盐酸多奈哌齐联合盐酸川芎嗪治疗轻、中度血管性痴呆疗效观察

血管性痴呆（vascvlar dementia，VD）是由脑血管病变引起的脑组织供血障碍，导致脑功能衰退，临床上以多种认知缺陷和皮层功能损害为主要表现。盐酸多奈哌齐（Donepezil）为中枢乙酰胆碱酯酶选择性抑制剂，对中枢神经系统有较强的选择性，Román等[1]报道VD患者服用盐酸多奈哌齐后，认知功能较治疗前有显著改善。盐酸川芎嗪化学名称为2，3，5，6-四甲基吡嗪盐酸二水合物，为血管扩张剂，对治疗脑栓塞及其他缺血性血管疾病有效。笔者通过联合使用盐酸多奈哌齐与盐酸川芎嗪治疗VD，探讨该治疗方案对轻、中度VD患者的近期疗效，现报道如下。     

不同病期帕金森病患者睡眠障碍相关因素分析

目的探讨不同病期帕金森病患者睡眠障碍的发生率和相关因素。方法选取帕金森病患者60例，采用简明精神状态量表（MMSE）、Hoehn- Yahr分期(H- Y stage)、统一帕金森病评定量表（UPDRS）、汉密尔顿抑郁量表（HAMD）、匹兹堡睡眠质量指数量表（PSQI）分别评价患者认知功能、帕金森病疾病严重度、情绪状态以及睡眠质量。结果帕金森病患者睡眠障碍的发生率为78.3%，其中H- Y分期1~2期发生率为75.0%，2.5~3期发生率为65.0%，4期及以上发生率为95.0%，不同分期的患者睡眠障碍发生率的差异无统计学意义（P＞0.05）。女性睡眠障碍的发生率较男性高。多因素协方差分析显示睡眠障碍与性别、H- Y分期、HAMD分值呈正相关。睡眠障碍组与无睡眠障碍组患者在主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠干扰、催眠药物这6个因子的差异均有统计学意义（均P＜0.05）。结论睡眠障碍是帕金森病患者重要的非运动症状，在疾病的不同阶段均可发生，严重影响患者的生活质量。     

A Density Functional Study for the Reaction Mechanism of CO Oxidation on the Copper Cluster

We have studied the reaction mechanism of CO oxidation on the Cu_(13) cluster via density functional theory. There are two main reaction pathways to be considered: Eley-Rideal(ER) and Langmuir-Hinshelwood(LH) mechanisms, respectively. According to these two main reaction mechanisms, we have obtained five reaction pathways for the first CO oxidation(denoted as R_(ER1),R_(ER2), R_(LH1), R_(LH_2) and R_(LH3), respectively): R_(ER1) is CO_(gas) + O_(2(ads)) → O(ads) + CO_(2(gas)); R_(ER2) is CO_(gas) + O_(2(ads)) → CO_(3(ads)) → O(ads) + CO_(2(gas)); R_(LH1) refers to CO(ads) + O_(2(ads)) → O(ads) + CO_(2(gas)); R_(LH_2) refers to CO(ads) + O_(2(ads)) → OOCO(ads) → O(ads) + CO_(2(gas)) and R_(LH3) refers to O_(2(ads)) + CO(ads)→ O(ads) + O(ads) + CO(ads) → O(ads) + CO_(2(gas)). These pathways have low energy barriers and are strongly exothermic, suggesting the Cu_(13) cluster is very favorable catalyst for the first CO oxidation. However, there are higher energy barriers of 99. 8 and 45.4 kJ/mol in the process of producing and decomposing intermediates along the R_(LH_2) and R_(ER2), indicating that R_(ER1), R_(LH1) and R_(LH3) are superior pathways with lower energy barriers, especially the R_(ER1) channel. Thereafter, the second CO is more prone to react with the remaining oxygen atom on Cu_(13) along the ER channel in comparison with the LH pathway, in which the moderate barrier is 70.0 kJ/mol and it is exothermic by 59.6 kJ/mol. Furthermore, the interaction between the absorbate and cluster is analyzed by electronic analysis to gain insights into high activity of the copper cluster.