ICH评分量表--一种简单可靠的脑出血分级方法

目前,临床上缺乏标准和统一的脑出血(ICH)分级方法,这影响了ICH的临床研究和规范化治疗.近年来提出的包括Glascow昏迷量表评分、年龄、血肿来自幕下、血肿量和脑室出血的ICH评分量表是一种简单而可靠的ICH临床评分量表.     

脑出血抑郁症的发生及相关影响因素

对急性期和恢复期脑出血患者以汉密尔顿抑郁量表进行抑郁评估,以美国国立卫生研究院卒中量表进行神经功能缺损评分,采用经颅多普勒探索大脑中、前、后动脉的平均血流速度和阻力指数,同时通过脑CT确诊脑出血的发病部位、出血量.结果:①恢复期抑郁发生率高于急性期,女性高于男性(P＜0.05、＜0.01).②恢复期患者神经功能缺损评分及抑郁评分较急性期高(P＜0.05、＜0.01).③脑出血发病部位为额叶、颞叶、基底节时抑郁症发生率较高,出血量为20～50 ml抑郁症发生率较高.⑤急性期组和恢复期组脑出血患者中抑郁症患者的大脑中动脉、大脑前动脉平均血流速度低于非抑郁症患者,阻力指数高于非抑郁症患者.提示脑出血后抑郁症的发生与临床分期、性别、神经功能缺损评分、脑出血部位、出血量及大脑中、前动脉平均血流速度、阻力指数有关.     

老年患者高血压病脑出血NIHSS评分与病死率、致残率以及疾病相关耻辱感的相关性研究

目的 探索美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分与高血压性脑出血老年患者病死率、致残率和疾病相关耻辱感的相关性,为该病的临床干预提供依据.方法 同顾性分析2019年1月-2020年12月于南通市第一人民医院治疗的高血压性脑出血老年...     

早期降压对急性脑出血患者近期预后的影响

目的 研究早期降压治疗对急性脑出血患者预后的影响.方法 连续收集发病后6 h内住院确诊的急性脑出血患者14例,早期进行积极降压治疗,并对入院时以及发病后28 d和90 d采集的各项指标进行评价.结果 与入院时比较美国国立卫生院卒中量表评分(NIHSS)、改良Rankin量表(mRS)评分、Barthel指数(BI)、欧洲生活质量评分(EQ-5D)均有不同程度改善.结论 早期降压治疗能改善脑出血患者的近期预后.     

ICH评分量表——一种简单可靠的脑出血分级方法

目前，临床上缺乏标准和统一的脑出血(ICH)分级方法，这影响了ICH的临床研究和规范化治疗。近年来提出的包括Glascow昏迷量表评分、年龄、血肿来自幕下、血肿量和脑室出血的ICH评分量表是一种简单而可靠的ICH临床评分量表。     

急性脑出血患者早期血肿增大

目的:探讨脑出血患者早期血肿增大的发生率及早期血肿增大与早期神经功能恶化的相关性.方法:发病3 h内的脑出血患者分别在基线、基线后1、2、3、20 h进行神经系统评价和CT扫描.结果:在106例患者中,26%的患者基线和1 h内CT扫描出现脑实质血肿显著增大,12%的患者在1、2、3和20 h之间CT扫描血肿增大.通过测量基线和1 h时Glasgow昏迷量表评分以及美国国立卫生研究院卒中量表评分的变化发现,基线状态和1 h内的血肿增大与临床神经功能恶化显著相关.结论:脑出血患者早期常出现血肿显著增大,并伴有神经系统功能恶化.为明确治疗措施能否改善这种早期出血的自然病程和减少其发生,有必要进行随机临床试验.     

三种量表预测自发性脑出血患者预后的研究

目的对比3种脑出血量表在预测自发性脑出血（intracerebral hemorrhage，ICH）患者预后中的作用。方法选择自发性脑出血患者61例。入院时采用Hemphill等的原始的ICH量表（original ICH score，OICH）及Chenug等的改良的ICH量表（modified ICH score，MICH）、新的ICH量表（new ICH score，NICH）进行评分。同时于入院时采用美国国立卫生研究院卒中量表（NIHSS）、Barthel指数评分。3个月时进行NIHSS、Barthel指数和改良的Rankin量表（MRS）评分。分析3种ICH量表与其他量表评分的相关性；以MRS为标准，对比3种ICH量表评价脑出血患者预后的准确性。结果①3种ICH量表评分与脑出血患者入院时NIHSS评分和3个月MRS、NIHSS评分均呈正相关，差异均有统计学意义（P〈0．01），而与入院时和3个月Barthel指数呈负相关，差异均有统计学意义（P〈0．01）。②与MRS量表比较，OICH、MICH、NICH量表判断ICH患者预后不良的敏感性分别为73．1％、84．6％、80．8％，特异性分别为80．0％、88．6％、60．0％，符合率分别为77．0％、86．9％、68．9％。结论OICH、MICH、NICH量表评分与脑出血患者神经功能缺损程度相关。3种量表相比，MICH量表对脑出血预后判断的敏感性、特异性及符合率最高。     

血清透明质酸水平与急性自发性脑出血患者转归的相关性

目的 探讨脑出血患者血清透明质酸水平与临床转归的相关性.方法 纳入明确诊断为急性自发性脑出血的患者,记录基线临床资料,在入院24 h内检测血清透明质酸水平,在发病3个月后采用改良Rankin量表评价临床转归,分为转归良好组(0～2分)和转归不良组(＞2分),对2组临床资料进行比较和分析.结果 共纳入321例患者,转归良好组184例,转归不良组137例.转归良好组年龄[(46.3±8.6)岁对(62.4± 10.5)岁;t=3.761,P=0.025]、体质指数[(24.1±5.3)kg/m2对(27.8±6.1)kg/m2;t=6.193,P=0.013]、血肿体积[(59.7±9.7)ml对(89.2±14.9)ml;=6.278,P＜0.001]、基线格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分[(6.3±1.5)分对(3.9±0.7)分;t=9.121,P＜0.001]、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(9.6±1.5)分对(16.3±4.5)分;=9.989,P＜0.001]和血清透明质酸水平[(376.2 ±22.9)ng/ml对(876.1±19.6)ng/ml;t=19.681,P＜0.001]与转归不良组存在显著统计学差异.多变量logistic回归分析显示,透明质酸[优势比(odds ratio,OR)4.396,95％可信区间(confidence interval,CI)1.912～6.897;P ＜0.001]、血肿体积(OR2.328,95％ CI 1.912 ～3.843;P=0.013)、NIHSS评分(OR2.662,95％ CI 1.127 ～2.976;P=0.023)和GCS评分(OR 0.879,95％ CI 0.097～0.969;P =0.046)是影响脑出血患者转归的独立因素.结论 基线血清透明质酸水平增高是急性自发性脑出血患者转归不良的独立预测因素.     

脑白质疏松对自发性幕上脑出血患者预后的影响

目的探讨脑白质疏松(leukoaraiosis,LA)对自发性幕上脑出血预后的影响。方法选择118例自发性幕上脑出血患者的临床资料,根据格拉斯哥结局量表评分,分为预后良好组58例和预后不良组60例。比较2组人口统计学资料、血肿特征以及LA的严重程度;采用van Swieten量表评价头颅CT上LA的严重程度。结果与预后良好组比较,预后不良组患者年龄、收缩压、血糖、LA评分、血肿体积、合并脑室出血明显升高(P<0.05.P<0.01),格拉斯哥昏迷评分明显降低(P<0.01)。多因素logistic逐步回归分析显示,LA评分、格拉斯哥昏迷评分、血肿体积以及合并脑室出血是预后不良的独立预测因素。结论 LA是自发性幕上脑出血患者预后不良的独立预测因素之一。     

心理干预对脑出血患者焦虑情绪的影响

目的 探讨心理干预对脑出血患者焦虑情绪的影响.方法 将186例脑出血患者随机分为观察组和对照组.对照组给予常规护理和健康教育,观察组在对照组的基础上给予心理干预,分别于干预前、干预后1周用Zung焦虑自评量表(SAS)评估两组患者的焦虑程度.结果 干预后观察组的SAS评分较对照组显著降低(P＜0.001).结论 实施心理干预可减轻脑出血患者的焦虑情绪,提高对疾病的应对能力,促进康复.     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.     

Morphological and immunocytochemical heterogeneity of cultured pinealocytes from one-week-and two-month-old rats: Planimetric and densitometric investigations

Abstract: In vitro preparations of rat pinealocytes are widely used for biochemical analyses of signal transduction processes. This paper deals with morphological and immunocytochemical features of such preparations. Special attention was paid to the problems of whether pinealocytes represent a heterogeneous cell population and how such heterogeneity may develop during ontogeny. The investigations were performed with cells which were obtained from the pineal organ of one-week-and two-month-old rats, attached to synthetic peptide-coated coverslips or tissue culture chamber slides, and maintained under in vitro conditions overnight. The attached cells were then fixed with paraformaldehyde. These preparations yielded monolayers of spherical cells of different sizes; most cells were isolated, but some of them were aggregated and formed small clusters. On the average, the cells from the one-week-old animals were smaller than the cells from the two-month-old animals. Immunocytochemical demonstration of S-antigen, a pinealocyte-specific marker, showed that the majority of the cells from two-month-old animals were intensely or moderately labelled. Pinealocytes from one-week-old animals were less S-antigen immunoreactive. Only very few cells (less than 1% displayed glial fibrillary acidic protein (GFAP)-immunoreactivity. Planimetric investigations of the cell size and semiquantitative densitometric investigations of the intensity of the S-antigen immunoreaction revealed that (i) pinealocytes kept in vitro form a heterogeneous cell population, and that (ii) this heterogeneity increases during postnatal development from one-week-old to two-month-old animals. Two groups of pinealocytes can be distinguished based on their developmental fate: pinealocytes of one group grow dramatically, but show only a moderate increase in S-antigen immunoreactivity, and pinealocytes of the other group retain their size, but display a distinct increment in S-antigen immunoreacti vitv.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.