不同类型缺血性脑血管病与血同型半胱氨酸、超敏C反应蛋白及静息心率的关系

目的观察急性期不同血管病变类型缺血性脑血管病与血同型半胱氨酸、超敏C反应蛋白及静息心率的关系。方法对183例急性期缺血性脑血管病患者进行血浆Hcy、hs-CRP水平和静息心率的测定,将患者分为腔隙性脑梗死(LI)组和动脉粥样硬化血栓形成性脑梗死(ACI)组,比较2组患者的血浆Hcy、hs-CRP水平和静息心率的变化。结果 ACI组血浆Hcy水平(26.60±14.43)μmol/L显著高于LI组的(17.44±4.04)μmol/L(P<0.05),ACI组静息心率(82.72±8.26)次/min显著高于LI组的(73.26±12.59)次/min(P<0.05),ACI组hs-CRP水平(4.12±11.94μg/mL)高于LI组的(1.33±1.91)μg/mL(P<0.05)。2组年龄、性别、吸烟史、血脂、体质量指数以及高血压、糖尿病患病率差异无统计学意义。结论血浆Hcy和hs-CRP水平及静息心率的升高同血管变病类型密切相关,而且是AS的危险因素。     

血浆同型半胱氨酸水平与缺血性脑卒中复发的关系

目的探讨血浆同型半胱氨酸(Hcy)水平与缺血性脑卒中(ICS)复发的关系。方法用荧光偏振免疫法检测303例初发、97例复发ICS患者[动脉粥样硬化性血栓性脑梗死173例(血栓组)、腔隙性脑梗死170例(腔梗组)、心源性脑栓塞57例(栓塞组)]及200例非脑血管病患者(对照组)的血浆Hcy水平。对ICS复发因素进行多因素回归分析。结果(1)ICS患者血浆Hcy水平[血栓组(16.17±10.83)μmol/L、腔梗组(14.64±7.71)μmol/L、栓塞组(15.75±6.8)μmol/L]显著高于对照组[(9.61±4.22)μmol/L](均P<0.01);各类型ICS组之间血浆Hcy水平差异无统计学意义(均P>0.05);(2)ICS复发患者血浆Hcy水平[(18.04±10.68)μumol/L]显著高于初发患者[(14.57±8.50)μmol/L](P<0.01),以及高Hcy血症比率(50.5%)显著高于初发患者(32.3%)(P<0.01);(3)各类型ICS复发患者之间血浆Hcy水平差异无统计学意义(均P>0.05);(4)高Hcy血症、糖尿病是ICS复发的独立危险因素(P<0.001,P...     

急性脑梗死患者血浆同型半胱氨酸浓度与颈动脉粥样硬化的相关性分析

目的 研究脑梗死患者血清同型半胱氨酸(Hcy)水平与血脂及颈动脉斑块形成之间的关系.方法 选择128例脑梗死患者和40例健康对照者,采用荧光偏振法测定血Hcy,并常规抽血化验Tc、TG、HDL、LDL;并进一步行彩超检查颈动脉内膜及斑块.结果 脑梗死患者血清Hcy(27.32±12.12) μmol/L,明显高于对照组的(15.21±9.90) μmol/L,2组比较差异有统计学差异(P＜0.05).颈动脉粥样硬化程度越重其Hcy水平越高.结论 高同型半胱氨酸血症与脑梗死、颈动脉斑块的发生有一定关系.     

亚甲基四氢叶酸还原酶(MTHFR)C677T基因多态性与血管性认知功能障碍相关性的研究

目的 探讨亚甲基四氢叶酸还原酶(MTHFR) C677T突变基因与血管性认知功能障碍(VCI)的关系.方法 采用酶联免疫法测定血浆同型半胱氨酸(Hcy)浓度,应用聚合酶链反应-限制性内切酶片段长度多态性技术检测143例VCI患者、122例无认知损害脑梗死患者及140例正常对照的MTHFR C677T基因型.结果 (1)VCI组、脑梗死组和对照组的血浆同型半胱氨酸(Hcy)平均水平分别为(12.257±3.595) μmol/L、(11.028 ±3.198)μmol/L、(9.784±3.074) μmol/L,两病例组Hcy水平明显高于正常对照组(P＜0.05);(2)3组研究对象的TT基因型分布有明显差异(x2=19.464,P＜0.01),CT型及CC型分布无差异(P＞0.05);VCI组及脑梗死组的T等位基因发生频率明显高于正常对照组(P＜0.05),相对危险度分别为1.79和1.47;(3)VCI组、脑梗死组及正常对照组中,MTHFR基因有C677T突变者(尤其TT型者)血浆Hcy水平均显著高于无基因突变者.结论 血浆Hcy水平升高是VCI和脑梗死共同的致病基础;MTHFR C677T基因突变致血浆Hcy水平升高可能是VCI发病的重要遗传因素.     

进展性脑梗死患者血清超敏C反应蛋白水平的变化及其临床意义

目的探讨进展性脑梗死患者血清超敏C反应蛋白(hs-CRP)水平的变化及其临床意义。方法检测63例脑梗死患者(25例进展性脑梗死、38例完全性脑梗死)和73名健康对照者(正常对照组)的血清hs-CRP含量。结果脑梗死患者的血清hs-CRP水平[(5.69±3.78)mg/L]明显高于正常对照组[(0.85±0.47)mg/L](P<0.01);进展性脑梗死组血清hs-CRP水平[(7.55±4.25)mg/L]明显高于完全性脑梗死组[(4.52±2.96)mg/L](P<0.01)。结论脑梗死患者血清hs-CRP水平明显升高,进展性脑梗死患者较完全性脑梗死患者血清hs-CRP水平升高更明显;提示hs-CRP参与了脑梗死的发生与发展过程。     

糖化血红蛋白及高敏C反应蛋白与脑梗死急性期患者颈动脉粥样硬化的关系

目的 探讨脑梗死急性期患者糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)与颈动脉粥样硬化斑块的关系. 方法 连续收集广州医学院第二附属医院神经内科自2010年1月1日至12月31日收治的110例脑梗死急性期患者(急性脑梗死组)和同期98例健康体检者(正常对照组),通过颈动脉彩超测量颈总动脉内中膜厚度(IMT)并根据其值将脑梗死组分为3个亚组(正常组、轻度粥样硬化组、重度粥样硬化组),同时观察有无颈动脉斑块形成;全自动生化仪器检测HbA1c、hs-CRP水平. 结果 与正常对照组相比,急性脑梗死组HbA1c、hs-CRP水平[(4.8±0.3)％vs(5.9±0.6)％;(0.78±0.11) mg/Lvs(3.25±0.72) mg/L]明显升高,差异有统计学意义(P＜0.05).轻度粥样硬化组HbA1c水平[(5.1±0.5)％]明显高于正常组[(4.3±0.3)％],重度粥样硬化组HbA1c、hs-CRP水平[(7.1±0.9)％;(1.37±1.5)mg/L]高于正常组、轻度粥样硬化组[(1.11±1.1) mg/L;(1.02±0.3) mg/L].脑梗死急性期患者颈动脉IMT值与HbA1c、hs-CRP水平及二者乘积均呈明显正相关关系(r=0.437,P=0.000;r=0.215,P=0.000; r=0.729,P=0.000). 结论 糖耐量异常和炎症的联合作用与脑梗死急性期患者颈动脉粥样硬化有一定的相关性.     

急性一氧化碳中毒后迟发性脑病患者血清NO与NOS水平及其临床意义

目的 探讨血清一氧化氮(nitric oxide,NO)、一氧化氮合酶(nitric oxide synthsae,NOS)的水平及其动态变化与急性一氧化碳中毒后迟发性脑病(delayed encephalopathy after acute carbon monoxide poisoning,DEACMP)患者病情变化的关系.方法 应用比色法(colorimetric method)动态测定31例DEACMP患者血清NO及NOS水平,并与30例急性一氧化碳中毒(acute carbon monoxide poisoning,ACMP)后未发生迟发脑病患者和30 例正常对照进行比较.结果 DEACMP患者急性期血清NO及NOS水平[(62.67 ± 14.39)μmol/L,(27.68 ± 6.14)U/mL]明显高于正常对照组[(50.18 ± 9.95) μmol/L,(20.88 ± 6.32)U/mL] (均P ＜ 0.05),与ACMP组急性期[(62.00 ± 16.46)μmol/L,(28.13 ± 5.23)U/mL]比较无统计学差异(均P ＞ 0.05);DEACMP患者恢复期血清NO及NOS水平[(54.66 ± 11.73)μmol/L,(21.74 ± 5.88)U/mL]明显低于急性期(均P ＜ 0.05),与ACMP组随访期[(52.79 ± 11.22)μmol/L,(20.64 ± 5.92)U/mL]比较无统计学差异(均P ＞ 0.05).结论 NO-NOS系统参与了DEACMP的发病机制,NO-NOS水平变化与病情变化基本一致.     

蛋氨酸负荷试验在糖尿病周围神经病变中的临床意义

目的评估蛋氨酸负荷试验(MLT)与糖尿病周围神经病变的关系。方法选空腹血浆同型半胱氨酸(Fhcy)水平在正常范围(≤15 mmol/L)内的103例2型糖尿病患者,分为糖尿病周围神经病变(DPN )组和无糖尿病神经病变(DPN-)组,另50例健康体检者作为对照(CON)组,于MLT后行Hcy(Phcy)测定,按体重0.1g/kg口服蛋氨酸,并测取服药前后4 h血同型半胱氨酸(Hcy)及糖化血红蛋白(HbAlc)、甘油三酯(TG)、胆固醇(TC)等水平。结果Phcy水平DPN 组[(37.3±1.3)mmol/L]明显高于DPN-组[(25.0±1.2)mmol/L]及CON组[(9.8±1.4)mmol/L,P<0.01];餐后2 h血糖(PPG)、TG水平均DPN 组高于DPN-组及CON组,差异有统计学意义(P<0.05),而叶酸(FA)、维生素B12(Vit B12)水平则DPN 组低于DPN-组及CON组(P<0.01)。结论高Hcy(Hhcy)及低FA、VitB12水平与2型DM患者伴发周围神经病变相关,在DPN 组患者中进行MLT检查有助于Hhcy血症及早发现。     

血浆同型半胱氨酸与脑梗死关系的研究

目的　探讨同型半胱氨酸 (Hcy)与脑梗死的关系。方法　应用高效液相色谱仪 ,HPLC FD法测定 87例急性脑梗死患者和 80例对照者血浆Hcy浓度 ,进行Logistic回归分析。结果　病例组空腹血浆Hcy浓度 [(15 .2 8± 4 .33) μmol/L]较对照组 [(11.32± 3.86 ) μmol/L]高 (P <0 0 0 1) ;高Hcy血症与脑梗死相关 ,相对危险度OR为 9.10 3(95 %CI2 .4 9～ 33.2 4 )。结论　高Hcy血症是脑梗死的独立危险因素     

老年糖尿病性脑梗死患者血清脂蛋白(a)水平的变化

目的 探讨老年糖尿病性脑梗死(CI)患者血清脂蛋白(a)[Lp(a)]的水平变化.方法 根据病史及空腹血糖水平,将272例老年CI患者分为糖尿病CI组(DCI组,128例)和非糖尿病CI组(NDCI组,144例),另设正常对照绀160人,分别检测其血清Lp(a)、血脂、血糖、体质昔指数(BMI);对CI两组行影像学检查,并进行比较.结果 与正常对照组血清Lp(a)水平[(148.4±145.5)ms/L]比较,DCI组[(398.0±132.9)mg/L]与NDCI组[(253.2±119.3)mg/L]明显增高(均P<0.01);DCI组明显高于NDCI组(P<0.01).DCI组三酰甘油(TG)[(3.62±1.76)mmol/L]、低密度脂蛋白(LDL)[(4.63±0.79)mmol/L]水平较NDCI组[(1.50±0.37)mmol/L、(3.20±0.80)mmol/L]明显增高,而高密度脂蛋白(HDL)水平[(0.85±0.33)mmol/L]较NDCI组[(1.77±0.81)mmol/L]明显降低(P<0.05～0.01),总胆固醇(TC)水平差异无统计学意义.DCI组BMI[(26.72±2.67)ks/m2]明显高于NDCI组[(23.12±2.11)ks/m2](P<0.01).影像学结果显示,DCI组以腔隙性脑梗死多见(46.9%),而NDCI组以单发性脑梗死多见(52.8%).结论 Lp(a)水平升高与老年DCI发病密切相关.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -