"步长脑心通"治疗急性期脑梗死120例疗效观察

目的观察步长脑心通胶囊治疗急性期脑梗死患者的疗效。方法将120例脑梗死患者按随机对照的方法分为两组，治疗组60例在对照组60例常规治疗的基础上加用步长脑心通胶囊，治疗四周后观察神经功能缺损改善及血液流变学变化情况。结果治疗组总有效率和愈显率，血液流变学变化差异具有显著意义，P〈0．05。结论步长脑心通在治疗急性期脑梗死具有很好的疗效。     

脑心通胶囊治疗急性脑梗死的临床疗效

目的观察脑心通胶囊治疗急性脑梗死的临床疗效。方法选择2014年6月—2015年12月在我院确诊的180例急性脑梗死病人,按照随机数字表法分为对照组和治疗组,每组90例。对照组采用抗凝、降脂等对症治疗;治疗组在对照组常规治疗基础上加用脑心通胶囊。两组用药疗程均为3周,治疗结束观察两组病人美国国立卫生研究院卒中量表(NIHSS)评分,血脂和血液流变学变化;采用简易智力状态量表(MMSE)、日常生活能力量表(ADL)和梗死灶体积变化情况评价疗效。结果治疗后,两组病人NIHSS评分均有改善,治疗组改善更为明显,差异有统计学意义(P0.05);治疗后两组病人血脂和血液流变学均降低,差异有统计学意义(P0.05);治疗组疗效明显优于对照组,治疗组MMSE、ADL评分均明显改善;治疗组梗死体积明显减小,差异有统计学意义(P0.05)。结论急性脑梗死的治疗中加用脑心通胶囊疗效肯定。     

脑心通胶囊与阿司匹林治疗急性脑梗死临床疗效及其对认知功能、凝血功能影响的对比研究

目的比较脑心通胶囊与阿司匹林治疗急性脑梗死的临床疗效及其对认知功能、凝血功能的影响。方法选取2015年1月—2018年7月深圳市龙华区人民医院收治的急性脑梗死患者120例,采用随机数字表法分为对照组和研究组,每组60例。在常规治疗基础上,对照组患者给予阿司匹林治疗,研究组患者给予脑心通胶囊治疗;两组患者均连续治疗1个月。比较两组患者临床疗效,治疗前后美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数评分、老年快速认知筛查量表(QCST-E)结果及凝血功能指标〔包括纤维蛋白原(FIB)、血浆黏度(PV)及D-二聚体〕。结果 (1)研究组患者临床疗效优于对照组(P0.05)。(2)两组患者治疗前NIHSS评分、Barthel指数评分比较,差异无统计学意义(P0.05);研究组患者治疗后NIHSS评分低于对照组,Barthel指数评分高于对照组(P0.05)。(3)两组患者治疗前时间定向、延迟记忆、即刻记忆、动作指令、简单计算、言语流畅性评分比较,差异无统计学意义(P0.05);研究组患者治疗后时间定向、延迟记忆、即刻记忆、动作指令、简单计算、言语流畅性评分高于对照组(P0.05)。(4)两组患者治疗前FIB、PV及D-二聚体水平比较,差异无统计学意义(P0.05);研究组患者治疗后FIB、PV及D-二聚体水平低于对照组(P0.05)。结论与阿司匹林相比,脑心通胶囊能更有效地提高急性脑梗死患者临床疗效,减轻神经功能缺损程度,改善日常活动能力、认知功能及凝血功能。     

丹红联合低分子肝素钙治疗急性脑梗死的临床研究

目的探讨丹红注射液联合低分子肝素钙治疗急性脑梗死的临床效果。方法将96例急性脑梗死患者随机分为两组,治疗组48例用丹红联合低分子肝素钙治疗;对照组48例用血塞通注射液联合低分子肝素钙治疗。治疗前后分别测定患者血液流变学参数,并进行神经功能缺损程度评分(NIHSS)及日常生活活动能力评分(BI)和疗效比较。结果治疗组显效率与对照组比较差异有显著性(P0.01),治疗组治疗后血液流变学参数、NIHSS以及BI均较治疗前有明显改善,且优于对照组(P均0.05)。结论丹红联合低分子肝素钙治疗急性期脑梗死效果明显,安全有效,值得推广。     

阿司匹林联合清心饮加减治疗风火闭窍型脑梗死的临床疗效研究

目的探讨阿司匹林联合清心饮加减治疗风火闭窍型脑梗死的临床疗效。方法选取2012年5月—2014年8月惠州市仲恺高新区人民医院收治的风火闭窍型脑梗死患者100例,采用随机数字表法将患者分为对照组和治疗组,各50例。对照组患者在常规治疗基础上给予阿司匹林治疗,治疗组患者在对照组治疗基础上给予清心饮加减治疗,均连续治疗1周。比较两组患者治疗前后血液流变学、血小板α-颗粒膜蛋白-140(GMP-140)水平、美国国立卫生院脑卒中量表(NIHSS)评分及Barthel指数评定量表(BI)评分,并观察治疗期间不良反应发生情况。结果治疗前两组患者全血黏度、血浆黏度、血小板聚集率、GMP-140水平、NIHSS评分及BI评分比较,差异无统计学意义(P>0.05);治疗后治疗组患者全血黏度、血浆黏度、血小板聚集率、GMP-140水平、NIHSS评分低于对照组,BI评分高于对照组(P<0.01)。治疗期间两组患者均未出现明显不良反应。结论阿司匹林联合清心饮加减治疗风火闭窍型脑梗死的临床疗效较好,能有效改善患者神经功能缺损程度、提高患者日常生活能力,其可能通过改善微循环而促进颅神经功能恢复。     

阿司匹林联合氯吡格雷治疗急性脑梗死并脑微出血的临床疗效

目的观察阿司匹林联合氯吡格雷治疗急性脑梗死并脑微出血的临床疗效。方法选取2015年5月—2016年5月延安大学咸阳医院收治的急性脑梗死并脑微出血患者76例,采用随机数字表法分为对照组与观察组,每组38例。在常规治疗基础上,对照组患者予以阿司匹林治疗,观察组患者在对照组基础上加用氯吡格雷治疗;两组患者均连续治疗2周。比较两组患者临床疗效、治疗前后血液流变学指标[全血低切黏度、血浆黏度、花生四烯酸(AA)诱导的血小板最大聚集率(MARAA)、二磷酸腺苷(ADP)诱导的血小板最大聚集率(MARADP)]、美国国立卫生研究院卒中量表(NIHSS)评分和Barthel指数(BI)评分,并观察两组患者治疗期间不良反应发生情况。结果观察组患者临床疗效优于对照组(P0.05)。治疗前两组患者全血低切黏度、血浆黏度、MARAA、MARADP比较,差异无统计学意义(P0.05);治疗后观察组患者全血低切黏度、血浆黏度、MARAA、MARADP低于对照组(P0.05)。治疗前两组患者NIHSS评分、BI评分比较,差异无统计学意义(P0.05);治疗后观察组患者NIHSS评分低于对照组,BI评分高于对照组(P0.05)。两组患者治疗期间不良反应发生率比较,差异无统计学意义(P0.05)。结论阿司匹林联合氯吡格雷治疗急性脑梗死并脑微出血的临床疗效确切,可有效改善患者神经功能,提高患者生活质量,且安全性较高。     

脑络欣通对脑梗死急性期气虚血瘀证患者神经功能、血液流变学及氧化应激的保护作用

目的用脑络欣通胶囊通治疗脑梗死急性期气虚血瘀证患者,评估对患者神经功能的改善作用,并观察血液流变学的影响及氧化应激的影响。方法脑梗死急性期气虚血瘀证患者110例,随机分为对照组和研究组各55例。对照组进行常规治疗,研究组同时给予脑络欣通胶囊治疗。评估中医症候积分、应用美国国立卫生研究院脑卒中量表(NIHSS)和Barthel指数(BI)评分评估患者神经功能改善状况及日常生活能力,检测血液流变学指标及C反应蛋白(CRP)、丙二醛(MDA)和超氧化物歧化酶(SOD)浓度。结果研究组治疗后中医症候总积分和NIHSS评分均明显低于对照组(均P0.05)。研究组治疗后BI评分明显高于对照组(P0.05);研究组治疗后全血黏度(高切、低切)、纤维蛋白原、血清CRP和MDA浓度均明显低于对照组(P0.05)。研究组治疗后SOD浓度明显高于对照组(P0.05)。结论应用脑络欣胶囊通治疗脑梗死急性期气虚血瘀证患者,能够显著改善患者临床症状及神经功能,改善血液流变学状况,减轻氧化应激反应,促进患者日常生活能力的提高。     

脑心通胶囊治疗烟雾病慢性脑缺血的临床疗效

目的探讨口服脑心通胶囊和阿司匹林胶囊治疗烟雾病(MMD)慢性脑缺血患者的临床疗效。方法广州医科大学附属第二医院、广州市第一人民医院、佛山市顺德区中医院住院的MMD患者随机分为两组各30例,入院后行血常规、血液流变学、凝血功能化验、智商(IQ)、神经功能缺损评分(NDS)、日常生活能力评价(DLA)测试及颈内动脉虹以及部脑血流量的变化(通过经颅多普勒TCD)。对照组予阿司匹林胶囊,3次/d,50 mg/次口服,实验组予脑心通胶囊3次/d,1.6 g/次,都连续口服90 d。服完药物后予复测上述7项指标。结果患者经口服阿司匹林或脑心通胶囊治疗后,血液流变学指标:高切变率下全血黏度、低切变率下全血黏度、血浆黏度可得到显著改善(P<0.05),而两组治疗后上述指标比较均无显著差别(P<0.05)。结论脑心通胶囊与阿司匹林对于改善MMD患者血液流变学指标同样有效。     

步长脑心通胶囊对冠心病患者血液流变的影响

目的研究步长脑心通胶囊对冠心病患者血液流变的影响。方法选择我院收治冠心病患者100例，随机分为两组：对照组50例，在常规治疗的基础上加用复方丹参片，每次3片，每日3次；治疗组50例，在常规治疗的基础上加用步长脑心通胶囊，每次3粒，每日3次。治疗时停用降血脂及抗凝药物，疗程为4周。结果治疗组显效率及总有效率均显著高于对照组，差异有统计学意义（P〈0．05）。两组患者治疗后血液流变学各指标间差异均有统计学意义（P〈0．05）。结论常规药物加步长脑心通胶囊对改善冠心病血液流变学异常有促进作用，可减少冠心病的危险因素。     

积极心理暗示联合康复训练对急性脑梗死患者神经功能及日常生活能力的影响

目的探讨积极心理暗示联合康复训练对急性脑梗死患者神经功能及日常生活能力的影响。方法选择急性脑梗死患者102例,随机分成两组,各51例。对照组:接受急性脑梗死的常规药物治疗。观察组:接受急性脑梗死的常规药物治疗,并且联合积极心理暗示与康复训练治疗。观察治疗前后两组患者的NIHSS评分、BI指数、HAMD评分、HAMA评分的变化。结果治疗后,观察组NIHSS评分低于对照组(P0.01)、BI指数高于对照组(P0.01);HAMD评分低于对照组(P0.01);HAMA评分低于对照组(P0.01)。结论积极心理暗示联合康复训练能够改善患者焦虑抑郁的情绪,促进患者神经功能的恢复,提高患者的日常生活能力。     

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.     

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.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

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.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.