Navien导管辅助SolitaireAB支架治疗急性基底动脉闭塞

目的 探讨在Navien导引导管辅助下Solitaire AB支架取栓治疗急性基底动脉闭塞的临床疗效。方法 回顾性分析2016年4月至2018年3月使用Navien导引导管联合Solitaire AB支架取栓治疗的36例急性基底动脉闭塞的临床资料。结果 单纯支架取栓24例,静脉应用阿替普酶桥接+支架取栓12例;取栓次数1次10例,2次18例,≥3次8例。血管成功再通33例（91.7%）,未通3例（8.3%）;发病到血管再通时间（257.6±35.43）min。术后24 h美国国立卫生研究院卒中量表评分[（15.7±4.31）分]较术前[（28.8±5.78）分]明显降低（P<0.05）。术后3个月,预后良好21例（改良Rankin量表评分0~2分;58.3%）,预后不良15例（改良Rankin量表评分3~6分;41.7%,其中死亡4例）。结论 Navien导引导管辅助Solitaire AB支架取栓治疗急性基底动脉闭塞再通率高,临床预后较好。     

一期支架置入补救治疗急性后循环大动脉闭塞机械取栓术失败病人的疗效

目的 探讨一期支架置入术作为急性后循环大动脉闭塞机械取栓失败后补救性治疗的疗效。方法 回顾性分析2016年1月至2018年6月单独支架取栓或联合抽吸取栓治疗后循环大动脉闭塞所致急性脑卒中186例，146例实现闭塞血管成功再通；40例血流恢复较差，其中28例接受一期支架置入补救性治疗（支架组）；12例拒绝支架置入治疗（非支架组），仅给予基础抗栓治疗。结果 支架组血管再通率（75.00%）明显高于非支架组（0％；P<0.05）。术后90 d，支架组预后良好率（64.29%，改良Rankin量表评分0~2分）明显高于非支架组（8.33%；P<0.05）。支架组术后90 d病死率（21.43%）明显低于非支架组（83.33%；P<0.05）。支架组症状性颅内出血发生率（7.14%）与非支架组（16.67%）无统计学差异（P>0.05）。结论 一期支架置入术作为急性后循环大动脉闭塞机械取栓术失败的补救性治疗，再通率高，并发症少，可显著改善病人的预后。     

急性基底动脉闭塞超时间窗支架取栓术治疗的疗效分析

目的 探讨急性基底动脉闭塞超时间窗Solitaire支架机械取栓术治疗的安全性和有效性。方法 回顾性分析2016年10月至2018年10月超时间窗Solitaire 支架机械取栓术治疗的8例基底动脉闭塞病人的临床资料。结果 8例经Solitaire 支架机械取栓后均成功获得再通。术前NIHSS评分为（24.83±2.71）分,术后30 d为（14.12±2.48）分,术后90 d为（8.12±2.48）分,两两比较差异有统计学意义（P<0.05）。术后3个月改良Rankin量表 评分1分1例,2分1例,3分2例,4分2例,5分2例。MRA或CTA复查显示,1例血管闭塞（左侧大脑后动脉）,余7例无开通血管再闭塞。结论 超时间窗Solitaire 支架机械取栓术治疗急性基底动脉闭塞是有效的、相对安全。     

多种技术在急性脑梗死机械取栓术中应用效果分析

目的 探讨Solumbra技术、SWIM技术 、双支架技术、球囊扩张术、支架成形术等多种技术对提高急性脑梗机械取栓术中血管再通率和临床效果的影响。方法 2016年7月至2017年5月，在急性脑梗死机械取栓术中应用Solumbra技术、SWIM技术 、球囊扩张术、支架成形术、双支架技术处理67例（观察组）；同时回顾2014年12月~2016年6月，在机械取栓术中没有应用上述技术的42例作为对照组。结果 观察组观察从腹股沟穿刺到闭塞血管复流的时间、取栓次数、血管完全再通（TICI分级2b~3级）率、术后2周美国国立卫生研究研究卒中量表评分、术后90 d预后良好（改良Rankin量表评分0~2分）率均明显优于对照组（P<0.05）。结论 在急性脑梗死机械取栓术中根据具体情况，灵活地应用Solumbra技术、SWIM技术 、双支架技术、球囊扩张术、支架成形术等技术可以明显提高血管再通率、减少取栓次数、改善良好。     

Solitaire AB支架取栓术在急性基底动脉闭塞的治疗体会

目的观察Solitaire AB支架取栓术在急性基底动脉闭塞患者治疗中的临床疗效。方法回顾性分析我科在2015年1月-2017年1月期间收治的9例急性基底动脉闭塞患者使用Solitaire AB支架进行器械取栓治疗的临床资料。分析血管再通情况和术后并发症,取栓前后使用美国国立卫生研究院卒中量表(NIHSS)对比,术后90 d使用改良Rankin评分(mRS)评估临床愈后。结果使用Solitaire AB支架进行器械取栓后血管再通8例,术后发生脑内出血2例,大面积脑梗死2例,死亡3例;术后NIHSS评分均值较术前明显改善,术后90 d生存率66.7%,其中mRS为0~2分的良好率为33.3%。结论使用Solitaire AB支架取栓是治疗急性基底动脉闭塞的有效方法,具有较高的血管再通率,能提高患者抢救生存率及改善生存质量。     

Solitaire-AB型支架取栓术治疗急性椎-基底动脉闭塞的疗效

目的 探讨Solitaire-AB型支架取栓术治疗急性椎-基底动脉闭塞的有效性及安全性。方法 回顾性分析2016年1月至2019年7月采用Solitaire-AB型支架取栓术治疗10例急性椎-基底动脉急性闭塞的临床资料。脑梗死溶栓（TICI）分级≥2b级认为血管再通。结果 10例取栓后均获得血管再通，TICI分级3级。1例合并枕叶少量出血，1周后复查出血消失。出院时mRS评分0分3例，1分1例，2分3例，3分1例，4分1例，死亡1例。出院3个月，mRS评分0分4例，1分3例，2分2例。结论 急性椎-基底动脉闭塞采取Solitaire-AB型支架取栓血流再通率高，能显著改善病人的预后。     

颅内中等血管急性闭塞的血管内治疗分析

目的 探讨血管内介入治疗颅内中等血管急性闭塞的安全性及有效性。方法 回顾性分析2017年1月至2021年9月采用血管内介入治疗的16例颅内中等血管急性闭塞的临床资料。颅内中等血管包括大脑中动脉M2/3段、大脑前动脉A2/3段和大脑后动脉P2/3段。结果 16例中,大脑中动脉M2段闭塞9例、M3段闭塞2例,大脑前动脉A2段闭塞2例,大脑后动脉P2段闭塞3例;8例符合静脉溶栓标准,行静脉溶栓后桥接血管内治疗。13例使用Solitaire AB支架取栓,2例动脉溶栓,1例直接球囊扩张成形。术后即刻TICI分级3级13例,2b级2例,血管再通率为93.7%（15/16）;另1例出现无症状性出血转化。术后90 d随访,预后良好率（mRS评分0~2分）为87.5%（14/16）。结论 对于颅内中等管径动脉急性闭塞,严格把握手术指征,采用可回收支架进行机械取栓治疗,血管开通率高,疗效好且安全。     

机械取栓治疗急性缺血性卒中的疗效评价——单中心数据分析

目的 评价急性缺血性卒中行机械取栓的疗效与安全性。方法 回顾性分析513例行机械取栓治疗的急性缺血性卒中病例资料,根据临床预后分为良好预后组(n=299)和不良预后组(n=214)。主要评价指标为90 d预后良好率,次要评价指标为血管成功再通率、挽救技术比例、并发症及病死率等。结果 机械取栓术后血管成功再通率(mTICI 2b～3级)为93.8%(481/513),术后90 d预后良好率(mRS 0～2分)为58.3%(299/513),颅内出血率为22.0%(113/513),其中症状性颅内出血率为9.6%(49/513),病死率为12.9%(66/513)。多因素回归分析表明:术前NIHSS22分、代偿评分≥2分、血管再通达mTICI 2b～3级及术后无出血,与良好预后密切相关(均P 0.05)。结论 机械取栓能明显改善颅内大血管闭塞和(或)远端血管闭塞的临床预后。低NIHSS评分、良好代偿、血管成功再通及无出血是机械取栓90 d预后良好的独立预测因素。     

急性大脑中动脉闭塞机械取栓治疗的观察性研究

目的探讨大脑中动脉急性闭塞后行血管内机械取栓的优化治疗方式及疗效。方法以行血管内机械取栓的大脑中动脉闭塞的急性缺血性卒中患者为研究对象,回顾性分析其责任病灶特点、血管内治疗方式、血管开通状况及术后神经功能改善状况。结果连续纳入2014年1月-2016年8月期间于中山市人民医院脑血管介入科行急性大脑中动脉闭塞机械取栓的患者77例,其中M1段闭塞52例(右侧27例,左侧25例),上干闭塞15例,下干闭塞10例。取栓后Solitaire支架释放在狭窄部位17例,合并大脑中动脉严重狭窄应用Gateway球囊扩张6例,局部动脉给予溶栓药物3例。经血管内治疗后,77例大脑中动脉闭塞全部成功开通。术后再灌注出血6例(7.79%),取栓术后因急性脑肿胀行去骨瓣减压术5例(6.49%),术后90 d患者预后良好[改良Rankin量表(modified Rankin Scale,m RS)评分2分]48例(62.34%)。结论大脑中动脉急性闭塞行Solitaire支架急诊取栓可获得满意的再通率及3个月良好预后。     

Solitaire FR支架取栓治疗急性脑动脉闭塞25例

目的 探讨Solitaire FR支架取栓治疗急性脑动脉闭塞的疗效。方法 回顾性分析2019年1月至2020年12月Solitaire FR支架取栓治疗的25例急性脑动脉闭塞的临床资料。术后即刻造影评估血管再通,TICI分级≥2b级为血管再通。出院时,采用改良Rankin量表（mRS）评分评估预后。结果 术后即刻造影显示TICI分级≥2b级23例,2a级1例,0级1例;取栓成功率为92.0%（23/25）。术后发生并发症3例,总发生率为12.0%（3/25）。出院时,mRS评分≤2分12例,3~5分11例,6分2例。结论Solitaire FR支架取栓术治疗急性脑动脉闭塞,再通率高,并发症发生率低,是一种有效、安全治疗方法。     

桥接治疗和直接血管内治疗对急性大血管闭塞性卒中的疗效对比分析

目的对比前循环大动脉急性闭塞性卒中患者行桥接治疗和直接血管内治疗（dEVT）的安全性和有效性。方法回顾性分析2014年6月至2017年5月于海军军医大学附属长海医院神经外科行血管内治疗的231例前循环大动脉急性闭塞性卒中患者的临床资料。其中接受桥接治疗（静脉溶栓＋机械取栓）119例（桥接治疗组）,接受dEVT 112例（dEVT组）。应用脑梗死溶栓（TICI）分级评估术后血管再通程度。采用美国国立卫生研究院卒中量表评分（NIHSS）、改良Rankin量表评分（mRS）评估患者的预后。结果两组患者的性别、年龄、入院时NIHSS评分、卒中病因、既往病史的差异均无统计学意义（均P〉0.05）。dEVT组的发病至就诊时间显著大于桥接治疗组（P〈0.001）。两组就诊至CT检查时间、就诊至穿刺时间、就诊至再通时间、穿刺至再通时间、取栓次数的差异均无统计学意义（均P〉0.05）。桥接治疗组和dEVT组的血管有效再通率（91.6%对比84.8%）、症状性颅内出血的发生率（12.6%对比14.3%）、病死率（16.0%对比15.2%）以及90 d预后良好率（52.1%对比50.0%）的差异均无统计学意义（均P〉0.05）。结论桥接治疗和dEVT对于前循环大血管急性闭塞性卒中的临床疗效和安全性相似。但这一结论仍需高级别循证医学证据进一步明确。     

Changes in body temperature after administration of antipyretics, LSD, delta 9-THC, CNS depressants and stimulants, hormones, inorganic ions, gases, 2,4-DNP and miscellaneous agents

This survey concludes a series of complications of data from the literature, primarily published since 1965, on thermoregulatory effects of antipyretics in afebrile as well as in febrile subjects, LSD and other hallucinogens, cannabinoids, general CNS depressants, CNS stimulants including xanthines, hormones, inorganic ions, gases and fumes, 2,4-dinitrophenol and miscellaneous agents including capsaicin, cardiac glycosides, chemotherapeutic agents, cinchona alkaloids, cyclic nucleotides, cycloheximide, 2-deoxy-D-glucose, dimethylsulfoxide, insecticides, local anesthetics, poly I:poly C, spermidine and spermine, sugars, toxins and transport inhibitors. The information listed includes the species used, route of administration and dose of drug, the environmental temperature at which the experiments were performed, the number of tests, the direction and magnitude of body temperature change and remarks on the presence of special conditions such as age or lesions, or on the influence of other drugs, such as antagonists, on the response to the primary agents.     

Literature review, case report, and expert discussion of prolonged refractory status epilepticus

We report the case of a 30-year-old woman with severe, prolonged refractory status epilepticus requiring more than 6 months of iatrogenic coma. Opinions on prognosis and clinical management were solicited from a number of experienced neurointensivists and epileptologists at multiple time-points during the clinical course. The ensuing discussion, annotated with references, is presented here. Several experts commented on isolated cases of young patients with encephalitis requiring up to 2–3 months of iatrogenic coma, yet still having good outcomes. Treatments discussed include ketamine, gammaglobulin, plasmapheresis, steroids, adrenocorticotropic hormone, very high-dose phenobarbital, isoflurane, lidocaine, electroconvulsive therapy, ketogenic diet, hypothermia, magnesium, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, and neurosurgery. The patient eventually suffered a cardiac arrest but was resuscitated as requested by the family. Seizures then stopped, and the patient has remained in a persistent vegetative state since.     

Bitterness of sweeteners as a function of concentration

Sizteen trained tasters provided sweetness and bitterness intensity ratings for 19 compounds including: acesulfame-K, alitame, aspartame, fructose, glucose, glycine, lactitol, maltitol, monoammonium glycyrrhizinate, neohesperidin dihydrochalcone, neosugar (fructo-oligosaccharide), palatinit (isomalt), rebaudioside-A, sodium cyclamate, sodium saccharin, stevioside, sucralose, sucrose, and thaumatin. With increasing concentration, high-potency sweeteners including acesulfame-K, neohesperidin dihydrochalcone, sodium saccharin, rebaudioside-A, and stevioside tended to become more bitter. Low-potency sweeteners including fructose, sucrose, and lactitol tended to become less bitter with increasing concentration.     

Higher cortical modulation of pain perception in the human brain: Psychological determinant

Pain perception and its genesis in the human brain have been reviewed recently. In the current article, the reports on pain modulation in the human brain were reviewed from higher cortical regulation, i.e. top-down effect, particularly studied in psychological determinants. Pain modulation can be examined by gene therapy, physical modulation, pharmacological modulation, psychological modulation, and pathophysiological modulation. In psychological modulation, this article examined (a) willed determination, (b) distraction, (c) placebo, (d) hypnosis, (e) meditation, (f) qi-gong, (g) belief, and (h) emotions, respectively, in the brain function for pain modulation. In each, the operational definition, cortical processing, neuroimaging, and pain modulation were systematically deliberated. However, not all studies had featured the brain modulation processing but rather demonstrated potential effects on human pain. In our own studies on the emotional modulation on human pain, we observed that emotions could be induced from music melodies or pictures perception for reduction of tonic human pain, mainly in potentiation of the posterior alpha EEG fields, likely resulted from underneath activities of precuneous in regulation of consciousness, including pain perception. To sum, higher brain functions become the leading edge research in all sciences. How to solve the information bit of thinking and feeling in the brain can be the greatest challenge of human intelligence. Application of higher cortical modulation of human pain and suffering can lead to the progress of social humanity and civilization.     

Au-delà de la peau,un regard porté… L’échographie et la pulsion scopique machinique

Throughout pregnancy, the pregnant woman pre-invests then invests the future child, feels it, to represent him, and see, watch the child. As the pregnant woman feels her unborn child, her story and her fantasies about him become rich and voluptuous. Shoring body is important and the introduction of ultrasound, it will then be able to rely on this image, on this look beyond the skin, both in the investment process of the baby, that level representations are the signs. A psychic creation's process supports the process of “creating organic” and, step-by-step, the child is there, in reality, beyond the womb. The ultrasound image is therefore helping to fantasizing, in a psychic creation's work, but sometimes it can also lead to freezing of the same fantasizing, to “freeze frame” of this creative work became a prisoner of madness maternal lethal. Indeed, the side of the destructiveness, the ultrasound image can become a fetish and a trauma, as will be shown in the case of a patient named Mary.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

EFNS‐ENS Guidelines on the diagnosis and management of disorders associated with dementia

Background and objectives

The last version of the EFNS dementia guidelines is from 2007. In 2010, the revised guidelines for Alzheimer's disease (AD) were published. The current guidelines involve the revision of the dementia syndromes outside of AD, notably vascular cognitive impairment, frontotemporal lobar degeneration, dementia with Lewy bodies, corticobasal syndrome, progressive supranuclear palsy, Parkinson's disease dementia, Huntington's disease, prion diseases, normal‐pressure hydrocephalus, limbic encephalitis and other toxic and metabolic disorders. The aim is to present a peer‐reviewed evidence‐based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists and other specialist physicians responsible for the care of patients with dementing disorders. It represents a statement of minimum desirable standards for practice guidance.

Methods

The task force working group reviewed evidence from original research articles, meta‐analyses and systematic reviews, published by June 2011. The evidence was classified (I, II, III, IV) and consensus recommendations graded (A, B, or C) according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided.

Results and conclusions

New recommendations and good practice points are made for clinical diagnosis, blood tests, neuropsychology, neuroimaging, electroencephalography, cerebrospinal fluid (CSF) analysis, genetic testing, disclosure of diagnosis, treatment of behavioural and psychological symptoms in dementia, legal issues, counselling and support for caregivers. All recommendations were revised compared with the previous EFNS guidelines. The specialist neurologist together with primary care physicians play an important role in the assessment, interpretation and treatment of symptoms, disability and needs of dementia patients.     

Electrodiagnostic evaluation of ulnar neuropathy and other upper extremity mononeuropathies

Upper extremity mononeuropathies are some of the common disorders seen in neurophysiology laboratories. Electrophysiologic studies rely on accurate localization based on knowledge of applicable anatomy and features of history and physical examination. Careful electrodiagnostic studies provide an accurate diagnosis, help localize the lesion site, exclude alternate diagnoses, reveal unsuspected diagnoses, determine pathophysiology of lesions, and assess severity, timeframe, and prognosis of lesions. This article discusses the electrodiagnostic approach to ulnar neuropathy, proximal median neuropathy, radial neuropathy, musculocutaneous neuropathy, axillary neuropathy, suprascapular neuropathy, and long thoracic neuropathy. Pertinent aspects of the history and physical examination, nerve conduction studies, and electromyography are presented.     

Review of synthetic MRI in pediatric brains: Basic principle of MR quantification,its features,clinical applications,and limitations

Quantitative magnetic resonance imaging (MRI) with multislice, multi-echo, and multi-delay acquisition enables simultaneous quantification of R₁ and R₂ relaxation rates, proton density, and the B₁ field in a single acquisition, and requires only about 6 minutes for full-head coverage. Using dedicated SyMRI software, radiologists can generate any contrast-weighted image by manipulating the acquisition parameters, including repetition time, echo time, and inversion time. Moreover, automatic brain tissue segmentation, volumetry, and myelin measurement can also be performed. Using the SyMRI approach, a shorter scan time, an objective examination, and personalized MR imaging parameters can be obtained in daily clinical pediatric imaging. Here we summarize and review the use of SyMRI in imaging of the pediatric brain, including the basic principles of MR quantification along with its features, clinical applications, and limitations.