Intravenous rt-PA in patients with ischaemic stroke and renal dysfunction

Objective

Renal dysfunction (RD) increases risk for ischaemic stroke (IS). The impact of RD on the effects of iv-thrombolysis in the Caucasian population has not been fully determined.

Aims

To evaluate the associations between RD and the outcome of iv-thrombolysis in Caucasian patients with IS.

Methods

The observational, multicentre study included 404 patients with IS who were treated with iv-thrombolysis. RD was defined as estimated glomerular filtration rate ≤60 ml/min/1.73 m². Outcome was assessed with modified Rankin Score at 3 months after the stroke onset.

Results

Medians baseline NIHSS score did not differ between groups of patients with and without RD (12.0 vs. 11.0 pts, p = 0.33). Unfavourable outcome was found in 52.1% of patients with and in 41.2% of patients without RD (p = 0.05), mortality was higher in patients with RD (29.9% vs. 14.3%, p < 0.001), and the presence of haemorrhagic transformation (HT) did not differ between the groups (17.1% vs. 17.1% respectively, p = 0.996). A multivariate analysis showed no impact of RD on the unfavourable outcome (OR 0.98; 95%CI 0.88–1.10), mortality (OR 0.92; 95%CI 0.81–1.05) or presence of HT (OR 1.03; 95%CI 0.90–1.18).

Conclusions

We found no impact of RD on the safety and efficacy of iv-thrombolysis in Caucasian patients with IS.     

Using the Alberta Infant Motor Scale to early identify very low-birth-weight infants with cystic periventricular leukomalacia

We examined whether the Alberta Infant Motor Scale (AIMS) is able to identify very low-birth-weight (VLBW) preterm infants with cystic periventricular leukomalacia (PVL) as early as 6 months of corrected age. Longitudinal follow-up AIMS assessments were done at 6, 12, and 18 months old for 35 VLBW infants with cystic PVL (cPVL⁺), 70 VLBW infants without cystic PVL (cPVL⁻), and 76 term infants (healthy controls: HC). Corrected age was used for the preterm infants. The cPVL⁺ group had significantly lower prone, supine and sitting subscales at age 6, 12, and 18 months than the cPVL⁻ group (all p < 0.05). The cPVL⁻ group showed significantly lower supine, prone, sitting, and standing subscales than the HC group only at age 6 months. At age 6 months, the areas under the receiver operator curve used to discriminate the cPVL⁺ infants from cPVL⁻ infants were 0.82 ± 0.04 for prone, 0.93 ± 0.02 for supine, 0.83 ± 0.05 for sitting, and 0.62 ± 0.07 for standing. The AIMS may help early identify VLBW infants with cystic PVL at age 6 months old.     

External validation of the ability of the DRAGON score to predict outcome after thrombolysis treatment

Easy-to-perform and valid assessment scales for the effect of thrombolysis are essential in hyperacute stroke settings. Because of this we performed an external validation of the DRAGON scale proposed by Strbian et al. in a Danish cohort. All patients treated with intravenous recombinant plasminogen activator between 2009 and 2011 were included. Upon admission all patients underwent physical and neurological examination using the National Institutes of Health Stroke Scale along with non-contrast CT scans and CT angiography. Patients were followed up through the Outpatient Clinic and their modified Rankin Scale (mRS) was assessed after 3 months. Three hundred and three patients were included in the analysis. The DRAGON scale proved to have a good discriminative ability for predicting highly unfavourable outcome (mRS 5–6) (area under the curve-receiver operating characteristic [AUC-ROC]: 0.89; 95% confidence interval [CI] 0.81–0.96; p < 0.001) and good outcome (mRS 0–2) (AUC-ROC: 0.79; 95% CI 0.73–0.85; p < 0.001). When only patients with M1 occlusions were selected the DRAGON scale provided good discriminative capability (AUC-ROC: 0.89; 95% CI 0.78–1.0; p = 0.003) for highly unfavourable outcome. We confirmed the validity of the DRAGON scale in predicting outcome after thrombolysis treatment.     

182例特重型颅脑损伤的死亡原因分析

目的分析特重型颅脑损伤的死亡原因,总结特重型颅脑损伤的救治经验。方法回顾性分析182例特重型颅脑损伤患者的临床资料,选择12个相关死亡原因进行统计分析及总结。结果182例特重型颅脑损伤的死亡率为67．58％,相关死亡原因中受伤原因、入院时GCS评分之间差异无统计学意义（P〉0．05）;院前急救情况、损伤类型之间差异有统计学意义（P〈0．05）,瞳孔的变化、基底池评分、手术情况、血氧水平、血糖水平、合并伤、并发症之间差异有统计学意义（P〈0．01）。结论特重型颅脑损伤死亡原因复杂,死亡率高,死亡因素与院前急救不及时、脑疝晚期、脑损伤程度、低血氧、高血糖、合并伤、并发症等有关;主要死亡原因是脑疝和肺部并发症。     

白芍总甙对局灶性脑缺血大鼠脑组织炎症信号表达的影响

目的观察白芍总甙对局灶性脑缺血(Focal Cerebral ischemic,FCI)大鼠脑组织Toll样受体4(TLR4)基因表达的作用。方法参照longa等方法制成大鼠局灶性大脑中动脉梗死(MCAO)模型,将80只SD雄性大鼠随机分为假手术组,溶剂组,白芍总甙低、高两个剂量组,采用RT-PCR法检测缺血灶周围脑组织TLR4基因表达水平。结果生理盐水组TLR4基因相对表达均明显高于假手术组(P<0.01);白芍总甙中高剂量组TLR4相对表达量明显低于生理盐水组(P<0.01)。结论生理盐水组大鼠缺血灶周围脑组织TLR4基因高表达,白芍总甙对TLR4表达有抑制作用,这可能是其抗炎作用的机理之一。     

PI3-K/Akt通路在脑缺血治疗中的调控机制研究

目的观察脑缺血-再灌注损伤后PI3-K/Akt通路的活性变化,并探讨阿利吉仑的调控机制。方法采用改良线栓法制备大脑中动脉缺血-再灌注模型。实验采用Western blot和qR-T PCR观察PI3-K、Akt基因和蛋白变化,比较各组脑梗死体积、患侧脑水肿和神经功能。结果缺血-再灌注后PI3-K、Akt表达明显减少。阿利吉仑通过激活PI3-K/Akt通路,明显改善神经功能缺失,减轻脑水肿,减小梗死体积。结论 PI3-K/Akt通路参与了阿利吉仑的脑保护作用,为其临床应用提供了理论基础。     

不同部位脑出血患者肠黏膜屏障功能变化研究

目的探讨不同部位脑出血(基底节区出血、脑干出血)患者肠黏膜屏障变化。方法选取脑出血患者共66例,其中脑干出血32例,基底节区出血34例,分别于患病后24h、72h、2w、4w采集静脉血,同时选取健康体检者30例作为对照,抽取外周血,采用双抗体夹心ELISA法测定血清二胺氧化酶(DAO)、D-乳酸(D-LAC)含量。结果无论基底节区出血还是脑干出血,患者在患病后很快出现肠黏膜屏障功能的改变,在患病24h达较高水平,随后的72h、1w及2w血清D-LAC及DAO持续高水平,两组患者于2w后呈降低趋势,两组在发病后4w明显降低,但仍高于对照组;结论不论基底节区出血还是脑干出血患者患病后24h内即可出现黏膜屏障功能损伤,两组患者肠黏膜屏障功能损伤可持续4w或更长时间。     

缺血性脑卒中患者颈动脉斑块性质与同型半胱氨酸、血脂水平的相关性分析

目的研究缺血性脑卒中与同型半胱氨酸（HCY）及血脂水平的关系,并探讨不同斑块性质与同型半胱氨酸和血脂代谢的相关性。方法选择湖北省十堰市太和医院通过彩色多普勒技术检测出伴有颈动脉斑块的脑卒中患者162例,根据斑块分型,易损斑块73例,稳定斑块89例,并选择健康体检者70例,检测其血脂及同型半胱氨酸水平。结果脑卒中患者胆固醇（TC）、低密度脂蛋白（LDL_C）及同型半胱氨酸（t-HCY）水平较对照组明显升高（P〈0．05）;与稳定斑块组比较,易损斑块组血浆胆固醇（TC）、低密度脂蛋白（LDL-C）及同型半胱氨酸（t-HCY）水平升高（P〈0．05）。结论颈动脉粥样硬化斑块的形成与血脂水平异常密切相关,而高水平的同型半胱氨酸可影响血脂代谢并且是脑卒中发病的一个重要危险因素,个体优化调脂及逆转同型半胱氨酸水平治疗在脑卒中的二级预防中具有重要意义。     

脑梗死后认知功能障碍的相关因素分析

目的 探讨脑梗死后认知功能障碍的相关因素.方法 选取入住我院的127例脑梗死患者作为脑梗死组,83例正常人群为对照组,简易精神状态评分测定认知功能,分析脑梗死后影响认知功能障碍的相关因素.结果 对照组中,认知功能障碍者12例,发生率为14.5%.脑梗死组中,认知功能障碍者97例,发生率达76.3%,2组比较,差异有统计学意义.本研究中年龄、性别、高血压和冠心病与脑梗死后认知功能障碍无显著相关性.文化程度、运动与否、交流沟通与脑梗死后认知功能障碍呈负相关,而发病次数和并发糖尿病与脑梗死后认知功能障碍呈正相关性.结论 脑梗死后认知功能障碍与文化程度、运动、交流、发病次数和并发糖尿病密切相关.     

The effect of video-guidance on passive movement in patients with cerebral palsy: fMRI study

In patients with cerebral palsy (CP), neuroimaging studies have demonstrated that passive movement and action–observation tasks have in common to share neuronal activation in all or part of areas involved in motor system. Action observation with simultaneous congruent passive movements may have additional effects in the recruitment of brain motor areas. The aim of this functional magnetic resonance imaging (fMRI) study was to examine brain activation in patients with unilateral CP during passive movement with and without simultaneous observation of simple hand movement. Eighteen patients with unilateral CP (fourteen male, mean age 14 years and 2 months) participated in the study. Using fMRI block design, brain activation following passive simple opening–closing hand movement of either the paretic or nonparetic hand with and without simultaneous observation of a similar movement performed by either the left or right hand of an actor was compared. Passive movement of the paretic hand performed simultaneously to the observation of congruent movement activated more “higher motor areas” including contralesional pre-supplementary motor area, superior frontal gyrus (extending to premotor cortex), and superior and inferior parietal regions than nonvideo-guided passive movement of the paretic hand. Passive movement of the paretic hand recruited more ipsilesional sensorimotor areas compared to passive movement of the nonparetic hand. Our study showed that the combination of observation of congruent hand movement simultaneously to passive movement of the paretic hand recruits more motor areas, giving neuronal substrate to propose video-guided passive movement of paretic hand in CP rehabilitation.