Abstract:癫痫是儿童神经系统常见疾病之一，其发病原因、临床表现及治疗原则较成人癫痫具有明 显差异。随着抗癫痫药物的不断创新、扩展及人们对癫痫的深入研究，大多数癫痫患儿可以得到理想的 控制，但仍有部分患者经药物治疗无效而成为难治性癫痫，是外科干预治疗的潜在目标。近年来手术治 疗难治性癫痫的技术得到迅速发展，特别是针对儿童难治性癫痫的手术治疗取得重大突破。目前用于儿 童癫痫的外科治疗方法主要有切除性手术、毁损性手术、阻断通路手术和神经调控手术等。

Abstract:Objective　To study the effects and mechanism of olanzapine on energy consumption and glucose metabolism in male mice. Methods　Ten C57BL/6J male mice were randomly divided into two groups. The mice in two groups were given olanzapine or its solvent by gavage separately for 2 weeks. Food intake, body weight, fasting blood glucose, glucose tolerance and insulin tolerance were recorded. Energy consumption of 24 h was monitored. And expressions of hepatic glucose metabolism related genes were compared. Results　 After administration of olanzapine for two weeks, insulin resistance and hyperglycemia were observed, oxygen and energy consumptions were significantly decreased during the daytime, and respiratory exchange ratio showed a downward trend which indicated that the oxidized substrates were transferred from glucose to fat. And mRNA levels of phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G-6-pase) were significantly increased. Conclusions　Olanzapine-induced hyperglycemia may not dependent on hyperphagia and weight gain. Olanzapine can directly induce insulin resistance and promote hepatic gluconeogenesis.

Abstract:Objective　To investigate the effects of tetrahydroxy-stilbene glucoside (TSG) on the behavioral and pathological changes in A53T mutant α-synuclein (α-syn) transgenic mice. Methods　Six months old A53T α-syn transgenic mice were divided into model group (Tg+ group)， model+ low dose group (50 mg/kg) and model+high dose group (100 mg/kg). Brood negative transgenic mice were divided into control group (Tg-) and high dose group (100 mg/kg). The administration groups were given TSG by gavage everyday for 9 months， while the control and model groups were given equal volume of distilled water. The movement abilities of mice were measured by pole test and nest building test. The immunohistochemical method was used to detect tyrosine hydroxylase (TH)-labeled neurons in the substantia nigra of mice. Results　Compared to negative transgenic mice， the latency prolonged in pole test and the score of nest building were decreased， and the number of TH positive neurons were declined in substantia nigra compacta of A53T α-syn transgenic mice. Intragastrical administration of TSG for 9 months significantly shortened the latency in pole test， increased the score of nest building， and increased the number of TH positive neurons in substantia nigra compacta of α-syn transgenic mice. Conclusions　TSG could obviously improve the motor function and increase the number of dopaminergic neurons in substantia nigra of A53T α-syn mice. It is suggested that TSG may be beneficial to the treatment of synuclein-related neurodegenerative diseases such as Parkinson disease.

Abstract:Objective　To explore the related risk factors of subjective cognitive impairment (SCI) to provide references for prevention. Methods　Fifty-four patients admitted to Shanghai Changzheng Hospital from March to September of 2016 were evaluated by Mini-mental State Examination (MMSE) and self-made questionnaire. Univariate and multivariate logistic regression analyses were performed on related exposure factors. Results　By univariate and multivariate logistic regression analyses， three meaningful independent factors were screened out. Age (OR=1.243， 95%CI=1.072-1.442) and history of cerebrovascular diseases (OR=130.466， 95%CI=1.688-3 630.660) were independent risk factors of SCI， while education level (OR=0.016， 95%CI=0.007- 0.607) was an independent protective factor. Conclusions　Age and history of cerebrovascular diseases are risk factors of SCI. It’s necessary to enhance the prevention of the risk factors. Education level is an independent protective factor. So the aged people should be advocated and encouraged to use their brains and think more.

Abstract:Objective　To explore the coping style of patients with depression and bipolar disorder， and the association between bipolar disorder and coping style. Methods　The study was designed as a cross-sectional case-control study. 144 patients with bipolar disorder， 189 patients with recurrent depression and 123 healthy controls were enrolled. Trait Coping Styles Questionnaire (TCSQ) was used to evaluate the coping style of all participants. Results　Compared to control group， patients in both bipolar disorder group and recurrent depression group scored significantly differentially in terms of coping style (P＜ 0.01). The score of positive coping style was significantly higher in bipolar disorder group than depression group (P＜ 0.01). In bipolar disorder group and recurrent depression group， patients in non-remission period showed higher negative coping style score and lower positive coping style score than those in remission period. In Logistic analysis， while controlled the effect of age and disease status， positive coping style was a risk factor of bipolar disorder (OR=1.064， 95%CI=1.026-1.102). The predictive rate of logistic regression equation was 64.3%. Conclusions　Compared with recurrent depression， patients with bipolar disorder might use relatively positive coping style. The patients with depressive episode who use relatively positive coping style are more likely to develop bipolar disorder.

Abstract:Objective　To confirm the clinical features and therapeutic efficacy of botulinum toxin type A(BTX-A)for hemifacial spasm(HFS) and benign essential blepharospasm(BEB) patients. Methods　Totals of 110 HFS patients and 90 BEB patients from Department of Neurology， Renmin Hospital of Wuhan University between April 2013 and October 2013 were included in this cross-section study. All patients were instructed to be reviewed in the second week after BTX-A injection. The duration of effects of BTX-A injection was recorded. Results　(1) Of 200 patients who were included， the mean duration was 61.6 months. The onset time was 0-30 d (median 4 d). The duration of response was 2-128 weeks (median 16 weeks). Of all patients， the effective rate was 96.9%， while 99.3% for HFS patients and 90.2% for BEB patients. Patients with HFS received a lower mean dose of BTX than patients with BEB［ (53.2±15.8)U vs (74.8±20.2)U］. And patients with HFS had a longer treatment duration than patients with BEB［(20.3±10.2)weeks vs (13.6±5.5)weeks］. (2) BTX-A injection was the most commonly used treatment (70.9%)， followed by acupuncture (68.2%) and oral medication (65.5%) in HFS patients. Most patients gave up acupuncture and oral medication because of the ineffectiveness. In BEB patients， BTX-A injection was the most commonly used treatment (88.9%)， followed by oral medication (86.7%) and orbicularis oculi myectomy (31.3%)， whereas orbicularis oculi myectomy was not effective. Conclusions　HFS and BEB are most common diseases in movement disorder clinic. BTX-A treatment is safe and effective for both BEB and HFS， with better effect for HFS. BEB patients require more frequent injections， highlighting that facial dystonia in patients with BEB is more challenging to manage.

Abstract:Objective To investigate the relationship between cognitive function and eventrelated potential P300 in male long-term hospitalized patients with schizophrenia. Method Totals of 82 male long-term hospitalized patients with schizophrenia and 52 healthy controls were recruited. The eventrelated potential P300 was analyzed by the United States Nicolet Viking Quest evoked potential instrument. The cognitive function was tested by animal naming test， category fluency test， digital cancellation test， trail taking test (TMT-A， TMT-B)， stroop test (word， colour， word-colour interference test)， block design test and WMS-Ⅲ spatial span test. Results There were significant differences between patient group and control group in all items of cognitive function assessment scales (P＜ 0.01) . There were longer latency of P300 (t=22.990， P ＜ 0.01) and lower amplitude of P300 (t=-9.699， P ＜ 0.01) in patient group than that in control group. The P300 latency was positively correlated with digital cancellation test and the score of TMT-A in patient group (r=0.481，P＜0.01； r=0.245，P＜0.05). Moreover， P300 amplitude was negatively correlated with digital cancellation test in patient group (r= -0.338， P＜0.01). Conclusion The male long-term hospitalized patients with schizophrenia still have cognitive impairment， even when their psychiatric symptoms are stable. The latency and amplitude of event-related potential P300 may be an electrophysiological marker of cognitive function in schizophrenic patients， which were correlated with the results in the cognitive assessment scales.

Abstract:Objective　To investigate the distribution of serum folate， vitamin B12 and ferritin in patients with schizophrenia. Methods　Blood samples were collected from 1 042 patients with schizophrenia. Levels of serum folate， vitamin B12 and ferritin were detected by electrochemiluminescence immunoassay. Results 　The prevalence of low vitamin B12， folate and ferritin levels in schizophrenia patients was generally higher than 5%. And the prevalence of low folate was as high as 38.29%. The prevalence of low vitamin B12 was about 18.14%. There were gender differences in levels of folate (t=-5.83，P＜ 0.01)， and age differences in levels of vitamin B12 (t=2.08，P＜ 0.05) in patients with schizophrenia. Conclusions　The prevalence of low serum vitamin B12， folate and ferritin levels in patients with chronic schizophrenia is high， which need to be actively concerned about.

Abstract:Objective To study the effects of pioglitazone (PGZ) on the expressions of 11β-hydroxysteroid dehydrogenase type 1(11β-HSD1) in central nervous system of diabetic rats and its asociation with cognitive function. Methods Thirty male SD rats were equally randomized into Control group (C group)， Diabetic group (D group) and Diabetes+Pioglitazone group (DP group). Morris-water maze was used to test the cognitive function after 8 weeks. Western Blot was used to detect the expressions of 11β-HSD1 in hippocampus and hypothalamus. Results In Morris water maze， the number of crossing the platform in D group were significantly less than C group and DP group (P＜ 0.01). The 11β-HSD1 expressions in hippocampus and hypothalamus of D group were significantly increased than C group and DP group， while the 11β-HSD1 expressions of DP group were significantly increased than C group (P＜ 0.01). Conclusion Pioglitazone may improve cognitive function in diabetic rats， partly through the decrease of 11β-HSD1 expressions in hippocampus and hypothalamus.

Abstract:Objective　To evaluate the efficacy of injectable botulinum toxin type A on muscle spasms and motor function in subacute and convalescent stroke patients. Methods　From June 2013 to January 2016， 86 stroke patients were included in this study. They were divided into subacute group (＜ 1 month， n=37) and convalescent group (≥ 1 month，n=49) according to the length of disease history. Modified Ashworth Scale (MAS)， Modified Tardieu Scale (MTS)， Manual Muscle Test (MMT)， Passive Range of Motion (PROM)， Barthel index and Fugl-Meyer scale were evaluated after intramuscular injection of 200 U botulinum toxin for 4 weeks. Results　All patients were successfully treated. The follow-up time was 26 d (22 ~ 30 d) and 29 d (24 ~ 31 d) separately， with no significant differences (Z=1.332，P=0.307). The MAS scores of subacute group in elbow and wrist were improved after treatment (P＜ 0.05)， but there was no significant difference in convalescent group (P＞ 0.05). Subacute group was significantly superior to convalescent group (P＜ 0.05). The elbow R1， D and wrist R1 after treatment in subacute group were improved (P＜ 0.05). Elbow R1， D and wrists R1 of MTS in convalescent group were improved after treatment (P＜ 0.05). Wrist R1， R2 of subacute group were significantly superior to convalescent group (P＜ 0.05). In the subacute group， the PROM abduction and activity of the wrist were improved (P＜ 0.05). There was no significant improvement in convalescent group after treatment. The recovery of the wrist in subacute group was better than that in convalescent group (P＜ 0.05) . The Barthel index， Fugl-Meyer in subacute group and Fugl-Meyer of convalescent group were higher after treatment. But there was no significant difference between two groups (P＞0.05). Conclusions　Botulinum toxin can ameliorate the spasticity and function in patients with subacute and convalescent stage of stroke， but the effect for subacute stage is more obvious.

Abstract:Objective　To investigate the clinical significance of pseudocapsule based extracapsular resection of pituitary adenomas. Methods　Totals of 173 patients who underwent tumor resection from April 2015 to July 2016 were selected. All patients were divided into two groups according to pseudocapsule based extracapsular or intracapsular resection. Total removal rate， biology cure rate and complications were evaluated. Results　In the 173 patients， pseudocapsule was found in 90 patients (52.0%) and mostly was found in non-functional and growth hormone secreting pituitary adenoma. No significant differences were found in total removal rate between extracapsular resection group (95.6%) and intracapsular resection group (88.0%). In patients with functional pituitary adenoma， biology cure rate of patients in extracapsular resection group was significantly higher than those in intracapsular resection group (89.7% vs 71.4%，χ2=4.279，P ＜ 0.05). The incidence of cerebrospinal fluid leak during surgery was 47.8% and 41.0% in extracapsular resection group and intracapsular resection group respectively. No cerebrospinal fluid leak was found after surgery. Postoperative pathology confirmed that pseudocapsules had tumor cell infiltration. Conclusions　Pseudocapsule based extracapsular resection is effective and safey for pituitary adenoma. It could increase total removal rate and increase biology cure rate in patients with functional pituitary adenoma without increasing postoperative complications.

Abstract:Objective　To explore the application and clinical significance of one stop whole brain dynamic volume CTP-CTA imaging in cerebral vasospasm after traumatic brain injury. Methods　Totals of 50 patients with suspected symptomatic cerebral vasospasm were treated with one stop whole brain dynamic volume imaging. The results of CTP were compared with that of the contralateral mirror area. Results　In 50 patients， 48 showed low perfusion areas outside the scope of brain injury which was consistent with clinical symptoms. The accuracy rate was 96%. There were significant differences in cerebral blood flow (CBF)， cerebral blood volume (CBV)， time-to-peak (TTP) and mean transit time (MTT) compared to the contralateral mirror area. In 50 traumatic brain injury patients， 42 showed intracranial vasospasm of great vessels in 3D-CTA. Conclusions　One-stop whole brain dynamic volume CTP-CTA imaging could be applied in evaluating cerebral vasospasm after traumatic brain injury. Microcirculation vasospasm in brain parenchyma could be detected by low perfusion cerebral area in CTP. Vasospasm of great vessels outside brain parenchyma could be detected by CTA. Therefore， CTP combined with CTA has significant clinical value in early diagnosis， selection of treatment options and evaluation of efficacy for cerebral vasospasm after traumatic brain injury.

Abstract:Objective　To summarize the curative effect and surgical skills of microvascular decompression( MVD) via keyhole for the treatment of cranial neuropathy. Methods　Totals of 513 cases of primary cranial neuropathy under MVD treatment between January 2005 and January 2016 were retrospectively analyzed， which included 263 trigeminal neuralgia cases， 234 hemifacial spasm cases and 16 glossopharyngeal neuralgia cases. The surgical techniques and prevention of postoperative complications were analyzed. Results　There was no death or other severe complications in our group．The postoperative cure rate with trigeminal neuralgia was 94.67％，97.01% with hemifacial spasm and 75.00% with glossopharyngeal neuralgia. Conclusions　MVD is a reliable method for primary cranial neuropathy，what is more， skilled microsurgical techniques， rich microsurgical experience and familiarity with the anatomy are the foundation of the surgical treatment for cranial neuropathy.

Abstract:目的　探讨易肇事肇祸严重精神障碍患者在村医全程督导服药管理下的效果。方法　在石家庄市随机选取2个县（区）作为试点，对登记在册的严重精神障碍患者进行筛查，采用社会功能缺陷 量表（SDSS）、患者危险性评估表（参照《重性精神疾病管理治疗工作规范（2012年版）》危险性评估）分别在 入组时以及干预后3，6，9，12个月时，对患者的社会功能和危险性进行评定，并比较两组患者的再入院率。 结果　干预9个月后干预组的SDSS评分明显优于对照组，干预6个月后干预组的危险性等级明显低于对 照组，两组差异均有统计学意义（P ＜ 0.01）；干预其间，干预组中12例次（12.12%）再次住院接受治疗，对 照组有65例次（66.33%），两组差异有统计学意义（χ2=60.777，P ＜ 0.01）。结论　对易肇事肇祸严重精神 障碍患者进行全程督导服药管理能够改善患者的社会功能，降低患者的危险性分级，减少对家庭社会的 影响，降低患者的再住院率。

Abstract:目的　探讨百乐眠胶囊治疗老年脑卒中后失眠的临床疗效及可能作用途径。方法　将120例 老年脑卒中后失眠患者分为研究组和对照组，各60例，分别给予百乐眠胶囊和艾司唑仑治疗。8周治疗 后观察患者的匹兹堡睡眠质量指数(PSQI)、多导睡眠图指标及脑内神经递质水平的情况。结果　研究 组的治疗效果优于对照组(P ＜ 0.05)。研究组患者治疗后脑内5-羟色胺(5-HT)水平及γ-氨基丁酸/谷 氨酸(GABA/Glu)比值均高于治疗前和对照组治疗后，差异有统计学意义(P ＜ 0.05)。两组患者治疗后的 PSQI得分、入睡时间、觉醒次数和浅睡眠时间均较治疗前明显降低，而总睡眠时间和深度睡眠时间均较 治疗前明显增加(P ＜ 0.05)，但组间比较差异无统计学意义(P ＞ 0.05)。结论　百乐眠胶囊能有效改善老 年脑卒中失眠患者脑内的神经递质水平，从而提高睡眠质量。

Abstract:目的　探讨岛叶癫痫症状学特点，为临床诊断提供思路。方法　回顾分析20例确诊的 岛叶癫痫患者临床资料，结合文献复习，总结岛叶癫痫先兆、传播途径、有定侧定位意义的症状等。 结果　所有患者均有先兆，种类多样，其中躯体感觉异常6例，内脏感觉异常12例，味觉异常1例，不能 描述1例。继发症状中过度运动13例，不对称强直9例，“军帽征”12例，口咽手自动症5例。先兆起始后 沿不同的途径传播引起多种临床症状。结论　先兆中喉部发紧感提示岛叶癫痫，躯体感觉症状先兆有一 定的定侧意义，心率异常可能有定侧意义。继发症状中，“军帽征”是岛叶癫痫常见的传播症状，过度运 动和非对称强直对定位定侧有一定意义。

Abstract:病历书写是住院医师规范化培训的基础。掌握神经内科疾病的病历书写和诊疗思路是住 院医师必经的临床训练。结合首都医科大学宣武医院神经内科对住院医师培训的实践和经验，我们认为 病历书写从基础到专病，从集中到个体化循序渐进的培训和考核、监控方法，有助于神经内科医师临床 思维能力培养和临床水平的提高。

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