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Objective:To analyze the diagnosis and treatment process, treatment methods and clinical efficacy of children with refractory Tourette′s syndrome (TS), thus providing a basis for comprehensive prevention and treatment of refractory TS.Methods:A total of 90 children with refractory TS treated in the Child Mental Health Research Center of Nanjing Brain Hospital Affiliated to Nanjing Medical University from May 2012 to July 2019 were recruited.Their baseline characteristics, diagnosis of comorbidities before and after hospitalization, combined non-drug therapy during hospitalization, the drug types used before and after admission, the dosages of main anti-tic drugs used before admission and at discharge, and the treatment outcomes of comorbidities after admission were retrospectively analyzed.The Yale global tic severity scales (YGTSS) scores and the reduction rate were used to assess the severity of tic disorder and therapeutic effect, and the clinical global impression-efficacy index (CGI-EI) scores were graded for assessing the final therapeutic efficacy.Results:Among the 90 children with refractory TS, 82 children were males and 8 children were females.There was a significant difference in the YGTSS scores at admission and discharge (25.04±12.77 vs.67.64±12.46) ( t=27.55, P<0.05). The proportion of all recruited children diagnosed with comorbidities at discharge was significantly higher than that of admission (85.56% vs.47.78%, χ2=28.90, P<0.05). Combined non-drug therapies after admission mainly included psycho-education and supportive therapy (90 cases), comprehensive behavioral intervention for tics (47 cases) and relaxation therapy (19 cases). The distribution of drugs used before and after admission was the same, and there was no significant difference in the dosages of the five major anti-tic drugs before admission and at discharge (all P>0.05). There were no significant differences in YGTSS scores and reduction rate, and CGI-EI scores of children with or without comorbidities before and after admission (all P>0.05), suggesting the similar therapeutic outcomes. Conclusions:There is no difference in efficacy between outpatient treatment and anti-tic medication of children with refractory TS, and a comprehensive hospitalized intervention can significantly improve their clinical symptoms.Diagnosis and treatment of comorbidities and combined non-drug treatments like comprehensive psychological and behavioral interventions are the key events to improve the prognosis of children with refractory TS.
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Objective To explore the developmental characteristics of white matter volume in autism spectrum disorder (ASD) children longitudinal.Methods From May 2011 to September 2014,37 ASD children (ASD group)and 27 developmental delays (DD) children (control group) were treated at the Child Mental Health Research Center,Nanjing Brian Hospital Affiliated of Nanjing Medical University,and the children whose age,gender and developmental quotient matched with the ASD children were scanned by structure magnetic resonance imaging (sMRI) at the age of 2-3 years old and 4-5 years old respectively.Region of interest (ROI) technology was adopted to investigate the change of the cerebrum white and the sub-lobes structure white matter volume with time.Then the correlation between clinical symptoms and brain white matter volume changes was analyzed.Results Among the 2-3 years old,compared with the control group,the white matter volume of the total brain[(383 521.84 ±6 427.57) mm3 vs.(364 014.06 ±6 856.97) mm3],the left cerebral hemisphere [(191 609.35 ± 3 206.60) mm3 vs.(181 695.89 ± 3 389.54)mm3],temporal lobe [(41 860.49 ±816.38) mm3 vs.(39 444.18 ± 834.85) mm3] and the right temporal lobe [(21 312.79 ± 414.07) mm3 vs.(20 084.22 ± 412.13) mm3] were significantly larger in the ASD group,and the differences were statistically significant (all P ＜ 0.05).With the analysis of covariance with age or the total brain volume as the covariate,the differences disappeared(all P ＞ 0.05).Among the 4-5 years old,compared with the control group,the white matter volumes of the total brain[(417 651.42 ± 6 443.86) mm3 vs.(394 317.27 ± 6 404.86)mm3],left cerebral hemisphere [(208 714.16 ±3 214.61) mm3 vs.(197 192.82 ±3 262.02) mm3],right cerebral hemisphere [(208937.26±3242.09) mm3 vs.(7 124.45 ±3 193.13) mm3],frontal lobe [(107 107.46±1 681.99) mm3 vs.(100 326.19 ± 1 883.24) mm3],left frontal lobe [(54 569.63 ± 846.85) mm3 vs.(51 177.25 ±979.09) mm3],right frontal lobe [(52 537.83 ± 841.99) mm3 vs.(49 148.94 ±928.31) mm3],temporal lobe [(45 189.75 ± 833.29) mm3 vs.(42 487.73 ± 786.27) mm3],left temporal lobe [(22 204.21 ±411.77) mm3 vs.(20 922.90 ± 418.46) mm3],and right temporal lobe [(22 985.54 ± 426.93) mm3 vs.(21 564.83 ± 378.78) mm3]were significantly larger in the ASD group,and the differences were statistically significant (all P ＜ 0.05).With the analysis of covariance with age as the covariate,the differences still existed (all P ＜ 0.05).With the analysis of covariance with the total brain volume as the covariate,the differences disappeared (all P ＞ 0.05).For longitudinal analysis,there was a significant difference in the white matter volume between the whole brain,left cerebral hemisphere,right cerebral hemisphere,frontal lobe,left frontal lobe,fight frontal lobe,temporal lobe,left temporal lobe,right temporal lobe and the differences were statistically significant (F =5.521,5.533,5.459,5.830,5.800,5.723,4.857,4.418,5.159,all P ＜0.05).There was a positive correlation between the changes of the volume of whole brain,the white matter volume in the whole brain,bilateral cerebral hemisphere,frontal lobe,parietal lobe,right parietal lobe and Childhood Autism Rating Scale (r =0.367,0.343,0.321,0.349,0.296,0.308,0.351,all P ＜ 0.05).Conclusions Among the 2-3 years old,the white matter volume of the brain regions have been increased significantly in ASD.Among the 4-5 years old,the increase of the white matter volume of the brain regions implicated more widely which mainly concentrated in the frontal and temporal lobe in ASD.The severity of the clinical symptoms of ASD may be associated with the white matter volume of the total brain,bilateral cerebral hemisphere,frontal lobe,parietal lobe and right parietal lobe.
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Objective:To study the distribution and related factors of aggressive behavior among school aged children in Nanjing.Methods:Totally 4678 primary school students in Nanjing were sampled by cluster random sampling in this study.The General questionnaire and Achenbach's child Behavior Checklist were used to investi gate the general situation and aggressive behavior.Results:The rate of aggressive behavior of school-age children in Nanjing was 3.6 ％ (167/4678).Multivariate logistic regression analysis indicated that democratic parenting style [other parenting styles (OR =1.94,95％ CI =1.10-3.42),mixed parenting style(OR =1.96,95％ CI =1.35-2.85)],and genetic screening before birth (OR =0.71,95％ CI =0.52-0.99) were protective factors for children's aggressive behavior.The factor figures of aggressive behavior were positively correlated with that of oth er behavior problems in Pearson correlation analysis (r =0.52-0.80,Ps ＜0.01).Conclusion:About 3.6％ of the school aged children in Nanjing have aggressive behavior.It is more likely to have aggressive behaviors for children who is in other parenting styles except the democratic style and never have the genetic screening before birth.And children who with aggressive behavior may co-occur with other behavior problems.
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This report deals with the brain and spinal cord of a porencephalic nursling of 8months. Intermittent serial colloidin sections were cut and stained by Nissl and Weiltechniques. The left cerebral hemisphere is smaller with deeper sulci and narrower gyri. Theinsular lobe is non-existent; and the frontal parietal and temporal opercula are all miss-ing. A cavity underlies this region and communicates with the lateral ventricle beingcovered Iaterally by a thickened membrane about 4?0.8 cm in area. Most of the front-al, parietal and temporal lobes and the whole occipital lobe are present. The left pyramidal tract is undeveloped. Compensatory hypertrophy is shown byvarious central structures such as the right pyramidal tract (together with the aberrantpyramidal bundles), and the extrapyramidal gray masses-lenticular, caudate and sub-thalamic nuclei and substantia nigra. In the cerebellar system, the brachium conjunc-tivum on the left side and the red nucleus and the inferior olivary nucleus on the rightare over-developed. Other hypertrophied structures include the left gracile and cuneatenuclei, the right lemniscus medialis, together with the anterior funiculus, posterior hornand the nucleus dorsalis in the right half of the spinal cord. The postnatal heightened use of bodily organs naturally induces an over-developmentof, besides others, the central structure. With a short life-span and retarded develop-ment, the present case had a too limited activity to influence the size of its central or-gans. Moreover, a number of central nuclear masses manifest a compensatory enlarge-ment, thus indicating a heightened mitotic activity of the nerve cells in the embryonicperiod. This hypertrophy is, them, largely prenatal. The current theories of compensation such as self-regulation, substitution and trans-fer of functions, are not explanatory and, thus, unsatisfactory. Behind such concepts,there shou1d exist a more fundamental and yet unspecified factor of growth. The pre-sent study has demonstrated more facts of compensatory development than the previousauthors. As to the theories of compensation, it is better to reserve a definite judgement.