treatment for SAH.

<正>进展性缺血性卒中(progressive ischemic stroke,PIS)是指卒中发生后,经临床积极、正确干预,导致卒中发生的原发病理过程仍继续进展,神经缺失症状和体征在一段时间内明显继续严重恶化的缺血性卒中。其发病率占卒中患者30%左右,致残

Objective To evaluate the relationship between pyramidal tract injury in acute intracerebral hemorrhage assessed by MR diffusion tensor tractography(DTT) techniques and motor rehabilitation. Methods Diffusion tensor imaging was performed on 30 patients with basal ganglia or thalamus hemorrhage within 2 weeks after upsets, and the integrity of the pyramidal tracts was assessed by DTT. Motor function rehabilitation was assessed with Barthel Index(BI) after 6 months from upsets. BI scores of the different groups were compared and the correlation was analyzed between the integrity of the pyramidal tracts and the BI scores. Results 7 cases were eliminated because of unsatisfi ed data and 23 cases were enrolled. BI scores had significant difference among the groups divided by DTT findings of the pyramidal tracts integrity(F=9.693, P<0.01). There was signifi cant correlation between the integrity of the pyramidal tracts in acute stage and the BI scores after 6 months(r=0.733, P<0.01). Conclusion The DTT fi ndings for pyramidal tract in acute intracerebral hemorrhage may be used to predict the motor outcome.

Objective:To observe the changes of directionality and integrity of neurofibra tracts in patients with intracerebral hemorrhage(ICH)and to explore the relationship between motor dysfunction and integrity of neurofibras Methods:Twenty-one patients with ICH were randomly divided into groups drug and surgery.Injury extent of the corticospinal tracts in patients was detected by Diffusion Tensor Imaging(DTI),and activating extent of the tracts was detected by fMRI in acute and recovery phases.The association of the motor dysfunction in recovery phase with the injury degree of the corticospinal tracts has been analyzed.Results:There was no differences in BI scores of two groups in acute and recovery phases(P=0.2905,P=0.6018).However,there was a significant difference between acute phase and convalescence in each groups(R=0.89862,P=0.0002)by multivariate analysis of variance.The coefficient correlation between the degree of injury of the corticospinal tracts and BI score was 0.764(P=0.0001)in recovery phase.Conclusion:There was correlation between the the recovery of motor function and the integrity of the tracts.The combined use of DTI and fMRI could detect the injury degree of the corticospinal tracts and predicate the prognosis to some extent.

指出了目前医院奖金分配方案思路不清晰的问题,提出了医院奖金分配方案应当关注的几个重要指标:奖金贡献率、奖金换手率、奖金占利润的比例。在此基础上结合实际工作经验提出了医院制定奖金分配方案的基本思路,为我国医院收入分配制度改革提供了科学参考。

作者探究1H磁共振波谱(1H-MRS)在短暂性脑缺血发作(TIA)中的表现,并探讨相关临床意义[1-2],旨在积极指导临床及时诊断与治疗,提高患者的生存质量.

早期检出骨转移瘤,对恶性肿瘤的临床分期、治疗方案的合理选择、预后判断均有重要意义.长期以来,对恶性肿瘤骨转移的诊断主要靠骨99Tcm-MDP骨显像,但此方法具有定位不精确、特异性差等缺点.近年来,文献初步报道了全身磁共振成像(wbMRI)检查在恶性肿瘤骨转移的诊断价值[1-7].作者对本院2007年1月～2007年2月10例怀疑恶性肿瘤骨转移的患者行wbMRI检查,并以之结果与骨显像对照研究,现报道如下.

目的探讨支气管动脉造影显示肺动脉分支假性动脉瘤在诊断及治疗大咯血中的价值。方法回顾性分析98例大咯血患者的支气管动脉造影和临床资料。依支气管动脉造影是否显示支气管动脉-肺动脉分流(B-P分流)及肺动脉假性动脉瘤将98例患者分为3组,A组:无B-P分流;B组:仅有B-P分流而无假性动脉瘤;C组:假性动脉瘤。分别计算3组支气管动脉栓塞止血的有效率,行列表χ2检验3组之间差异是否有统计学意义。结果A、B、C3组患者止血有效率分别为92%(57/62)、86%(25/29)和43%(3/7),3组间差异具有统计学意义(χ2=13.19,P=0.001)。结论肺动脉假性动脉瘤很可能是支气管动脉栓塞后咯血复发的重要原因。

Objective To observe the effect of the electro-acupuncture on apoptosis of the hippocampal neurons in depression model rats. Methods 30 rats were divided into three groups at random, the control group, the model group and the electro-acupuncture group. The model was established by lonely raising and randomly stimulation. The rats in the electro-acupuncture group received electro-acupuncture at Baihui and Yintang points. The changes of rats behavior were measured. Ultrastructural changes and apoptosis of the rat hippocampal neurons were observed by electron microscope and TUNEL respectively. Results There were behavior changes in the three groups. There were heterochromatin collecting, endoplasmic reticulum expanding and light anomalous nucleus in electro-acupuncture group and there were apoptotic bodies in some hippocampal nerve cells in model group. The positive cells in the CA3 area of hippocampus in model group and electro-acupuncture group were far more than those in control group, and there was significant difference between model group and electro-acupuncture group. Conclusion There is apoptosis in the CA3 area of hippocampal of depression model rats. Electro-acupuncture can suppress the phenomenon and protect rat brain from damage to a certain extent.

Objective To investigate the perihematomal changes of hyperacute parenchymal hematomas and the clinical value by MRI. Methods Multi-sequence MRI was performed on 4 hematomas in vitro and on 15 pigs with lobar intracerebral hemorrhage (ICH) for about 30～60 min and 3 h respectively. The integrity of blood-brain barrier (BBB) in ICH pigs was assessed by electron microscopy and Evan's blue dye technique. MR scanning was performed on 2 ICH patients proved by CT for 4 and 9 h after onsets. Results FLAIR and T 2-weighted images showed hyperintensity signal around the hematomas in vitro and in pigs with ICH within 1 h, and more obviously at 3 h. When the gelose cavity was cut, plasma was seen around the clot. The perihematomal ADC values of the pigs increased both within 1 and at 3 h after ICH. However, the BBB was intact at 3 h, which was proved by electron microscopy and Evan's blue dye technique. Water-like intensity signal was observed around the hematomas in two patients with acute ICH. Conclusion The perihematomal changes of hyperacute ICH observed on MRI are resulted from the blood clot contraction and the serum formation and extravasation, but not real cerebral edema.

目的 评价针刺体表穴位对脑部相应区域的功能性磁共振成像(fMRI)表现. 方法 17例健康志愿者,在1.5 T MRI仪上进行针刺足三里(S36)、阳陵泉(G34)的实时动态fMRI检查,观察并分析针刺效果明显者的脑部功能变化情况,判断针刺效果及其意义. 结果 17例志愿者中13例检查成功, 可见躯体感觉运动区(SMC)、运动前区(PMC)、副运动区(SMA)激活明显,额叶前部、扣带回、尾状核头部、豆状核及丘脑、岛叶、岛盖皮质大多有大面积明显激活,小脑和桥脑也可见有激活,在左侧丘脑、SMA、SMC、PMC激活区附近有信号减低的现象,但激活的像素数不多;信号减低区包括两侧额叶内侧面皮质,双侧扣带回前部皮质,两侧海马区,右侧眶回、基底节、尾状核头部等. 结论针刺对脑部相关穴位的治疗效应显著,可产生广泛而复杂的脑功能变化,fMRI可清楚显示针刺效应引起的脑部功能变化,是针刺机制及效应良好且直观的评价途径。

目的 通过MRI成像技术,观察电针"百会"、"印堂"穴对慢性应激抑郁模型大鼠脑形态结构的影响,从神经生理学的角度探讨针刺治疗抑郁症的机理. 方法选择Open-field法评分相近的30只成年SD雄性大鼠并将其随机分为正常组、模型组和电针组,每组10只;应用分养和长期不可预见性中等强度应激建造大鼠抑郁模型,电针组参照 取百会、印堂两穴进行针刺;以Open-field实验和糖水消耗实验等方法测定动物的行为变化;多片多回波的T2加权成像、扩散加权成像和翻转恢复的T1加权成像,对照研究各组大鼠脑内形态学及各脑区信号强度的改变. 结果正常组大鼠的体重远高于电针组,且差异有统计学意义,模型组大鼠的体重虽然高于电针组,但差异无统计学意义;模型组大鼠的1%蔗糖水摄取量明显低于正常组和电针组,且差异有统计学意义,正常组高于电针组,但差异无统计学意义;采用Open-field法检测大鼠活动性,电针组、模型组分别与正常组比较,水平运动次数、垂直运动次数均明显降低并且差异有统计学意义.电针组与模型组相比较差异均无统计学意义;从T2加权像上观察到大鼠脑裂扩大现象,但三组之间并无显著差异;模型组和电针组与正常组相比较,中脑水管的横截面积有增加,统计结果显示三组之间差异有统计学意义;对T2值的分析结果显示,电针组和正常组的海马区T2值接近,而模型组的海马区T2值与电针组和正常组相比较有增加,其海马区T2值与电针组相比较差异有统计学意义,其它脑区, 如尾壳核、杏仁核和皮层,T2值在三组之间并无明显差别;对扩散加权像的数据处理结果显示,模型组和电针组海马区和颞叶及听觉皮质区的ADC值(表观扩散系数)相对于正常组有降低,并且与正常组相比差异都有统计学意义;而纹状皮质区的ADC值三组之间差异无统计学意义. 结论 MRI证实电针对抑郁模型大鼠的脑形态结构有影响,提示电针作为一种治疗手段在临床治疗抑郁症中取得的显著疗效,可能与电针作用于抑郁症患者脑部组织并影响了其相关组织的功能有关.但本实验体现的是好坏参半的结果,提示以大鼠为对象来研究针刺机理,必须注意人与大鼠的种属差异和受试主体的精神心理作用对实验指标乃至实验结论的影响。

Objective To characterize the human motor cortex reaction on acupuncture stimulations of ZUSANLI(S36) and YANGLINGQUAN(G34) by using real time imaging processing functional magnetic resonance imaging(fMRI). Methods fMRI was performed in 20 healthy volunteers and 17 patients with limb motion impairment caused by lesions in central sulcus area. The healthy volunteers were asked to perform two tasks: being acupunctured at acupoints of S36 and G34 (on the right side) and doing digital opposition movement of the right hand. The region of interest (ROI) was detected by fMRI, including the right and left primary motor cortex (RMI and LMI), premotor cortex(RPMC and LPMC) and the supplementary motor area(SMA). Only the ROI in which CC≥0.6 and range exceeds 4 pixels was counted as an activated area. All the patients were punctured at S36 and G34 and the observation of changes of the surrounding area of the lesion site was conducted through fMRI. Results Of the 20 volunteers, functional MR images were obtained in 19 volunteers while doing the digital opposition movement task except one subject who failed doing so,showing the activation of RMI in 8 subjects,RPMC in 8,SMA in 9,LMI in 19,LPMC in 9. While being acupunctured, the fMR images of 4 volunteers were abandoned due to gross motion artifacts. For the remaining 16 subjects, activation was shown of RMI in 7 subjects,of RPMC in 11,of SMA in 9,of LMI in 11 and of LPMC in 13 subjects. The possibility of RMI activation by acupuncture was higher than by digital opposition movement( P 0.05 ). However, there was no significant difference between the acupuncture and digital opposition movement with regard to the activation of the other ROIs( P 0.05). In all the 17 patients, acupuncture at S36 and G34 obviously activated the areas surrounding the lesion site as shown with the fMRI brain mapping. Conclusion Functional MRI demonstrated the widely distributed response in human motor cortex to acupuncture at S36 and G34. These findings may shed light on the CNS mechanism of acupuncture effect. fMRI is valuable in exploring acupuncture mechanisms.

通过观察不同时间点乳猪脑出血模型血肿周围脑组织的损伤程度,旨在探讨最佳手术时机,为界定脑出血的治疗时机提供理论依据.

目的:阐明脑出血1～7 d时血肿周围水肿的演变规律和性质. 方法:将15只质量10～15 kg的仔猪动脉血2.5 mL注入右侧额叶,在24 h(n=15),72 h(n=9)和7 d(n=5)后用1.5T MR行FLAIR(液体衰减返转恢复快速自旋回波序列), DWI(弥散加权成像)和血肿周围组织的1H-MRS(质子波谱分析); 病理观察4只动物24 h时血肿周围组织对伊文思蓝的外渗以确定血脑屏障的完整性,同时对各时间点处死动物的脑组织进行常规病理观察. 结果:FLAIR显示24 h至7 d时血肿周围组织水肿严重,局部平均表观弥散系数(ADC)升高,24 h时灶周大量伊文思蓝外渗,但水肿区1H-MRS分析除1例大量出血者外均无乳酸峰. 结论:中等量脑出血时血肿周围以血管源性脑水肿为主,并未发现缺血性损害,但不排除大量出血时存在缺血性损害的可能性.

采用功能性磁共振成像(MR),研究猪脑叶出血超早期灶周水肿的演变及其性质.

目的观察脑出血急性期灶周水肿的演变规律和血肿抽吸引流术前后的影像学改变,探讨该手术治疗价值的理论依据.方法采取乳猪的自体血脑叶出血模型,以1.5T的MRI借助EPI等软件动态观察出血后0.5、3、24、48、72h脑水肿演变规律,并与对照组(注入凝血酶500U)比较.观察部分脑出血患者超早期血肿抽吸引流治疗的手术前后的CT变化及穿刺物检查.结果脑出血后1h血肿周围出现高信号区,而此时DWI未发现异常.动态MRI 序列提示出血后灶周水肿在48h达高峰.对照组0.5、3h水肿程度轻.3h脑大体标本可以看到血肿周围的半透明区.脑出血患者发病6h内CT可见明显的灶周水肿带,穿刺引流定位于血肿表层,可以抽出清亮液体5～11ml,检验提示为血清成分,复查CT示血肿周围水肿带缩小或消失.结论脑出血超早期灶周水肿与血块收缩有关,超早期血肿抽吸引流术能减轻细胞毒性脑水肿.