急性缺血性脑卒中患者血清NfL、Galectin-3、Netrin-1水平变化及临床意义

目的 探讨急性缺血性脑卒中患者血清神经丝轻链(NfL)、半乳糖凝集素-3(Galectin-3)、神经导向因子(Netrin-1)水平变化及临床意义.方法 选取2017年6月至2020年6月我科收治的130例急性缺血性脑卒中患者作为观察组,根据神经功能缺损程度,将其分为轻度组(n=33)、中度组(n=56)和重度组(n=41).同期,另选取我院体检健康人群100例(对照组).应用酶联免疫吸附法检测血清NfL、Galectin-3、Netrin-1水平.出院后随访90 d,采用改良Rankin量表(mRS)评分评估患者神经功能预后,采用多因素Logistic回归分析影响急性缺血性脑卒中患者临床预后的危险因素.绘制ROC曲线,分析血清NfL、Galectin-3、Netrin-1对患者不良预后的评估价值.结果 观察组血清NfL、Galectin-3、Netrin-1水平与对照组血清NfL、Galectin-3、Netrin-1水平相比,差异有统计学意义(P<0.05).不同神经功能缺损程度的血清NfL、Galectin-3、Netrin-1水平相比,差异有统计学意义(P<0.05).预后不良组血清NfL、Galectin-3水平高于预后良好组,血清Netrin-1水平低于预后良好组,差异有统计学意义(P<0.05).多因素Logistic回归分析结果示,血清NfL、Galectin-3、Netrin-1是影响急性缺血性脑卒中患者短期预后的独立危险因素(P<0.05).ROC曲线结果示,血清NfL、Galectin-3、Netrin-1及三者联合检测预测急性缺血性脑卒中患者不良预后的AUC分别为0.769、0.784、0.811、0.892.结论 急性缺血性脑卒中患者血清NfL、Galectin-3水平升高,血清Netrin-1水平降低,其血清水平变化与患者神经功能缺损程度和短期不良预后有关,可作为急性缺血性脑卒中患者神经功能预后评估的参考指标.     

TIMP-1、TNF-α水平监测对急性脑梗死患者预后评估的价值

目的 分析TIMP-1、TNF-α水平监测在急性脑梗死患者预后评估中的应用价值,为临床应用提供依据.方法 选取2015年5月至2016年8月间我院收治的48例脑梗死患者及50例健康体检者作为本组研究对象,使用双抗夹心酶联免疫吸附法检测血清中TIMP-1及TNF-α水平,并分析TIMP-1及TNF-α水平与患者梗死面积、意识功能及存活的关系.结果 观察组患者TIMP-1及TNF-α水平明显高于对照组,且差异具有统计学意义(P＜0.05);大面积梗死患者血清中TIMP-1及TNF-α水平显著高于非大面积梗死患者(P＜0.05);相较于无意识障碍,意识障碍组患者血清中TIMP-1及TNF-α水平显著升高(P＜0.05);死亡组患者血清中TIMP-1及TNF-α水平明显高于生存组,且差异有统计学意义(P＜0.05).结论 临床中检测TIMP-1及TNF-α水平在评估急性脑梗死患者预后质量时具有较高的应用价值,TIMP-1及TNF-α水平较高常提示急性脑梗死预后质量可能较差.     

血清尿酸水平与急性缺血性中风患者预后的关系

目的探讨血清尿酸(UA)水平与急性缺血性中风(IS)患者预后的关系.方法观察450例IS患者入院(13.5±11.2)h的血清UA水平,同时测定血糖(GLU)、甘油三酯(TG)、胆固醇(CHO)、肌酐(Cr)、红细胞比容(Hct)和血沉(ESR).并根据患者出院时神经功能恢复程度将其分为两组:轻度组(n=287)和中重度组(n=163).结果IS患者入院时血清UA水平轻度组明显高于中重度组(P＜0.01).经多因素Logistic回归分析,OR=1.14,OR 95%CI为1.00～1.26.结论血清UA水平升高可能是急性缺血性中风患者预后良好的独立预示因素之一.提示急性缺血性中风与氧化损害有关.     

高血压脑出血患者血清IL-6和TGF-β1水平与脑出血量及神经功能损伤的相关性

目的 探讨高血压脑出血患者血清白细胞介素-6(IL-6)和转化生长因子-β1 (TGF-β1)水平与脑出血量及神经功能损伤的相关性.方法 选取2018年1月至2020年12月我院收治的高血压脑出血患者103例(病例组)、未发生脑出血的高血压患者42例(疾病对照组)以及中老年健康体检者35例(健康对照组).根据病例组患者出血量分为少量出血组34例、中等量出血组49例、大量出血组20例.根据神经功能缺损分级分为轻度组20例、中度组27例、中重度组37例、重度组19例.根据患者住院28 d是否死亡将病例组分为存活组86例和死亡组17例.比较各组血清IL-6和TGF-β1水平.采用Spearman秩相关分析血清IL-6、TGF-β1水平与脑出血量及神经功能损伤的相关性.采用ROC曲线分析血清IL-6和TGF-β1水平对高血压脑出血预后的预测价值.结果 病例组的血清IL-6水平高于疾病对照组和健康对照组,血清TGF-β1水平低于疾病对照组和健康对照组(P＜0.05).少量出血组的血清Ib6水平低于中等量出血组和大量出血组,血清TGF-β1水平高于中等量出血组和大量出血组(P＜0.05).轻度组的血清IL-6水平低于中度组、中重度组和重度组,血清TGF-β1水平高于中度组、中重度组和重度组(P＜0.05).死亡组的血清IL-6水平高于存活组,血清TGF-β1水平低于存活组(P＜0.05).血清IL.-6水平与脑出血量、神经功能损伤程度呈正相关(r=0.545,r=0.328,P＜0.05),血清TGF-β1水平与脑出血量、神经功能损伤程度呈负相关(r=-0.590,r=-0.366,P＜0.05).血清IL-6预测高血压脑出血预后的灵敏度为70.93％,特异性为82.35％ (AUC=0.788).血清TGF-β1预测高血压脑出血预后的灵敏度为86.05％,特异性为70.59％ (AUC=0.836).结论 高血压脑出血患者血清IL-6和TGF-β1水平可能与脑出血量及神经功能损伤密切相关,对患者预后有一定的预测价值.     

脑梗死患者血清Hcy、hs-CRP及NEFA水平与患者预后的相关性分析

目的 探讨脑梗死患者血清同型半胱氨酸(Hcy)、超敏C反应蛋白(hs-CRP)及游离脂肪酸(NEFA)水平与患者预后的相关性.方法 收集2018年6月至2019年6月医院收治的108例脑梗死患者(研究组)和同期体检70名健康志愿者(对照组)为研究对象.依据脑梗死病情程度不同分为大梗死组、中梗死组、小梗死组,依据患者神经功能受损程度分为重度组、中度组、轻度组,根据患者预后不同分为预后良好组、预后不良组.比较研究组、对照组基线资料和血清Hcy、hs-CRP及NEFA水平,同时比较研究组各亚组间Hcy、hs-CRP及NEFA水平.结果 研究组血清Hcy、hs-CRP及NEFA水平较对照组明显升高(P<0.05),而两组性别、年龄、BMI、吸烟史、饮酒史等基线资料比较差异无统计学意义(P>0.05).大梗死组、中梗死组、小梗死组血清Hcy、hs-CRP及NEFA水平依次明显降低,差异有统计学意义(P<0.05).重度组、中度组、轻度组血清Hcy、hs-CRP及NEFA水平依次明显降低,组间两两比较差异有统计学意义(P<0.05).预后良好组血清Hcy、hs-CRP及NEFA水平较预后不良组明显降低(P<0.05);ROC曲线分析提示血清Hcy、hs-CRP及NEFA水平联合检测诊断脑梗死患者预后的曲线下面积、灵敏度和特异性较三项单独检测的明显提高.结论 脑梗死患者血清Hcy、hs-CRP及NEFA水平呈明显升高趋势,且Hcy、hs-CRP及NEFA水平与患者预后密切相关,三者联合检测利于脑梗死患者预后的有效评估.     

急性缺血性脑卒中患者血清血小板膜糖蛋白水平的变化及对预后的评估价值

目的 分析急性缺血性脑卒中患者入院时血清血小板膜糖蛋白-血小板活化因子-1(PAF-1)水平与疾病严重程度和患者90d临床预后的关系,为疾病早期诊断和预后评估提供敏感的生化指标.方法 选择2019年3月至2020年9月入我院初次确诊急性缺血性脑卒中患者共102例,采用改良Rankin量表(MRS)评分评估观察组出院后90d神经预后,并以此分为良好组(共81例,MRS评分0～2分)和较差组(共21例,MRS评分3～6分).另选同期门诊体检的80名健康人员作为对照组.分析患者入院血清PAF-1水平与美国国立卫生研究院卒中量表(NIHSS)评分的相关性;比较两组临床资料以及相关生化指标和入院PAF-1水平的差异.采用多因素Logistic回归分析筛选观察组90d预后的主要影响因素,采用受试者工作曲线(ROC)分析入院PAF-1水平预测90 d预后的效能.结果 缺血性脑卒中组血清PAF-1水平高于对照组(P<0.01).患者入院血清PAF-1水平与NIHSS评分呈现较好的正相关性(r=0.812,P=0.008).治疗90d预后良好组的PAF-1水平、NIHSS评分和梗死体积明显小于较差组(P<0.05).多因素Logistic回归分析显示,入院PAF-1水平和NIHSS评分是90d预后的主要影响因素(P<0.05).ROC分析显示,入院PAF-1水平截断值为9.5ng/mL预测90d预后不良的AUC为0.867,灵敏度为80.5％,特异性为73.6％.结论 急性缺血性脑卒中患者血清PAF-1水平升高与疾病发生以及90 d预后有紧密联系,可作为临床早期诊断脑卒中和判断短期预后的重要生化指标.     

急性脑梗死患者血清YKL-40检测的临床意义

目的通过检测急性脑梗死患者发病后48h内血清YKL-40的表达量,探讨其与牛津郡社区卒中项目（OCSP）分型及梗死面积大小的关系,以指导临床诊治。方法对54例急性脑梗死患者和20例正常对照者进行血清YKL-40的检测,然后分析其与病情程度及临床分型的关系。结果急性脑梗死患者血清YKL-40浓度中位数为158.47ng/ml（IR：182.40）,正常对照组为50.50ng/ml（IR：34.85）,两组比较差异有统计学意义（P〈0.001）;OCSP各亚型YKL-40升高幅度不同,完全前循环梗死（TACI）型表达量明显高于其他亚型（P〈0.01）;YKL-40在大梗死型的含量显著高于其他亚型（P〈0.02）。结论脑梗死后血清YKL-40水平升高,与病灶大小相关,在不同OCSP分型之间表达量不同,血清YKL-40可能成为指导脑梗死临床分型及评估病情程度的新的生物学指标。     

急性脑梗塞患者巨噬细胞移动抑制因子水平的动态变化及意义

目的 观察急性脑梗塞(ACI)患者发病后不同时间、不同梗死体积、不同神经功能缺损外周血中巨噬细胞移动抑制因子(MIF)水平,并探讨其动态变化的临床意义.方法 选择发病72小时内的ACI患者80例,用酶联免疫分析法(ELISA)检测其入院后第1、14d血清MIF水平,同时观察不同大小的梗死体积与神经功能缺损程度ACI患者上述指标的相关性,并与健康人组20例MIF水平作对照.结果 ACI患者入院第1d血清MIF水平明显低于健康人组(P<0.05),14d虽有升高,但仍低于健康人组;中等面积脑梗死患者MIF水平显著低于小面积梗死的患者(P<0.05);中型脑梗死中风患者较轻症患者血清MIF水平显著降低(P<0.05).结论 ACI患者MIF水平减低,MIF的水平高低与ACI患者病情轻重、梗死灶体积大小密切相关.     

半乳糖凝集素3与急性缺血性脑卒中的相关性研究

目的 探讨半乳糖凝集素3(galectin-3,gal-3)与急性缺血性脑卒中的关系及临床意义.方法 选择急性缺血性脑卒中患者165例为患者组,同期健康体检中心无脑卒中病史的健康体检者100名为对照组,采用酶联免疫吸附法(ELISA)检测gal-3;行头颅核磁共振检查计算脑梗死体积大小,按美国国立卫生研究所中风量表(NIHSS评分)进行神经功能缺损程度评估.结果 对照组血清gal-3水平(5.18±1.56μg/L)与患者组(14.57±3.35 μg/L)差异有统计学意义(t=23.517,P＜0.01);gal-3水平随脑梗死体积增加而呈递增趋势,差异有统计学意义(F=130.86,P＜0.01).Spearman相关分析显示,脑梗死体积与血清gal-3水平正相关(rs =0.927,P＜0.01);gal-3水平随神经缺损程度增加而呈递增趋势,差异有统计学意义(F=126.53,P＜0.01).Spearman相关分析显示,神经缺损程度与血清gal-3水平正相关(rs =0.872,P＜0.01).结论 急性缺血性脑卒中患者gal-3水平显著升高,其升高程度与脑梗死体积、神经功能缺损程度相关.     

血清淀粉样蛋白A1、脂蛋白结合指数预测急性冠脉综合征患者病情严重程度及预后的价值

目的 探讨血清淀粉样蛋白A1(SAA1)、脂蛋白结合指数(LCI)对急性冠脉综合征(ACS)患者病情严重程度及预后的评估价值.方法 选取2016年12月至2019年1月我科收治的130例ACS患者作为研究对象(观察组),同时,另选我院体检健康志愿者80例(对照组).比较各组受试者血清SAA1、LCI水平.根据患者出院后6个月是否发生不良心血管事件(MACE)分为预后良好组和预后不良组.采用COX比例风险模型分析影响ACS患者预后的危险因素,采用受试者工作特征曲线(ROC)分析SAA1、LCI对ACS患者短期预后的评估价值.结果 观察组血清SAA1、LCI水平高于对照组,差异有统计学意义(P＜0.05).ACS重度组血清SAA1、LCI水平高于中度组、轻度组,中度组血清SAA1、LCI水平高于轻度组,差异有统计学意义(P＜0.05).预后不良组患者血清SAA1、LCI水平高于预后良好组患者,差异有统计学意义(P＜0.05).COX多因素回归分析结果显示,Genisis评分、SAA1、LCI是影响ACS患者预后的独立危险因素(P＜0.05).ROC曲线显示,SAA1、LCI预测ACS患者短期预后的曲线下面积分别为0.821、0.840.结论 ACS患者血清SAA1、LCI水平明显升高,与患者病情严重程度及短期预后密切相关,且对ACS患者预后评估有一定预测价值.     

Modes of reinforcement and gender and culture of experimenter and subject: effects of "alien" and external reinforcement for Japanese and American men and women

In this study, we examined external and "alien" reinforcement (ER and AR. respectively) as a factor in social learning, and studied the combined effects of culture and reinforcement mode. A female (Experiment 1) and a male (Experiment 2) experimenters conducted experimental sessions. Both men and women, who grew up in the same culture as the experimenter, participated and performed the experimental task. A three-way interaction effect of experimenter gender, culture, and reinforcement mode was found on task performance. And the effect was more pronounced for a Japanese experimenter. A female and a male experimenters conducted Experiments 3 and 4, respectively; however participants this time were men and women who grew up in different cultures than the experimenter. Results indicated that the pattern of the subject gender and reinforcement mode interaction effect, when the experimenter was Japanese with American subjects, was exactly opposite to that when the experimenter was American. These experiments showed that AR was as effective for social learning as ER, and that the cultural backgrounds of experimenter and subject influenced AR and ER effectiveness.     

Timing and intensity of early fevers and the development of allergies and asthma

BACKGROUND: Early childhood fevers appear to protect against later allergies and asthma. What is not known is the time in which fevers exert this effect and whether the degree of temperature increase is important. OBJECTIVE: We sought to examine the relationship between the time and degree of early fevers and later allergies and asthma. METHODS: Eight hundred thirty-five children from southeast Michigan were enrolled at birth. Clinic records from their first 2 years were abstracted for episodes of fever. At age 6 to 7 years, children underwent allergy testing. We examined fevers occurring within 6-month intervals in the first 2 years of life and outcomes at age 6 to 7 years. The primary outcome measures were allergic sensitization, asthma, asthma with allergic sensitization, and asthma without allergic sensitization. RESULTS: In the unadjusted analysis each episode of fever between 7 and 12 months of age was associated with a lower odds of allergic sensitization (odds ratio [OR], 0.71; 95% CI, 0.54-0.93) and asthma with allergic sensitization (OR, 0.43; 95% CI, 0.21-0.90) at age 6 to 7 years. Likewise, every 1 degrees C increase in the maximum temperature between 7 and 12 months was associated with a lower odds of allergic sensitization (OR, 0.77; 95% CI, 0.61-0.96) and asthma with allergic sensitization (OR, 0.62; 95% CI, 0.40-0.94). After adjusting for potential confounders, each episode of fever between 7 and 12 months was associated with a lower likelihood of asthma with allergic sensitization (adjusted OR, 0.33; 95% CI, 0.11-0.94) at age 6 to 7 years. CONCLUSIONS: Both the timing and intensity of childhood fevers appear to be important factors in the development of allergies and asthma.     

Rates of oxygen consumption and of anaerobic glycolysis in renal cortex and medulla of adult and new-born rats and guinea-pigs

1. Rates of oxygen uptake and of anaerobic glycolysis were estimated in slices from the renal cortex and medulla (a) of adult rats and guinea-pigs, (b) of new-born (1-, 5- and 21-day-old) rats and of guinea-pigs of 1, 12, 21, 24 and 120 hr age.2. In the adult rat, Q(O2) values for the cortex were 12.55 +/- 0.20 (22) and for the medulla: 8.56 +/- 0.17 (22) mul./hr.mg dry weight, while in the new-born rat (24 hr old) they were 10.99 +/- 0.46 (12) and 9.33 +/- 0.18 (9) mul./hr.mg dry weight respectively.3. Values for Q(CO2) (N2) (anaerobic glycolysis) in the 14 hr old new-born rat were in the renal cortex 9.65 +/- 0.35 (5) and in the medulla 7.39 +/- 0.43 (5) mul./hr.mg dry weight; while in the adult they were 2.25 +/- 0.08 (16) and 5.76 +/- 0.14 (16) mul./hr.mg dry weight, respectively.4. In the adult guinea-pig values for Q(CO2) (N2) were of the same order as in the adult rat, though the rate of O(2) uptake was for the cortex 8.12 +/- 0.22 (12) and for the medulla 5.02 +/- 0.23 (11) mul./hr.mg dry weight.5. Though the Q(O2) values in the renal cortex and medulla were smaller in the 1 hr old new-born guinea-pig, they were already increasing in the 12 hr old neonate.6. The results are discussed in the light of enzyme changes occurring during the process of maturation of the nephron as indicated by histochemical observations.     

Association between functional alterations of senescence and senility and disorders of gait and balance

OBJECTIVES:

Declines in cognition and mobility are frequently observed in the elderly, and it has been suggested that the appearance of gait disorders in older individuals may constitute a marker of cognitive decline that precedes significant findings in functional performance screening tests. This study sought to evaluate the relationship between functional capacities and gait and balance in an elderly community monitored by the Preventive and Integrated Care Unit of the Hospital Adventista Silvestre in Rio de Janeiro, RJ, Brazil.

METHODS:

Elderly individuals (193 females and 90 males) were submitted to a broad geriatric evaluation, which included the following tests: 1) a performance-oriented mobility assessment (POMA) to evaluate gait; 2) a mini-mental state examination (MMSE); 3) the use of Katz and Lawton scales to assess functional capacity; 4) the application of the geriatric depression scale (GDS); and 5) a mini-nutritional assessment (MNA) scale.

RESULTS:

Reductions in MMSE, Katz and Lawton scores were associated with reductions in POMA scores, and we also observed that significant reductions in POMA scores were present in persons for whom the MMSE and Katz scores did not clearly indicate cognitive dysfunction. We also demonstrated that a decline in the scores obtained with the GDS and MNA scales was associated with a decline in the POMA scores.

CONCLUSIONS:

Considering that significant alterations in the POMA scores were observed prior to the identification of significant alterations in cognitive capacity using either the MMSE or the Katz systems, a prospective study seems warranted to assess the predictive capacity of POMA scores regarding the associated decline in functional capacity.     

男性乳腺发育症临床病理分析及雌,孕激素受体检测

对１１３例男性乳腺发育症进行临床病理分析。同时检测其中３０例乳腺组织中雌激素受体和孕激素受体分布情况，结果发现两者阳性率分别为８０．０％和８３．３３％。结合文献讨论了男性乳腺发育症的发生与高血清激素浓度及乳腺组织高受体水平的关系。