While experimental studies in the monkey have shown that motor recovery after partial destruction of the hand motor cortex was based on adjacent motor reorgan ization, functional MRI (fMRI) studies with isolated prima...While experimental studies in the monkey have shown that motor recovery after partial destruction of the hand motor cortex was based on adjacent motor reorgan ization, functional MRI (fMRI) studies with isolated primary motor cortical stro ke have not yet been reported in I humans. Based on experimental data, we design ed a study to test if recovery after stroke within primary motor cortex (M1) was associated with reo rganization within the surrounding motor cortex, i.e. the motor cortex was able to vicariate. Since motor recovery is time-dependent and might be inflected acc ording to the tested task, the delay after stroke and two motor tasks were inclu ded in our design. We examined four patients with one ischaemic stroke limited t o M1, and four sex-and age-matched healthy controls in a temporally balanced p rospective longitudinal fMRI study over three sessions:< 20 days, 4 months and 2 years after stroke. The paradigm included two motor tasks, finger tapping (FT) -and finger extension (FE). Distinct patterns of motor activation were observed with time for FT and FE. At the first session, FT-related activation was later alized in the ipsilateral hemisphere while FE-related activation was contralate ral, involving bilateral cerebellar regions for both tasks. From 4 months, skill ed motor recovery was associated with contralateral dorsal promoter and sensorim otor cortex and ipsilateral cerebellum motor-related activations, leading to la teralized motor patterns for both tasks. For the left recovered hand, FT and FE -related activations within M1 were more dorsal in patients than in controls. T his dorsal shift progressively increased over 2 years, rejecting functional reor ganization in the motor cortex adjacent to the lesion. In addition, patients sho wed a reverse representation of FT and FE within M1, corresponding to a greater dorsal shift for FT than for FE. TMs functional dissociation might reflect the s tructural subdivision of M1 with two distinct finger motor representations withi n M1. Recovery of FT, located within the lesioned depth of the rolandic sulcus i n controls, might be related to the re-emergence of a new representation in the intact dorsal M1, while FE, located more dorsally, underwent minor reorganizati on. This is the first fMRI study of humans presenting with isolated M1 stroke co mparable with experimental lesions in animals. Despite the small number of patie nts, our findings showing the re-emergence of a fingers motor task in the intac t dorsal M1 instead of in ventral M1 are consistent with ‘vicariation’models o f stroke recovery.展开更多
目的:探讨血清炎性因子降钙素原(Procalcitonin,PCT)、白细胞介素-6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)联合检测对老年肝功能失代偿期肝癌患者发生感染的预测效能。方法:选取我院2019年9月至2021年9月就诊的158...目的:探讨血清炎性因子降钙素原(Procalcitonin,PCT)、白细胞介素-6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)联合检测对老年肝功能失代偿期肝癌患者发生感染的预测效能。方法:选取我院2019年9月至2021年9月就诊的158例肝功能失代偿期肝癌患者作为研究组,另选取同期79名健康体检者作为对照组。入院时,抽取患者外周静脉血,全自动微生物分析仪分离并鉴定病原菌感染和分布情况,电化学发光法测定患者血清PCT水平;免疫比浊法测定患者血清CRP水平,酶联免疫吸附法测定患者血清IL-6水平,比较研究组、对照组及研究组中感染患者、未感染患者血清PCT、IL-6、CRP水平,Logistic回归方程分析上述指标与发生感染的关系,受试者工作特征曲线(Receiver operating characteristic,ROC)及曲线下面积(Area under the ROC curve,AUC)分析其对发生感染的预测价值。结果:入院时,研究组血清PCT、IL-6、CRP水平高于对照组(P<0.05);研究组中共43例发生感染,感染病原菌以金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌为主,分别占22.92%、27.08%、18.75%;研究组中感染患者血清PCT、IL-6、CRP水平高于未感染患者(P<0.05);Logistic回归分析显示,入院时血清PCT、IL-6、CRP水平与失代偿期肝癌患者发生感染具有显著相关性(OR=12.346、8.682、10.554,P<0.05);入院时血清PCT、IL-6、CRP水平对失代偿期肝癌患者发生感染的预测AUC分别为0.872、0.789、0.848,联合预测AUC为0.923,联合预测AUC大于单一指标。结论:血清PCT、IL-6、CRP水平变化与老年肝功能失代偿期肝癌患者发生感染密切相关,临床可通过联合检测血清PCT、IL-6、CRP水平可早期预测失代偿期肝癌是否发生感染,以针对性制定干预措施。展开更多
文摘While experimental studies in the monkey have shown that motor recovery after partial destruction of the hand motor cortex was based on adjacent motor reorgan ization, functional MRI (fMRI) studies with isolated primary motor cortical stro ke have not yet been reported in I humans. Based on experimental data, we design ed a study to test if recovery after stroke within primary motor cortex (M1) was associated with reo rganization within the surrounding motor cortex, i.e. the motor cortex was able to vicariate. Since motor recovery is time-dependent and might be inflected acc ording to the tested task, the delay after stroke and two motor tasks were inclu ded in our design. We examined four patients with one ischaemic stroke limited t o M1, and four sex-and age-matched healthy controls in a temporally balanced p rospective longitudinal fMRI study over three sessions:< 20 days, 4 months and 2 years after stroke. The paradigm included two motor tasks, finger tapping (FT) -and finger extension (FE). Distinct patterns of motor activation were observed with time for FT and FE. At the first session, FT-related activation was later alized in the ipsilateral hemisphere while FE-related activation was contralate ral, involving bilateral cerebellar regions for both tasks. From 4 months, skill ed motor recovery was associated with contralateral dorsal promoter and sensorim otor cortex and ipsilateral cerebellum motor-related activations, leading to la teralized motor patterns for both tasks. For the left recovered hand, FT and FE -related activations within M1 were more dorsal in patients than in controls. T his dorsal shift progressively increased over 2 years, rejecting functional reor ganization in the motor cortex adjacent to the lesion. In addition, patients sho wed a reverse representation of FT and FE within M1, corresponding to a greater dorsal shift for FT than for FE. TMs functional dissociation might reflect the s tructural subdivision of M1 with two distinct finger motor representations withi n M1. Recovery of FT, located within the lesioned depth of the rolandic sulcus i n controls, might be related to the re-emergence of a new representation in the intact dorsal M1, while FE, located more dorsally, underwent minor reorganizati on. This is the first fMRI study of humans presenting with isolated M1 stroke co mparable with experimental lesions in animals. Despite the small number of patie nts, our findings showing the re-emergence of a fingers motor task in the intac t dorsal M1 instead of in ventral M1 are consistent with ‘vicariation’models o f stroke recovery.
文摘目的:探讨血清炎性因子降钙素原(Procalcitonin,PCT)、白细胞介素-6(Interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)联合检测对老年肝功能失代偿期肝癌患者发生感染的预测效能。方法:选取我院2019年9月至2021年9月就诊的158例肝功能失代偿期肝癌患者作为研究组,另选取同期79名健康体检者作为对照组。入院时,抽取患者外周静脉血,全自动微生物分析仪分离并鉴定病原菌感染和分布情况,电化学发光法测定患者血清PCT水平;免疫比浊法测定患者血清CRP水平,酶联免疫吸附法测定患者血清IL-6水平,比较研究组、对照组及研究组中感染患者、未感染患者血清PCT、IL-6、CRP水平,Logistic回归方程分析上述指标与发生感染的关系,受试者工作特征曲线(Receiver operating characteristic,ROC)及曲线下面积(Area under the ROC curve,AUC)分析其对发生感染的预测价值。结果:入院时,研究组血清PCT、IL-6、CRP水平高于对照组(P<0.05);研究组中共43例发生感染,感染病原菌以金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌为主,分别占22.92%、27.08%、18.75%;研究组中感染患者血清PCT、IL-6、CRP水平高于未感染患者(P<0.05);Logistic回归分析显示,入院时血清PCT、IL-6、CRP水平与失代偿期肝癌患者发生感染具有显著相关性(OR=12.346、8.682、10.554,P<0.05);入院时血清PCT、IL-6、CRP水平对失代偿期肝癌患者发生感染的预测AUC分别为0.872、0.789、0.848,联合预测AUC为0.923,联合预测AUC大于单一指标。结论:血清PCT、IL-6、CRP水平变化与老年肝功能失代偿期肝癌患者发生感染密切相关,临床可通过联合检测血清PCT、IL-6、CRP水平可早期预测失代偿期肝癌是否发生感染,以针对性制定干预措施。
