中老年缺血性脑梗死复发的临床特点及危险因素

缺血性脑梗死是神经系统的常见病与多发病,因患者脑部血流供应障碍导致局部脑组织缺血、缺氧性坏死,是一种致残率很高的疾病[1].近几年来,随着社会的发展及人口老龄化,我国脑梗死的发病率逐年升高.本文拟分析老年缺血性脑梗死复发的临床特点,探讨复发的危险因素.     

依达拉奉治疗进展性脑梗死35例临床观察

急性脑梗死是因脑部血液循环障碍导致局部神经功能缺失为特征的一种疾病,是神经内科常见病,具有发病率高、死亡率高、致残率高的特点.进展性脑梗死是一种特殊形式,是指脑梗死发病6h后,局限性脑缺血症状逐渐进展,呈阶梯式加重,这是脑梗死致残的主要原因,也是脑血管疾病治疗的难点.进展性脑梗死临床常见,发病率高,为26％～43％[1],常规抗凝、降纤治疗效果差.采用新型自由基清除剂依达拉奉治疗进展性脑梗死,观察其有效性及安全性.     

高频超声检测颈动脉粥样硬化与脑梗死相关性探讨

目的 探讨颈动脉粥样硬化与脑梗死的相关性.方法 应用高频超声对150例脑梗死患者和100名健康者进行颈动脉超声检查,测量颈动脉内径、内-中膜厚度,有无斑块,斑块分布部位、大小及内部回声特点,观测颈动脉内部及血流情况、收缩期血流峰值速度(PSV)、血流阻力指数(RI)、S/D值,并将脑梗死患者颈动脉超声检查结果与脑部CT或磁共振成像(MRI)检查结果比较.结果 脑梗死组与对照组颈动脉粥样硬化阳性率(尤其是软斑阳性率)差异有统计学意义(P<0.05),脑梗死部位与颈动脉粥样硬化斑块(特别是软斑)的侧向符合率高.结论 颈动脉粥样硬化与脑梗死密切相关.     

脑梗死的社区防治

脑梗死又称缺血性脑卒中，是指由于脑部血液供应障碍、缺血、缺氧引起的局限性脑组织的缺血性坏死或脑软化。脑梗死的临床常见类型有脑血栓形成、腔隙性梗死和脑栓塞等。脑梗死约占全部脑卒中的80％。     

颈动脉粥样硬化与脑梗死发生及预后关系的概述

颈动脉粥样硬化病变常可导致脑部供血异常,是引起缺血性脑病的重要原因,颈动脉闭塞、粥样斑块或血栓的脱落则可引起脑梗死.约68%缺血性脑血管疾病伴有颈动脉粥样硬化[1].     

脑梗死200例临床分析

脑梗死是指脑部血液供应障碍、缺血、缺氧引起脑组织坏死、软化而言，是脑血管病中最常见者。现将我院近年来收住院经CT确诊为脑梗死病例200例做一临床分析，探讨脑梗死的发病因素、临床特点，以便在今后的临床工作中及时预防和合理治疗。     

脑梗死治疗进展

脑梗死又称缺血性脑卒中,是指由于脑部血液供应障碍、缺血、缺氧引起的局限性脑组织的缺血性坏死或脑软化。脑梗死约占全部脑卒中的80％。脑梗死具有高发病率、高病死率、高致残率、高复发率等特点。为了提高治愈率,降低病死率,本文就脑梗死近几年治疗进展情况综述如下,为临床治疗提供参考。     

急性脑梗死的血管再通治疗

脑梗死是指各种原因引起的脑部血液供应障碍,使局部脑组织发生不可逆损害,导致脑组织缺血、缺氧性坏死。急性脑梗死后早期血管再通和再灌注被广泛证明能够短期内恢复脑功能。临床和基础研究均证明,早期的血管再通,使得处于缺血半暗     

老年出血性脑梗死患者相关危险因素

出血性脑梗死即患者发生脑梗死之后再出现脑部出血,老年人出血性脑梗死的发病率较高,这与老年患者血管弹性减弱有关,且老年患者多半有高血压、高血糖等慢性疾病,使出血的风险明显增大,脑出血致残率极高,而且有很大的致死率,所以应该引起临床医生的高度重视。出血的发生与梗死面积、血     

静息性脑梗死的研究进展

正静息性脑梗死(silent brain infarction,SBI)又称无症状性脑梗死,因无临床表现,临床医师对其重视程度不够。近年来,随着头颅MRI的普及和广泛应用,很多老年人在行头颅影像学检查时,可发现脑部有陈旧性脑梗死灶,但这些患者并无典型的肢体麻木、无力、言语不利等神经功能缺损的症状或体征,这种脑梗死灶称为"无症状"或"静息性"或"隐匿性"脑梗死。此类患者既往无脑梗死史,而头颅MRI检查时,可见排除其他非血管因素的新发的或者陈     

Tightly coupled brain activity and cerebral ATP metabolic rate

A majority of ATP in the brain is formed in the mitochondria through oxidative phosphorylation of ADP with the F(1)F(0)-ATP (ATPase) enzyme. This ATP production rate plays central roles in brain bioenergetics, function and neurodegeneration. In vivo (31)P magnetic resonance spectroscopy combined with magnetization transfer (MT) is the sole approach able to noninvasively determine this ATP metabolic rate via measuring the forward ATPase reaction flux (F(f,ATPase)). However, previous studies indicate lack of quantitative agreement between F(f,ATPase) and oxidative metabolic rate in heart and liver. In contrast, recent work has shown that F(f,ATPase) might reflect oxidative phosphorylation rate in resting human brains. We have conducted an animal study, using rats under varied brain activity levels from light anesthesia to isoelectric state, to examine whether the in vivo (31)P MT approach is suitable for measuring the oxidative phosphorylation rate and its change associated with varied brain activity. Our results conclude that the measured F(f,ATPase) reflects the oxidative phosphorylation rate in resting rat brains, that this flux is tightly correlated to the change of energy demand under varied brain activity levels, and that a significant amount of ATP energy is required for "housekeeping" under the isoelectric state. These findings reveal distinguishable characteristics of ATP metabolism between the brain and heart, and they highlight the importance of in vivo (31)P MT approach to potentially provide a unique and powerful neuroimaging modality for noninvasively studying the cerebral ATP metabolic network and its central role in bioenergetics associated with brain function, activation, and diseases.     

Effects on the diet on brain neurotransmitters.

The synthesis of neurotransmitters in mammalian brain responds rapidly to changes in precursor availability. Serotonin synthesis depends largely on the brain concentrations of L-tryptophan, its precursor amino aicd. This relationship appears to be physiologic: when brain tryptophan levels vary because of insulin secretion or meal ingestion, corresponding alterations occur in the rate of serotonin formation. The ability of any food to modify brain tryptophan (and serotonin) depends on how its ingestion changes the serum concentration of not only tryptophan, but also several other large neutral amino acids that compete with tryptophan for uptake into the brain. Such precursor-induced changes in brain serotonin appear to be functionally important: animals having a reduced level of brain serotonin (caused by the chronic ingestion of a naturally tryptophan-poor diet, such as corn) demonstrate a heightened sensitivity to painful stimuli; this pain sensitivity can be acutely restored to normal values by a single injection of L-tryptophan, which rapidly elevates brain serotonin. The synthesis of catecholamines (e.g., dopamine, norepinephrine) in the brain also varies with the availability of the precursor amino acid L-tyrosine. Single injections of this amino acid increase brain tyrosine levels and accelerate brain catechol synthesis, while injections of a competing neutral amino acid (e.g., leucine, tryptophan) reduce brain tyrosine and its rate of conversion to dopa. The rate of catecholamine synthesis, however, appears to be influenced less by precursor levels than is serotonin formation: tyrosine hydroxylase, whcih catalyzes the rate-limiting step in catecholamine synthesis, responds strongly to end-product inhibition and to other controls that reflect variations in neuronal activity. The synthesis of acetylcholine in brain responds to substrate (choline) availability much like serotonin synthesis. Short-term alterations in brain choline levels are mirrored by similar changes in brain acetylcholine concentration. Variations in the daily dietary intake of choline also modify brain choline and acetylcholine. The relationship between choline availability and acetylchyoline synthesis has already foudn a cletween choline availability and acetylchyoline synthesis has already found a clinical application: choline has been used successfully in the treatment of tardive dyskinesia, a disorder of the central nervous system thought to reflect a deficiency in cholinergic transmission. These relationships between precursor availability from the periphery and brain neurotransmitter synthesis may ultimately provide the brain with information about peripheral metabolic state.     

应用MRI观察β-七叶皂甙钠对大鼠脑出血后脑水肿的治疗作用

目的　观察 β 七叶皂甙钠对大鼠脑出血后脑水肿的治疗作用。 方法　大鼠尾壳核注射胶原酶造成脑出血模型。用磁共振显像 (MRI)观察 β 七叶皂甙钠治疗组和对照组脑出血后脑水肿的动态变化。 结果　治疗组血肿区、水肿区的吸收率显著高于对照组 ;在 72h时 ,血肿区的T1 、T2 信号值与对照组的T1 、T2 信号值比较差异有显著性意义 ;治疗组除超急性期外 ,其余各期均提前。结论　β 七叶皂甙钠对大鼠脑出血后脑水肿有明显治疗作用     

重型脑干出血两种治疗方法对比研究

目的探讨重型脑干出血治疗方法与预后的关系。方法通过复习文献结合我院2007年8月—2009年12月收治的重型脑干出血38例患者,将GCS≤9分17例患者及GCS〈5分21例患者随机分为两组,应用侧脑室穿刺外引流术综合治疗20例为观察组,内科保守治疗18例为对照组,进行预后对比。结果观察组有效率70%,对照组有效率33.3%;与对照组比较应用侧脑室穿刺外引流术综合治疗有效率提高,病死率无明显变化。结论重型脑干出血患者预后凶险,但侧脑室穿刺外引流术综合治疗能提高疗效,有助于改善患者预后。     

Interactions of IGF-1 with the blood-brain barrier in vivo and in situ

Insulin-like growth factor-1 (IGF-1) given peripherally has been found effective in clinical trials to slow down neuronal degeneration in some nervous system diseases. This raises the question of whether and how IGF-1 crosses the blood-brain barrier (BBB). In this report, we found that IGF-1 had a half-life of 4.5 min in blood, could remain intact for 20 min, and entered brain and spinal cord linearly. In the brain, IGF-1 had an influx rate of 0.4 microl/g x min after intravenous (iv) bolus injection as determined by multiple-time regression analysis. Intact radiolabeled IGF-1 was present in brain at 20 min after iv injection. Most of the injected IGF-1 entered the brain parenchyma instead of being entrapped in the cerebral vasculature. Addition of nonradiolabeled IGF-1 enhanced the influx of radiolabeled IGF-1 after iv injection, but inhibited the influx of radiolabeled IGF-1 by in-situ brain perfusion, suggesting that protein binding can explain the difference between the iv and perfusion experiments. In the spinal cord, the cervical region had the fastest uptake, followed by lumbar spinal cord. The thoracic spinal cord had the slowest uptake, comparable to that of brain. By contrast, des(1-3)IGF-1, an IGF-1 analogue with little protein binding but similar biological activity, had a shorter half-life in blood, slower influx rate into brain, and no alteration in pharmacokinetics after addition of nonradiolabeled peptide. We conclude that IGF-1 enters the CNS by a saturable transport system at the BBB, which functions in synchrony with IGF binding proteins in the periphery to regulate the availability of IGF-1 to the CNS.     

Disseminated Nocardia asteroides and coinfection with Trichophyton rubrum in a renal transplant recipient

Abstract: Disseminated Nocardia infection has a high mortality and morbidity rate in solid organ transplant recipients, even when appropriate antibiotics are given. In this report a renal transplant recipient is described, who developed disseminated Nocardia asteroides infection with lung, eye, and brain involvement, in addition to coinfection with Trichophyton rubrum .     

Central hypotensive action of clonidine requires nitric oxide

Background- Clonidine has an antihypertensive effect by its action in the brain and, because we observed that the tonic production of nitric oxide (NO) in the brain is required to maintain blood pressure at its low, normotensive level, the current study was designed to determine whether the hypotensive action of clonidine resulted from its stimulation of excess NO in the brain. Methods and Results- Porphyritic microsensors were used to quantify NO concentration in the nucleus tractus solitarius (NTS) in vitro in brain slices and in vivo in the anesthetized rat. In both preparations, the basal production of NO in the NTS was 15+/-3 nmol/L. In vitro stimulation of the NTS with clonidine (50 nmol/L) resulted in an increase in the NO concentration to 84+/-7 nmol/L. In vivo, the intracerebroventricular (ICV) infusion of clonidine (0.03 microgram) caused an increase in NO concentration in the NTS to 128+/-17 nmol/L. This ICV injection of clonidine caused a fall in mean arterial pressure of -22+/-1 mm Hg and a decrease of heart rate of -18+/-2%. The blockade of NO production with N(G)-nitro-L-arginine-methyl ester (2 micromol; delivered ICV, 30 minutes before the clonidine) reduced responses to clonidine for both mean arterial pressure and heart rate (-3+/-1 mm Hg and -2+/-1% change, respectively). Conclusion- The stimulation of the release of NO in the brain by clonidine contributes to its central antihypertensive action.     

咪达唑仑在创伤性颅脑损伤患者镇静治疗中的应用及影响

目的研究静脉注射咪达唑仑对镇静治疗中创伤性颅脑损伤患者的脑血流动力学、呼吸状况及长期预后的影响。 方法纳入西安医学院第二附属医院神经外科自2014年5月至2019年12月收治的70例创伤性颅脑损伤患者,按照随机数字表法分为治疗组（35例）和对照组（35例）。治疗组患者以0.1 mg/（kg·h）的速度静脉注射咪达唑仑,同时对照组患者不采用任何镇静镇痛剂以及其他影响颅内血流动力学的药物。应用经颅多普勒超声分别测定2组患者的大脑中动脉平均血流速度,以及收集患者收缩压、心率、呼吸频率等参数。 结果治疗组患者的流速尽管有所降低,但与对照组比差异并无统计学意义（P>0.05）。此外,治疗组心率、收缩压和呼吸频率较对照组均有明显下降,其中呼吸频率的差异具有统计学意义（P=0.049）。进一步分析随访资料发现2组患者的死亡率及GOS评分差异均无统计学意义（P>0.05）。 结论静脉注射咪达唑仑可有效控制患者躁动,且可在一定程度上影响患者的颅内血流动力学以及呼吸状况,但对创伤性颅脑损伤患者的长期预后并无显著影响。     

肾上腺素对大鼠血脑屏障和脑水肿的影响

目的观察肾上腺素对大鼠血脑屏障与脑水肿的影响。方法检测肾上腺素注射后SD大鼠血压心率变化和对照组在相应各时间点脑组织的水含量和EB含量。结果大鼠注射肾上腺素后3min时出现心率加快,同时并发心律失常和血压下降,10min已趋用药前水平;1/2h出现脑组织水含量的升高,3h达高峰,6h时开始下降,9小时回到即刻水平,但其中只有3h和即刻相比有显著性区别;大鼠脑组织EB含量3h开始升高,6h达峰值,9h下降,但不同时间点比较无统计学上显著意义。结论肾上腺素可引起一过性心率增快血压下降和一过性的脑水肿,而脑水肿的形成和血脑屏障开放关系不大。     

Comparative analysis of constraints and caste differences in brain investment among social paper wasps

We compared species mean data on the size of functionally distinct brain regions to test the relative rates at which investment in higher-order cognitive processing (mushroom body calyces) versus peripheral sensory processing (optic and antennal lobes) increased with increasing brain size. Subjects were eusocial paper wasps from queen and worker castes of 10 species from different genera. Relative investment in central processing tissue increased with brain size at a higher rate than peripheral structure investment, demonstrating that tissue devoted to higher-order cognitive processing is more constrained by brain size. This pattern held for raw data and for phylogenetically independent contrasts. These findings suggest that there is a minimum necessary investment in peripheral sensory processing brain tissue, with little to gain from additional investment. In contrast, increased brain size provides opportunities to invest in additional higher-order cognitive processing tissue. Reproductive castes differed within species in brain tissue investment, with higher central-to-peripheral brain tissue ratios in queens than in workers. Coupled with previous findings that paper wasp queen, but not worker, brain architecture corresponds to ecological and social variation, queen brain evolution appears to be most strongly shaped by cognitive demands, such as social interactions. These evolutionary patterns of neural investment echo findings in other animal lineages and have important implications, given that a greater investment in higher-order processing has been shown to increase the prevalence of complex and flexible behaviors across the animal kingdom.